Flu Shot May Become Mandatory for Healthcare Workers

Sept. 11, 2010— -- All healthcare personnel should be required to get vaccinated against influenza, according to a new policy statement from the American Academy of Pediatrics.

The authors, from the AAP's Committee on Infectious Diseases, said that influenza vaccination is needed to protect patients, and that healthcare personnel have an ethical and professional obligation to be immunized.

"Mandatory influenza immunization for all healthcare personnel is ethically justified, necessary, and long overdue to ensure patient safety," the authors wrote online ahead of the October print issue of Pediatrics.

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The Advisory Committee on Immunization Practices (ACIP), which provides the CDC with guidance, has been recommending influenza vaccination for healthcare personnel since the early 1980s, and earlier this year recommended universal immunization of everybody older than 6 months.

"Healthcare personnel fail to lead by example if they recommend universal immunization, including influenza, to their patients but do not require it of themselves," the authors of the new AAP statement wrote. "It is surprising that many healthcare personnel and the organizations that employ them have been inexcusably silent in addressing this patient safety issue."

According to the Joint Commission, a vaccination rate of 80 percent or higher is needed to maintain the herd immunity necessary to substantially dampen the transmission of influenza in healthcare settings. The actual rate, however, has hovered around 40 percent in recent years.

There was a slight bump last year during the H1N1 pandemic to 61.9 percent for the seasonal vaccine, but only 37.1 percent of healthcare professionals received the pandemic vaccine and 34.7 percent received both the seasonal and pandemic vaccine.

Reasons cited in the literature for refusal to receive influenza vaccine among healthcare workers include fears of developing flu-like illness or adverse effects, a perception that the risk of becoming ill with influenza is low, and concerns about exposure to thimerosal, which is found in some influenza vaccines.

Voluntary programs aimed at increasing immunization rates through free and easily accessible vaccines, educational efforts, and incentives for getting vaccinated have resulted in little improvement in coverage rates, failing to overcome misconceptions about the risks and benefits of the vaccines.

"These findings highlight the importance of educating healthcare personnel of the risks, benefits, and basic principles of influenza vaccination," the statement authors wrote.

They said mandatory vaccination seems to be the only option for achieving coverage rates greater than 80 percent and cited several examples of health systems that maintained rates of 88 percent or higher through mandatory programs.

The authors pointed out that mandatory vaccination is not a new idea, since every state has laws requiring certain vaccines for school entry or attendance.

Immunization requirements also have been upheld by the Supreme Court if they are a public health necessity, if the vaccines have been proven effective, if the immunization process is not onerous or unfair, and if vaccination does not put the health of the individual at risk.

"Despite this reality, implementation of mandatory influenza immunization programs for healthcare personnel continues to be controversial to some who argue that a mandatory program violates civil liberties," the authors wrote.

The AAP has developed guidance to aid implementation of mandatory vaccination programs, which includes information on supply, payment, coding, and liability issues. It can be found at www.aapredbook.org/implementation.