Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice

Washington University School of Medicine, St Louis, MO 63110, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 02/2010; 50(4):459-64. DOI: 10.1086/650752
Source: PubMed


Influenza vaccination of health care workers has been recommended since 1984. Multiple strategies to enhance vaccination rates have been suggested, but national rates have remained low.
BJC HealthCare is a large Midwestern health care organization with approximately 26,000 employees. Because organizational vaccination rates remained below target levels, influenza vaccination was made a condition of employment for all employees in 2008. Medical or religious exemptions could be requested. Predetermined medical contraindications include hypersensitivity to eggs, prior hypersensitivity reaction to influenza vaccine, and history of Guillan-Barré syndrome. Medical exemption requests were reviewed by occupational health nurses and their medical directors. Employees who were neither vaccinated nor exempted by 15 December 2008 were not scheduled for work. Employees still not vaccinated or exempt by 15 January 2009 were terminated.
Overall, 25,561 (98.4%) of 25,980 active employees were vaccinated. Ninety employees (0.3%) received religious exemptions, and 321 (1.2%) received medical exemptions. Eight employees (0.03%) were not vaccinated or exempted. Reasons for medical exemption included allergy to eggs (107 [33%]), prior allergic reaction or allergy to other vaccine component (83 [26%]), history of Guillan-Barré syndrome (15 [5%]), and other (116 [36%]), including 14 because of pregnancy. Many requests reflected misinformation about the vaccine.
A mandatory influenza vaccination campaign successfully increased vaccination rates. Fewer employees sought medical or religious exemptions than had signed declination statements during the previous year. A standardized medical exemption request form would simplify the request and review process for employees, their physicians, and occupational health and will be used next year.

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    • "Most hospitals/health systems in the US and overseas are implementing a mandatory influenza vaccination protocol and have moved away from voluntary vaccination programs for health care workers, so these results can no longer be generalized. Nevertheless, our data demonstrate that neither mandatory vaccination nor incentives for vaccination are considered as realistic options by the Italian medical residents to implement vaccination adherence, confirming possible ethical and legal consequences and noticeable application difficulties within certain contexts [20,262728. However, having specific knowledge on the topic is not the only factor positively associated with influenza vaccination compliance; an important role is also played by the general work environment. "
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    ABSTRACT: Background: Although influenza vaccination has been demonstrated to be safe and effective, vaccination coverage rates among health care workers and among medical residents appear generally low. Several investigations have been performed worldwide to analyze the healthcare workers’ educational deficiencies. This multicentre survey aimed to investigate at a nationwide level training quality and work environment associated with seasonal influenza vaccination uptake among Italian medical residents. Methods: A retrospective cohort study was carried out from April 2012 to June 2012 on medical residents regularly attending the post-graduate medical schools of 18 Italian Universities via an anonymous, self administered, web-based questionnaire. Data have been analyzed by using the R statistical software package. Results: A total of 2506 out of 10,854 medical residents (23.1 %) have been recruited. The quality of training on influenza and influenza vaccination was reported as “fair” or “poor” during both pre-graduate (40.7 % of respondents) and post-graduate medical school (59.6 % of respondents). Vaccination uptake was associated with adherence to seasonal 2011/2012 influenza vaccination of medical school tutors (adjusted OR = 4.4; 95 % CI = 1.35–14.26) and other medical residents (adjusted OR = 2.2; 95 % CI = 1.14–4.23). Moreover, influenza vaccination uptake was also associated with correct knowledge about the virus composition of 2011/2012 influenza vaccine (adjusted OR = 2.43; 95 % CI = 1.64–2.58) and consultation of scientific sources or Institutional recommendations on influenza vaccination (adjusted OR = 6.96; 95 % CI = 3.38–214.36). Conclusions: Medical residency represents an opportunity to implement educational and training interventions aiming to promote appropriate professional behaviors and skills. Our study suggest that appropriate training, adequate education and proactive coworkers feelings can improve influenza vaccination attitudes towards young doctor.
    Full-text · Article · Dec 2016 · BMC Medical Education
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    • "99% 95% 98% 98% 96% 99% 98% 92% 72% 71% 71% 68% 54% 30% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Feemster, 2011 Miller, 2011* Smith, 2012 Babcock, 2010 Huynh, 2012 Karanfil, 2011 Rakita, 2010 "
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    ABSTRACT: Context Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates. Evidence acquisition MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk. Evidence synthesis Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94%. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p<0.001 for all comparisons). Two single-institution studies reported limited, inconclusive results on absenteeism among HCP. No studies reported on clinical outcomes among patients. Medical and religious exemptions and terminations or voluntary resignations were rare. Conclusions Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.
    Full-text · Article · Sep 2014 · American Journal of Preventive Medicine
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    • "Information on contraindications was not available, so it is not known with certainty what the ideal vaccination rate should be in these cases. However, prior research has estimated the prevalence of medical exemptions for the influenza vaccine at 1.24% [16]. Contraindications vary by vaccine as does the prevalence of those contraindications, so it is difficult to generalize. "
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    ABSTRACT: In order to adequately assess the effectiveness of vaccination in helping to control vaccine-preventable infectious disease, it is important to identify the adherence and uptake of risk-based recommendations. THE CURRENT PROJECT INCLUDES DATA FROM FIVE CONSECUTIVE DATASETS OF THE NATIONAL HEALTH AND WELLNESS SURVEY (NHWS): 2007 through 2011. The NHWS is an annual, Internet-based health questionnaire, administered to a nationwide sample of adults (aged 18 or older) which included items on vaccination history as well as high-risk group status. Vaccination rates and characteristics of vaccinees were reported descriptively. Logistic regressions were conducted to predict vaccination behavior from sociodemographics and risk-related variables. The influenza vaccination rate for all adults 18 years and older has increased significantly from 28.0% to 36.2% from 2007 to 2011 (ps<.05). Compared with those not at high risk (25.1%), all high-risk groups were vaccinated at a higher rate, from 36.8% (pregnant women) to 69.7% (those with renal/kidney disease); however, considerable variability among high-risk groups was observed. Vaccination rates among high-risk groups for other vaccines varied considerably though all were below 50%, with the exception of immunocompromised respondents (57.5% for the hepatitis B vaccine and 52.5% for the pneumococcal vaccine) and the elderly (50.4% for the pneumococcal). Multiple risk factors were associated with increased rate of vaccination for most vaccines. Significant racial/ethnic differences with influenza, hepatitis, and herpes zoster vaccination rates were also observed (ps<.05). Rates of influenza vaccination have increased over time. Rates varied by high-risk status, demographics, and vaccine. There was a pattern of modest vaccination rate increases for individuals with multiple risk factors. However, there were relatively low rates of vaccination for most risk-based recommendations and all fell below national goals.
    Preview · Article · Nov 2012 · PLoS ONE
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