Mandate Flu Vaccination for Healthcare Workers, Say Infectious Disease Experts

August 31, 2010

August 31, 2010 — Healthcare professionals should be required to get vaccinated against seasonal influenza or else lose their jobs and professional privileges, the Society for Healthcare Epidemiology of America (SHEA) says in a position paper released today.

The paper, endorsed by the Infectious Diseases Society of America, argues that allowing healthcare workers to go unvaccinated except for recognized medical contraindications is just as unacceptable as allowing physicians and nurses to forgo scrubbing before a surgical procedure.

"SHEA views influenza vaccination of HCP [healthcare personnel] as a core patient and HCP safety practice with which non-compliance should not be tolerated," according to the position paper, published online today and in the October print issue of Infection Control and Healthcare Epidemiology. "SHEA endorses a policy in which annual influenza vaccination is a condition of both initial and continued HCP employment and/or professional privileges."

The goal of HCP vaccination is not only preventing virus transmission to patients, but also reducing the risk for infection of HCPs, which in turn preserves an adequate healthcare workforce, the position paper notes. At the same time, HCPs who get vaccinated contribute to "herd immunity" and set a good example.

The position paper, which updates a SHEA statement issued in 2005, recommends mandatory vaccination of all HCP working in all healthcare settings, regardless of whether they come into contact with patients and whether they are directly employed by the facility. The recommendation extends to students, volunteers, and contract workers.

Mandated Vaccination Has Met Resistance

The recommendations from SHEA come on the verge of the 2010-2011 influenza season and follow a previous season in which seasonal influenza vaccination among HCP reached an all-time high of 62% as of mid-January 2010, according to the US Centers for Disease Control and Prevention. Physicians, physician' assistants, nurse practitioners, and dentists posted the highest immunization rate as a group among HCP — 77%. In contrast, the immunization rate among all HCP against the H1N1 influenza virus stood at 37%.

SHEA believes a voluntary approach will not dramatically increase HCP immunization rates. Its position paper points to several healthcare organizations such as Virginia Mason Medical Center (VMMC) in Seattle, Washington, and BJC Healthcare in St. Louis, Missouri, that have achieved immunizations rates surpassing 98% by mandating vaccination of HCPs.

The success of institutions like VMMC and BJC notwithstanding, some HCP have not taken kindly to vaccine mandates.

During the H1N1 influenza pandemic of 2009-2010, for example, the state of New York ordered its healthcare workers to get vaccinated against both seasonal and pandemic influenza only to rescind the requirement several months later. At the time, New York Gov. David Patterson said the mandate turned out to be impractical in light of a shortage of pandemic influenza vaccine, but the state also had encountered several lawsuits and opposition from a large healthcare union.

Noting the possibility of continued resistance by labor unions to vaccine mandates, the SHEA position paper states that requiring HCPs to get immunized is just as reasonable as requiring them to wear appropriate attire in the operating room or to care for patients "regardless of underlying disease, even when they have disease that might place the HCP at some risk."

"One hopes that, in the interests of protecting both patients and their members, these organizations will not oppose mandatory programs that are developed in collaboration with employees," the position paper states.

One author reports that he is a consultant for Joint Commission Resources. He and some other authors report various financial relationships with Avianax, BD Diagnostics, Care Fusions, CSL, Cubist, EMD Serono, Emergent BioSolutions, GlaxoSmithKline, Human Genome Sciences, Liquidia Technologies, MedImmune, Merck, Novartis Vaccines and Therapeutics, Novavax, OrthoMcNeil, PaxVax, Pfizer, Rymed Technology, Sage, Sanofi Pasteur, Theraclone Sciences (formally Spaltudaq Corporation), Vaxxinate, and/or Wyeth. All other authors have disclosed no relevant financial relationships.

Infect Control Hosp Epidemiol. Published online August 31, 2010.

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