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A Successful Strategy for Increasing the Influenza Vaccination Rate of Healthcare Workers without a Mandatory Policy Outside of the United States: A Multifaceted Intervention in a Japanese Tertiary Care Center

Published online by Cambridge University Press:  02 January 2015

Hitoshi Honda*
Department of Infection Prevention, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan Department of Infection Prevention, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
Yumiko Sato
Department of Infection Prevention, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
Akinori Yamazaki
Department of Infection Prevention, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
Simi Padival
Division of Infectious Diseases, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Akira Kumagai
Department of Infection Prevention, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
Hilary Babcock
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri
Department of Infection Prevention, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan (



Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult.


Before-and-after trial.

Participants and Setting.

Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan.


We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution.


With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study.


Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Original Article
Copyright © The Society for Healthcare Epidemiology of America 2013

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