State’s flu-shot mandate for health workers 1st of its kind in nation

Rhode Island says the requirement is needed to protect the health of residents and prevent the spread of the illness to vulnerable populations.

By — Posted Nov. 2, 2012

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Rhode Island, the nation’s smallest state, has taken a big step toward protecting the public’s health by mandating that all health care workers who have direct contact with patients be vaccinated against seasonal influenza.

The requirement, issued by the Rhode Island Dept. of Health, marks the nation’s first statewide mandate of flu shots for health professionals. In other states, flu vaccine mandates have been set by individual employers, such as hospitals and health care centers.

The Rhode Island mandate took effect Oct. 26, as the 2012-13 flu season was starting. State health officials hope the move will lead to a shorter flu season with fewer people infected.

“Those who care for and interact with patients in a health care setting have a duty to protect the health and safety of those for whom they care,” said Michael Fine, MD, director of the health department. “A flu shot for all those who interact with patients as part of their employment or volunteer efforts at a health care facility is the best way to prevent the spread of influenza to some of our state’s most vulnerable populations.”

Under the mandate, health care workers and volunteers with medical contraindications to the flu vaccine must submit a medical exemption each year to the facility where they work. Individuals who choose not to receive the immunization for other reasons have to wear a surgical mask when they have contact with patients during periods of widespread flu. The Dept. of Health will determine when the flu is widespread in the state (link).

Dr. Fine said many physicians in the state seem to support the requirement. “It renews my faith that my physician colleagues are always about [selfless] advocacy. They are best at putting patient care first,” he said.

But there has been some opposition, mainly by unions representing health care workers in the state. “Every time there’s a new requirement [for health care employees], people get very anxious and talk about their civil liberties” being violated, said Nancy Kass, ScD, deputy director for public health at Johns Hopkins Berman Institute of Bioethics in Baltimore.

Because health care workers’ job is to keep the public safe, it makes sense that they are up to date on recommended vaccines, Kass said.

The Rhode Island Medical Society did not take a formal position on the requirement, in part because physician members were divided on the necessity of the mandate, said Steven R. DeToy, director of government and policy affairs for the medical society.

“No one argues that as many people as possible should be vaccinated” against influenza, DeToy said. “We would have hoped we could have gotten to the same goal with education and training.”

The American Medical Association has policy that supports universal influenza vaccination of health care workers. The Association encourages hospitals, health care systems and others to immunize them under guidelines set by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices to reduce the risk of transmission to others.

Let institutions decide

During the 2011-12 influenza season, 67% of health care workers were vaccinated against the flu, up slightly from the 64% who received the vaccine in the 2010-11 season, the CDC said.

Although the CDC calls it “critically important” for health professionals to get flu shots to protect themselves and patients, the agency stops short of calling for mandatory vaccinations, said CDC spokesman Tom Skinner. “We leave that decision up to each [health] institution to decide,” he said.

With the 2012-13 flu season under way, influenza activity remained low across the country, with one pediatric death reported as of Oct. 20, the CDC said. As of Oct. 19, 117.1 million doses of flu vaccine had been distributed. Manufacturers project that 135 million doses will be produced during the season (link).

“Each flu season is unique, so you can’t predict what’s going to happen,” Skinner said.

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