Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

Departments of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 10/2010; 31(10):987-95. DOI: 10.1086/656558
Source: PubMed


This document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled "Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages."1 In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper1 still serves as the Society's official statement on that issue. SHEA views influenza vaccination of HCP as a core patient and HCP safety practice with which noncompliance should not be tolerated. It is the professional and ethical responsibility of HCP and the institutions within which they work to prevent the spread of infectious pathogens to their patients through evidence-based infection prevention practices, including influenza vaccination. Therefore, for the safety of both patients and HCP, SHEA endorses a policy in which annual influenza vaccination is a condition of both initial and continued HCP employment and/or professional privileges. The implementation of this policy should be part of a multifaceted, comprehensive influenza infection control program; it must have full, visible leadership support with the expectation for influenza vaccination fully and clearly communicated to all existing and applicant HCP; and it must have ample resources and support to implement and to sustain the HCP vaccination program. This recommendation applies to all HCP working in all healthcare settings, regardless of whether the HCP have direct patient contact or whether the HCP are directly employed by the facility. It also applies to all students, volunteers, and contract workers. SHEA recommends that only exemptions due to recognized medical contraindications to influenza vaccination be considered. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.

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    • "recommends vaccination against influenza for health care personnel (HCP). Despite the availability of an effective and welltolerated vaccine, low seasonal and pandemic influenza vaccine acceptance among HCP is a major problem detailed in many studies from all over of the world (Salgado, Giannetta, Hayden, & Farr, 2004; Talbot et al., 2010). The perception of vaccination risks in addition to other expected vaccination costs are major reasons why HCP do not get vaccinated against influenza (Betsch & Wicker, 2012; Wicker, Rabenau, Doerr, & Allwinn, 2009). "
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    ABSTRACT: Objective: Vaccination yields a direct effect by reducing infection, but also has the indirect effect of herd immunity: If many individuals are vaccinated, the immune population will protect unvaccinated individuals (social benefit). However, due to a vaccination's costs and risks, individual incentives to free-ride on others' protection also increase with the number of individuals who are already vaccinated (individual benefit). The objective was to assess the consequences of communicating the social and/or individual benefits of herd immunity on vaccination intentions. We assume that if social benefits are salient, vaccination intentions increase (prosocial behavior), whereas salience of individual benefits might decrease vaccination intentions (free-riding). Methods: In an online-experiment (N = 342) the definition of herd immunity was provided with one sentence summarizing the gist of the message, either making the individual or social benefit salient or both. A control group received no information about herd immunity. As a moderator, we tested the costs of vaccination (effort in obtaining the vaccine). The dependent measure was intention to vaccinate. Results: When a message emphasized individual benefit, vaccination intentions decreased (free-riding). Communication of social benefit reduced free-riding and increased vaccination intentions when costs to vaccinate were low. Conclusions: Communicating the social benefit of vaccination may prevent free-riding and should thus be explicitly communicated if individual decisions are meant to consider public health benefits. Especially when vaccination is not the individually (but instead collectively) optimal solution, vaccinations should be easily accessible in order to reach high coverage.
    Full-text · Article · Sep 2013 · Health Psychology
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    • "The growing pressure on HCWs to vaccinate as part of their ethical professional responsibility is illustrated by the statement by the Canadian National Advisory Committee on Immunization for the 2010-2011 season that " in the absence of contraindications, refusal of HCWs who have direct patient contact to be immunized against influenza implies failure in their duty of care to patients " [2]. The fact that this is being taken even a step further with recommendations and pressure on institutions to mandate such vaccination at the expense of individual freedom and as a condition for continued employment [4] increases the urgency of examining the evidence. Is it sufficient for such draconian measures? "
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    ABSTRACT: Background and Methods. Vaccination of all healthcare workers is widely recommended by health authorities and medical institutions and support for mandatory vaccination is increasing. This paper presents the relevant literature and examines the evidence for patient benefit from healthcare worker vaccination. Articles identified by Medline searches and citation lists were inspected for internal and external validity. Emphasis was put on RCTs. The literature on self-protection from vaccination is also presented. Results. Published research shows that personal benefit from vaccinating healthy nonelderly adults is small and there is no evidence that it is any different for HCWs. The studies aiming to prove the widespread belief that healthcare worker vaccination decreases patient morbidity and mortality are heavily flawed and the recommendations for vaccination biased. No reliable published evidence shows that healthcare workers' vaccination has substantial benefit for their patients—not in reducing patient morbidity or mortality and not even in increasing patient vaccination rates. Conclusion. The arguments for uniform healthcare worker influenza vaccination are not supported by existing literature. The decision whether to get vaccinated should, except possibly in extreme situations, be that of the individual healthcare worker, without legal, institutional, or peer coercion.
    Full-text · Article · Nov 2012
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    • "Vaccination of healthcare personnel (HCP) is recommended as a strategy for preventing the spread of influenza. However, despite these official recommendations – e.g. from the Centers for Disease Control and Prevention (CDC) in the U.S.A and the Robert Koch Institute (RKI) in Germany – and the availability of an effective, well-tolerated vaccine, low seasonal and pandemic influenza vaccine acceptance among HCP is a problem detailed in many studies from all over of the world [2]. Recently, the Global Action Plan for Influenza Vaccines (GAP II) of the WHO formulated the goal to increase acceptance of influenza vaccinations among HCP for their own protection as well as the protection of others, as HCP are key multipliers due to their major influence on uptake in the population (e.g. of pregnant women [3]). "
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    ABSTRACT: was to improve understanding of mechanisms contributing to healthcare personnel's (HCP) reluctance to get vaccinated against seasonal influenza. We assessed the role of several drivers: vaccination knowledge, vaccination recommendations and the role of the Internet (so-called e-health) in creating vaccination knowledge. The key mechanism under consideration was the perceived own risk (regarding disease and the vaccine). 310 medical students at the Frankfurt University Hospital answered an anonymous questionnaire assessing risk perceptions, intentions to get vaccinated, knowledge, preferences regarding information sources for personal health decisions and search-terms that they would use in a Google-search directed at seasonal influenza vaccination. The key driver of vaccination intentions was the perceived own risk (of contracting influenza and of suffering from vaccine adverse events). The recommendation to get vaccinated was a significant, yet weaker predictor. As an indirect driver we identified one's knowledge concerning vaccination. 32% of the knowledge questions were answered incorrectly or as don't know. 64% of the students were e-health users; therefore, additional information search via the Internet was likely. An analysis of the websites obtained by googling the search-terms provided by the students revealed 30% commercial e-health websites, 11% anti-vaccination websites and 10% public health websites. Explicit searches for vaccination risks led to fewer public health websites than searches without risk as a search term. Content analysis of the first three websites obtained revealed correct information regarding the questions of whether the doses of vaccine additives were dangerous, whether chronic diseases are triggered by vaccines and whether vaccines promote allergies in 58%, 53% and 34% of the websites, respectively. These questions were especially related to own risk, which strongly predicted intentions. Correct information on vaccination recommendations were provided on 85% of the websites. Concentrating on the key drivers in early medical education (own risk of contracting influenza, vaccine safety, vaccination recommendation) promises to be a successful combination to increase vaccination uptake in HCP.
    Full-text · Article · Dec 2011 · Vaccine
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