Add the Trust for America's Health to the growing list of groups recommending flu vaccinations for all healthcare workers.

That suggestion was listed as part of Trust for America's Health research released today as providers cope with widespread influenza outbreaks across the country. The Washington-based not-for-profit group focuses on preventing the spread of diseases and other maladies.

“The flu is an annual threat. Some years, like this one, the threat is more severe than others. The problem is we let our guard down during mild seasons and then we aren't ready when a harder season hits,” the group's executive director, Jeffrey Levi, said in a prepared statement. “We need to maintain a steady defense and make annual flu vaccinations—and the manufacture of sufficient supply—a much higher priority every year.”

The group looked at Centers for Disease Control and Prevention stats and found that less than half of Americans 6 months and older were vaccinated in the 2010-11 and 2011-12 flu seasons. CDC data showed 12 states had vaccination rates below 40%. South Dakota, at 51.1%, ranked highest among states which vaccinated those 6 months and older, while Nevada ranked last at 32.6%. Twelve states had rates lower than 40%. For older patients, Iowa ranked first, at 75.9%, for vaccinations of those 65 or older. Alaska ranked last at 45.9%.

The Trust for America’s Health stopped short of recommending a mandate for healthcare workers, only suggesting that employers should ensure they receive vaccines annually. The group’s suggestions also included the reauthorization of the Pandemic and All-Hazards Preparedness Act, increased education about the need for vaccinations, more investments in domestic vaccine manufacturing, allowing public and private insurers to cover vaccines without cost-sharing and allowing some workers to accrue more sick days to recover from illness or care for loved ones.