Flu vaccine should be condition of health professionals' employment, group says

As physicians prepare for this year's influenza season, a major health organization is calling on health care professionals to be vaccinated as a condition of their employment.

The Society for Healthcare Epidemiology of America recommends that the annual seasonal flu vaccine be required for initial and continued employment of all health care employees, regardless of whether they have direct patient contact.

The mandate would apply to physicians, students, volunteers and contract workers. The only exemptions: workers with medical contraindication to the vaccine.

"It's the professional and ethical responsibility of all health care providers to prevent the spread of infections to patients," said SHEA President Neil Fishman, MD. "The influenza vaccine is the single best way to prevent the spread of [the flu]."

The organization's policy statement, issued Aug. 31, says the mandate should be implemented as part of a multifaceted flu infection control program that is clearly communicated to employees.

The policy, in the October Infection Control and Hospital Epidemiology, revises the society's 2005 statement. That year, the organization strongly recommended vaccines for all health professionals but stopped short of making annual immunizations a requirement for employment.

The SHEA joins a handful of organizations with similar recommendations. The U.S. Dept. of Defense requires annual flu vaccination for health professionals who provide direct patient care in military facilities. The Infectious Diseases Society of America supports annual flu immunizations as a condition of initial and continued employment.

The American Academy of Pediatrics released a policy statement on Sept. 8 that recommends mandatory flu immunization of all health care personnel. The AAP says medical and religious exemptions can be granted. When implementing mandatory immunization, medical facilities should make vaccines free to workers and conduct question-and-answer sessions about the new rules.

The American Medical Association encourages health professionals to be vaccinated against the flu. The AMA Council on Ethical and Judicial Affairs is analyzing ethical issues raised by proposals to mandate vaccination as a condition of employment. A report is expected to be presented to the AMA House of Delegates at the Interim Meeting in November.

Dr. Fishman said few health professionals get vaccinated, despite efforts to educate them about the importance of being immunized. "That is just not acceptable," said Dr. Fishman, director of the Dept. of Healthcare Epidemiology and Infection Control at the Hospital of the University of Pennsylvania.

As of mid-January, 61.9% of health professionals received the 2009-10 seasonal flu vaccine, according to the Centers for Disease Control and Prevention's April 1 Morbidity and Mortality Weekly Report. Experts say it's the first time the vaccination rate reached the Dept. of Health and Human Service's Healthy People 2010 target of 60%.

But only 37.1% of health professionals were immunized against the influenza A(H1N1) virus. The CDC said health workers were more likely to believe the seasonal flu vaccine was safe (80.9%) compared with the H1N1 vaccine (66.6%).

Concerns about vaccines

A concern about side effects is one reason health care employees decline vaccines, according to the Joint Commission. Other reasons include fear of contracting an influenza or influenza-like illness from the immunization, perceived ineffectiveness of the vaccine and a belief that the flu is not a severe disease.

Research has shown that such concerns are unfounded, said Greg Poland, MD, a professor of medicine and infectious diseases at the Mayo Clinic in Minnesota and an IDSA member.

He supports mandating annual vaccinations for health professionals, and said they should "set aside personal preference for the greater good of the patients you're privileged to care for."

"That's the rationale behind it," Dr. Poland said.

Since 1984, the CDC's Advisory Committee on Immunization Practices has recommended the seasonal flu vaccine for health professionals. Studies have shown that immunized workers minimize the risk of flu transmission not only to patients but also to colleagues. Vaccination also reduces absenteeism, ensuring that hospitals and practices are sufficiently staffed, the SHEA said.

In 2004, the Virginia Mason Medical Center in Seattle became the nation's first health care system to require its staff to be immunized, according to the SHEA. Since the initiative started, the center's vaccine rate among more than 5,000 employees and adjunct personnel is about 98%.

Other health care facilities have reported similar success with mandates. For example, BJC HealthCare in the St. Louis area achieved 98% immunization among its more than 26,000 employees after making vaccination mandatory in 2008.

As the 2010-11 seasonal influenza vaccines begin arriving, Dr. Fishman is urging health professionals to consider the facts before turning down the vaccine.

"It really is a core patient safety measure. There's very good evidence now that influenza vaccination of health care professionals decreases patient mortality," he said.