Debate against mandatory flu vaccines in HCWs grows
Debate against mandatory flu vaccines in HCWs grows
Professional organizations oppose requiring shots
Mandatory influenza vaccination for health care workers is not justified says the American College of Occupational and Environmental Medicine (ACOEM) in a new position statement. The college further opposes the use of declination statements noting that there is "no evidence to suggest that such programs will increase compliance." The statement — Influenza Control Programs for Healthcare Workers — applies to seasonal influenza and is not necessarily appropriate during a major antigenic shift in the virus resulting in a pandemic situation.
Influenza continues to be a major cause of death and disease, readily spread by respiratory droplets both in the community and in the hospital environment.
While ample reasons exist for employers to sponsor influenza vaccination programs for their employees and to pursue strategies to maximize participation, the college noted that mandatory flu shots are not justified for several reasons — the vaccine itself is variably effective; vaccination does not preclude the need for other controls; and a coercive program has the potential to harm the employer–employee relationship. In addition, the college points out that "given the ubiquitous nature of influenza in the community, patients will continue to be exposed to influenza through family members and friends regardless of the vaccination status of their health care workers, with whom they have much less intimate contact."
CDC issues tiered priorities for vaccinations
Given the uncertainties in doses and distribution, the Atlanta-based Centers for Disease Control and Prevention (CDC) recommends that the following priority groups receive trivalent inactive vaccines until Oct. 24, 2005:
- persons 65 years or older with comorbid conditions
- residents of long-term care facilities
- persons ages 2-64 years with comorbid conditions
- persons 65 years or older without comorbid conditions
- children age 6-23 months
- pregnant women
- health care personnel who provide direct patient care
- household contacts and out-of-home care-givers of children younger than 6 months
As of Oct. 24, 2005, all persons are eligible for vaccination, according to CDC guidelines. The tiered use of prioritization is not recommended for live attenuated influenza vaccine (LAIV) administration. LAIV may be administered at any time for vaccination of nonpregnant healthy persons age 5-49 years, including most health care personnel, others in close contact with groups at high risk for influenza-related complications, and others desiring protection against influenza. Additional information is available at http://www.cdc.gov/flu.
Vaccination only one part of control
"Vaccination is only one prong in a multifaceted approach to infection control," says William Buchta, MD, MPH, FACOEM, chair of the college's Medical Center Occupational Health Section and author of the paper. "Health care workers must also appropriately use hand washing and personal protective equipment and they should consider self-removal from work when experiencing symptoms of a communicable illness."
Buchta also notes that reliance on employee vaccinations alone for prevention and control of influenza in the health care environment offers a false sense of security and ignores some of the more practical, but also effective, means of minimizing nosocomial transmission.
While ACOEM endorses a multifaceted influenza control program in all health care facilities and strongly encourages health care organizations to facilitate participation by providing influenza vaccine and/or prophylactic medication at no expense to the employee, the college discourages generalized policies requiring mandatory compliance with employee vaccination or prophylactic medication, noting that such policies have already been successfully challenged in Canada.
The American Nurses Association (ANA), likewise, urges health care workers to be vaccinated, but "could not support mandatory vaccinations [because we] believe it is a nurse's personal decision," ANA spokeswoman Carole Cook says.
"Making people sign a statement that they have declined to receive a flu shot not only impacts the employer–employee relationship in a negative way, but diverts resources from activities known to increase compliance and devotes them to enforcement of a policy with no proven benefit," says Buchta. "Influenza control can be successful with creative programs that employ the 'carrot' rather than the 'stick,' while still respecting the rights of both patients and employees."
There currently are no states that require health care workers to be vaccinated against influenza. But even in years when the flu vaccine has been plentiful, the nationwide vaccination rate among health care workers has averaged only about 38%. Those involved with professional associations say the reasons for the low compliance rate are the same as in the general population — from apathy, to fear of contracting the virus from the vaccine, to fear of other side effects.
Influenza Control Programs for Healthcare Workers was approved by the ACOEM board on July 30. It is available on-line at www.acoem.org.
CDC guidelines and continually updated flu information are available at www.cdc.gov/flu.
[For more information contact:
- William Buchta, MD, MPH, FACOEM, chair, American College of Occupational and Environmental Medicine Medical Center Occupational Health section. 25 Northwest Point Blvd., Suite 700, Elk Grove Village, IL 60007. Phone: (847) 818-1800.]
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