BACKGROUND:
Persistent under use of influenza vaccine by adults for whom it is recommended has resulted in coverage rates of ~65% among those 65 and older, ~40% for adults 50-64 years old and ~20% for high risk adults 18-49 years old. These rates fall far short of the Healthy People 2010 influenza immunization objectives.

OBJECTIVE:
To determine attitudes about influenza immunization during 2003.

METHOD:
A telephone survey of 4,337 adults over 18 years of age was conducted early in 2003 to assess attitudes about influenza immunization. Routine statistical procedures were used to evaluate the results.

RESULT:
A substantial minority (15%) considered vaccines unnecessary to prevent certain diseases, yet 27% received a flu shot in the preceding 12 months. The majority (85%) considered vaccines necessary for disease prevention, and 41% of them (p<0.05) were immunized.
Compared to those appreciating the value of vaccines, significantly (p<0.05) more of the vaccine hesitant attributed their lack of influenza immunization to not needing the vaccine (26%), concern about allergic reactions or other complications (15%) or skepticism about the vaccine’s effectiveness (15%). Both groups cited not being offered the vaccine, not knowing that the vaccine was needed and its affordability, availability and convenience of access with equal frequency as reasons for not seeking immunization.
Although significantly (p<0.05) fewer of the vaccine hesitant were willing to accept smallpox vaccination under any conditions, the willingness of people in both subsets to accept vaccination increased as the perceived risk of exposure increased.

CONCLUSION:
Even among adults recognizing the value of vaccines, there is a need to better educate about the health risks associated with influenza, and the benefits of immunization. The findings relative to smallpox suggest that increased emphasis on risk of exposure to influenza might aid in increasing influenza vaccine uptake.

LEARNING OBJECTIVES:
1) Describe attitudinal differences between vaccine hesitant adults and those appreciating the public health value of vaccines
2) Identify barriers to adult use of influenza vaccine among both vaccine hesitant and non-hesitant adults
3) Discuss educational approaches that might increase the use of influenza vaccine