AAP Backs Mandatory Vaccination for HCPs, Updates Recs for Kids

Troy Brown, RN

September 07, 2015

Influenza vaccination should be mandatory for all healthcare personnel (HCP), according to a new policy statement by the American Academy of Pediatrics (AAP).

Henry H. Bernstein, DO, MHCM, a pediatrician at North Shore Long Island Jewish Medical Group, New Hyde Park, New York, Jeffrey R. Starke, MD, Texas Children's Hospital, Houston, Texas, and colleagues from the AAP's Committee on Infectious Diseases present the policy statement September 7 in Pediatrics.

"Employees of health care institutions have an ethical and professional obligation to act in the best interest of their patients' health," Dr Bernstein said in a news release. "For the prevention and control of influenza, we must continue to put the health and safety of the patient first."

The Healthy People 2020 objective for influenza vaccination of HCP is 90% coverage, but the highest coverage occurred during the 2013–2014 influenza season, when 75% of HCP were vaccinated. Mandatory immunization is more effective than voluntary immunization programs; coverage among HCP whose employers require the vaccine has exceeded 94%.

"Although some have suggested that medical and religious exemptions be granted on an individual basis, the US Constitution requires the granting of medical exemptions but not religious exemptions, so mandating influenza immunization for HCP can be ethically justified," the authors explain.

The AAP recommends the following:

  • Healthcare leaders should fully support the mandate;

  • Each institution should customize the plan, tailoring it to the geographic setting, educational resources, financial assets, local culture, and potential language barriers;

  • Institutions should make the vaccine free to all HCP;

  • Institutions should publicize the program to HCP at all levels. They should communicate program details regularly, hold question-and-answer sessions, and create a volunteer staff team to offer education (and vaccines, if possible) to fellow HCP with concerns.

  • Institutions should offer convenient times and locations for education and vaccine administration, within the institution if possible. In-house programs should accommodate HCP schedules, including expanding available hours for receiving the vaccine, increasing the number of locations where the vaccine is administered, and offering the vaccine at various locations in the institution;

  • Institutions should use a universal form that defines acceptable medical and religious exemptions; and

  • Institutions should create a clear institutional policy for managing employees who are exempted from immunization.

"Mandating influenza vaccine for all HCP nationwide is ethical, just, and necessary. For the prevention and control of influenza, we must continue to put the health and safety of the patient first," according to the position statement.

Updated Influenza Recommendations for Children

Dr Bernstein and the AAP's Committee on Infectious Diseases publish a second policy statement in this issue of Pediatrics, in which they recommend annual influenza vaccination for all children.

"Flu vaccine is the best way we have to protect children against this virus," Dr Bernstein said in a news release. "The flu virus is unpredictable. We cannot always anticipate how severely it will affect different groups of people. Being immunized with the flu vaccine every year significantly reduces the risk of your child being hospitalized due to flu, and it protects other vulnerable members of your family and community."

Previously, as many as 90% of influenza-related pediatric deaths were in unvaccinated children. During the 2014–2015 influenza season, 145 children died of influenza-related illness; many had no underlying medical condition.

The AAP recommends that parents vaccinate their children at the earliest opportunity because influenza season can begin early in the fall or winter, have more than one disease peak, and continue into late spring.

This statement updates recommendations for routine use of seasonal influenza vaccine and antiviral medications in children. The AAP recommends that all people aged 6 months and older, including all children and adolescents, be vaccinated annually.

Highlights for the 2015–2016 influenza season include the following:

  • Yearly universal influenza vaccination is indicated with a trivalent or quadrivalent vaccine (no preference);

  • The 2015–2016 influenza A (H3N2) and B (Yamagata lineage) vaccine strains differ from those used in the 2014–2015 seasonal vaccines. The trivalent vaccine contains an A/California/7/2009 (H1N1) pdm09-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like virus (B/Yamagata lineage). The quadrivalent vaccine contains an additional B virus (B/Brisbane/60/2008-like virus [B/Victoria lineage]).

  • For children aged 6 months through 8 years, the algorithm has been updated to reflect the changes in the virus strains from the last season.

The policy statement also covers the use of antiviral medications for prevention and treatment of influenza in children. Clinicians should promptly identify children clinically presumed to have influenza for rapid antiviral treatment, when indicated, the authors write.

Pediatrics. Published online September 7, 2015. Full text, Policy statement


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