The ethics of mandatory vaccination against influenza for health care workers

University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Vaccine (Impact Factor: 3.62). 09/2008; 26(44):5562-6. DOI: 10.1016/j.vaccine.2008.08.002
Source: PubMed


Vaccination of health care workers (HCW) in long-term care results in indirect protection of patients who are at high-risk for influenza. The voluntary uptake of influenza vaccination among HCW is generally low. We argue that institutions caring for frail elderly have the responsibility to implement voluntary programmes for vaccination against influenza of HCW. When uptake falls short a mandatory programme may be justified. The main justification stems from the duty of care givers not to harm one's patient when one knows there is a significant risk of harm and the intervention to reduce this chance has a favourable balance of benefit over burdens and risks.

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    • "In the Netherlands, studies have revealed a number of important, significant attitudes held by HCWs in relation to influenza vaccination. These include the responsibility not to harm patients, the knowledge that the vaccine has high efficacy, and the belief that they (HCWs) are in a high risk group in relation to contracting influenza infection [22,25,26]. "
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    ABSTRACT: Background WHO has set a goal of 75% vaccination coverage (VC) for seasonal influenza for residents and also recommends immunization for all healthcare workers (HCWs) in nursing homes (NHs). We conducted a cross-sectional study to estimate the VC for seasonal influenza vaccination in Norwegian NHs in 2012/2013 since the VC in NHs and HCWs is unknown. Methods We gathered information from NHs concerning VC for residents and HCWs, and vaccination costs for HCWs, using a web-based questionnaire. We calculated VC among NH residents by dividing the number of residents vaccinated by the total number of residents for each NH. VC among HCWs was similarly calculated by dividing the number of HCWs vaccinated by the total number of HCWs for each NH. The association between VC and possible demographic variables were explored. Results Of 910 NHs, 354 (38.9%) responded. Median VC per NH was 71.7% (range 0-100) among residents and 0% (range 0-100) among HCWs, with 214 (60%) NHs reporting that none of their HCWs was vaccinated. Median VC for HCWs in NHs with an annual vaccination campaign was 0% (range 0-53), compared to when they did not have an annual vaccination campaign 0% (range 0-12); the distributions in the two groups differed significantly (Mann–Whitney U, P = 0.006 two tailed). Conclusion Median influenza VC in Norwegian NHs was marginally lower than recommended among residents and exceptionally low among HCWs. The VC in HCWs was significantly higher when NHs had an annual vaccination campaign. We recommend that NHs implement measures to increase VC among residents and HCWs, including vaccination campaigns and studies to identify potential barriers to vaccination.
    BMC Public Health 05/2014; 14(1):434. DOI:10.1186/1471-2458-14-434 · 2.26 Impact Factor
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    • "Since patient welfare is not a sufficiently motivating factor for HCWs to choose influenza vaccination, the introduction of mandatory vaccination is a possible option. The main justification for mandatory vaccination stems from the duty of caregivers to protect their patients [41]. Current guidelines of the Infectious Diseases Society of America state that annual influenza vaccination should be mandatory for HCWs in the interest of safeguarding patients and protecting public health [42]. "
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    ABSTRACT: Healthcare workers (HCWs) are at an increased risk of exposure to and transmission of infectious diseases. Vaccination lowers morbidity and mortality of HCWs and their patients. To assess vaccination coverage for influenza and hepatitis B virus (HBV) among HCWs in Croatian hospitals, we conducted yearly nationwide surveys. From 2006 to 2011, all 66 Croatian public hospitals, representing 43--60% of all the HCWs in Croatia, were included. Statistical analysis was performed using the Kruskal--Wallis analysis of variance, Dunn's multiple comparison analysis and the chi-square test, as appropriate. The median seasonal influenza vaccination coverage rates in pre-pandemic (2006--2008) seasons were 36%, 25% and 29%, respectively. By occupation, influenza vaccination rates among physicians were 33 +/- 21%, 33 +/- 22% among graduate nurses, 30--34% among other HCWs, 26 +/- 21% among housekeeping and the lowest, 23 +/- 17%, among practical nurses (p < 0.01). In 2009--2010 season, seasonal influenza vaccination coverage was 30%, while overall vaccination coverage against pandemic influenza was fewer than 5%. Median vaccination coverage in the post-pandemic seasons of 2010--2011 and 2011--2012 decreased to 15% and 14%, respectively (reduction of 24% and 35%, respectively, p < 0.0001). Meanwhile, the median mandatory HBV vaccination coverage was 98%, albeit with considerable differences according to work setting (range 19--100%) and occupation (range 4--100%). We found substantial year-on-year variations in seasonal influenza vaccination rates, with reduction in post pandemic influenza seasons. HBV vaccination is satisfactory compared to seasonal influenza vaccination coverage, although substantial variations by occupation and work setting were observed. These findings highlight the need for national strategies that optimize vaccination coverage among HCWs in Croatian hospitals. Further studies are needed to establish the potential role of mandatory vaccination for seasonal influenza.
    BMC Infectious Diseases 11/2013; 13(1):520. DOI:10.1186/1471-2334-13-520 · 2.61 Impact Factor
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    • "More recently, the survey of Blank et al. also demonstrated low overall influenza vaccine coverage rates among health care workers in eleven European countries which ranged from 6.4% in Poland to 26.3% in Czech Republic in the 2007/2008 influenza season [10]. Vaccination rates exceeding 50% are difficult to reach [11,12]. "
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    ABSTRACT: Background The influenza vaccination rate in hospitals among health care workers in Europe remains low. As there is a lack of research about management factors we assessed factors reported by administrators of general hospitals that are associated with the influenza vaccine uptake among health care workers. Methods All 81 general hospitals in the Netherlands were approached to participate in a self-administered questionnaire study. The questionnaire was directed at the hospital administrators. The following factors were addressed: beliefs about the effectiveness of the influenza vaccine, whether the hospital had a written policy on influenza vaccination and how the hospital informed their staff about influenza vaccination. The questionnaire also included questions about mandatory vaccination, whether it was free of charge and how delivered as well as the vaccination campaign costs. The outcome of this one-season survey is the self-reported overall influenza vaccination rate of health care workers. Results In all, 79 of 81 hospitals that were approached were willing to participate and therefore received a questionnaire. Of these, 42 were returned (response rate 52%). Overall influenza vaccination rate among health care workers in our sample was 17.7% (95% confidence interval: 14.6% to 20.8%). Hospitals in which the administrators agreed with positive statements concerning the influenza vaccination had a slightly higher, but non-significant, vaccine uptake. There was a 9% higher vaccine uptake in hospitals that spent more than €1250,- on the vaccination campaign (24.0% versus 15.0%; 95% confidence interval from 0.7% to 17.3%). Conclusions Agreement with positive statements about management factors with regard to influenza vaccination were not associated with the uptake. More economic investments were related with a higher vaccine uptake; the reasons for this should be explored further.
    BMC Public Health 12/2012; 12(1):1101. DOI:10.1186/1471-2458-12-1101 · 2.26 Impact Factor
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