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Why do health workers decline flu vaccination?


Influenza is highly contagious but myths about the flu vaccine may lead to nurses declining vaccination, putting them at risk of transmitting the virus to their patients


Healthcare workers with influenza can easily pass on the flu virus to patients.Last year nurses (excluding those in GP practices) were the group least likely in the NHS to be vaccinated. This article explores the reasons for this and explains how NHS Employers’ annual flu fighter campaign can improve uptake.

Citation: Staniforth R (2014) Why do health workers decline flu vaccination? Nursing Times; 110: 49, 16-17.

Author: Rachel Staniforth is senior programme officer, NHS Employers.


In 2013, 55% of frontline NHS staff chose to have a flu vaccine. GP practice nurses were the most vaccinated staff group (65%) but 51% of all other qualified NHS nurses declined the offer of vaccination (Public Health England, 2014a). Nurses are at the frontline of delivering care in the NHS, so it is surprising that nurse flu vaccination uptake is below the average.

Flu vaccination is recommended for healthcare workers directly involved in patient care, and it is the responsibility of the employer to arrange and pay for this (Salisbury et al, 2014). Inconvenience may be a factor in some declining vaccination, but there are other reasons that are often based on myths.

Effects of flu

Flu can cause a range of mild-to-severe symptoms, and being in good health is no guarantee of protection. The symptoms usually last for one to two weeks and include a sudden onset of fever, chills, headache, myalgia and extreme fatigue (Box 1). The risk of serious illness from influenza is higher in children under six months, pregnant women, older people and those with underlying health conditions (Salisbury et al, 2014).

Box 1. Symptoms of flu

  • Sudden onset fever
  • Chills
  • Headache
  • Myalgia (aching muscles)
  • Extreme fatigue
  • Dry cough
  • Sore throat
  • Stuffy nose 
  • Difficulty sleeping
  • Loss of appetite
  • Limb or joint pain
  • Diarrhoea or upset stomach

Source: Salisbury et al (2014)

However, even previously healthy people can develop severe complications from influenza, including bronchitis, secondary bacterial pneumonia and, rarely, meningitis, encephalitis or death.

The impact of flu on the population varies each year, depending on how many people are susceptible, changes to the virus and the severity of the illness caused by the strain in circulation (Public Health England, 2013).

It is hard to predict the timing and severity of flu seasons and intermittent epidemics can cause significant illness and death. In the 2013/14 season it led to 904 admissions to intensive care units, and 10.8% of these patients died (Public Health England, 2014b).

Why vaccinate healthcare workers?

Frontline healthcare workers are more likely to be exposed to the flu virus, especially in winter, when some of their patients will be infected. It has been estimated that up to one in four could be infected with flu during a mild season - a much higher incidence than expected in the general population (Donaldson et al, 2009).

Some healthcare workers opt for vaccination to try to protect their family members, especially young children or other relatives in at-risk groups.

Protecting patients

Influenza is highly contagious and healthcare workers may transmit the virus to patients even if they only have mild symptoms themselves, and some patients are extremely vulnerable to the effects of the virus (Salisbury et al, 2014). There have been reports of outbreaks in hospitals and other care settings that are likely to have been transmitted from healthcare workers to patients (Horcajada et al, 2003; Papchucki et al, 1989). One outbreak caused six infections in neonates and one death (Cunney et al, 2000).

Why do staff decline vaccination?

Research by NHS Employers’ flu fighter campaign found many reasons for staff declining the offer of the flu vaccine. Myths about the vaccine are often a factor. Table 1 lists some of these myths.

Getting involved in flu fighter

Flu fighter offers tools to help NHS organisations increase vaccine uptake, including:

  • How to run and evaluate campaigns;
  • Toolkits with helpful facts;
  • Printed campaign materials (posters, stickers and leaflets);
  • Digital materials;
  • The “jab-o-meter” - a visual tool to help communicate uptake figures;
  • Case studies that share ideas of how to improve flu vaccination uptake.

There is no single way to run a local flu fighter campaign. The annual flu fighter awards showcases examples that have sought to raise local awareness. There is always work behind the scenes to make vaccinations convenient and follow good practice, and liaison with key staff groups, such as those in occupational health.

Last year, the flu fighter campaign ran in Wales for the first time. Staff vaccination uptake in Wales for the 2013/14 season was 40.6%, up from 35.5% the previous season.


Influenza is highly contagious, and healthcare workers may transmit the virus to patients, even if symptoms are mild or not noticeable. Their duty of care to patients includes taking precautions to protect them from communicable diseases.

Key points

  • Influenza is highly contagious and infected healthcare workers can pass it on to patients
  • Even though frontline healthcare workers are more likely to be exposed to the virus, some choose not to be vaccinated
  • GP practice nurses have the highest uptake of vaccination in the NHS at 65%
  • Other nurses have the lowest uptake of all staff groups in the NHS at 49%
  • Myths are often responsible for staff declining the vaccination

Readers' comments (2)

  • Nurses should have the same rights to choose whether or not to have any medication or vaccination as every one else. I have never had the flu jab and have not taken a day off sick in five years. All nurses around me who had the jab have all had the flu and taken time off work. This should never be compulsory but judged on individual cases.

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  • Teddy

    I caught flu when I was in my thirties . I vowed never to feel so ill again . I wanted to die . I feel the jab comes with a duty of care. I also do not get paid in the private sector when off sick . Why not stop pay if nhs workers are off sick with flu? It may be a good incentive!

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