Beyond flu, SHEA calls for vaccine mandates
Targeting HCWs for all ACIP recommended shots
Going beyond seasonal flu shots, infectious disease groups are calling for mandates on all recommended vaccinations for health care workers if volunteer efforts fall short of a 90% immunization rate.
Thus if voluntary efforts are lagging, health care employers would mandate and provide measles, mumps, rubella (MMR), varicella, pertussis and hepatitis B vaccines, in addition to the annual influenza vaccine.
The organizations — the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society — issued a joint statement supporting "universal immunization of health care personnel (HCP)" for all vaccines recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).
"Although some voluntary HCP vaccination programs have been effective when combined with strong institutional leadership and robust educational campaigns, mandatory immunization programs are the most effective way to increase HCP vaccination rates," the ID groups stated. "As such, when voluntary programs fail to achieve immunization of at least 90% of HCP, the Societies support policies that require HCP documentation of immunity or receipt of ACIP-recommended vaccinations as a condition of employment, unpaid service, or receipt of professional privileges."
For workers who cannot be vaccinated due to medical contraindications or because of vaccine supply shortages, health care employers should consider, on a case-by-case basis, the need for administrative and/or infection control measures to minimize risk of disease transmission (e.g., wearing masks during influenza season or reassignment away from direct patient care). The societies also called for comprehensive educational efforts to inform workers about the benefits of vaccination and the risks of not maintaining immunization. They cited the following points in making the recommendation for mandated vaccines:
- Immunizing HCP against vaccine-preventable diseases protects both patients and HCP from illness and death associated with these diseases.
- Immunizing HCP also prevents them from missing work during outbreaks, which would further negatively impact patient care.
- Immunization rates for ACIP-recommended vaccines remain low among HCP.
- Mandatory immunization programs are necessary where voluntary programs fail to maintain adequate HCP vaccination rates.
- ACIP-recommended vaccines are proven to be safe, effective, and cost-saving.
- Educational programs increase HCP compliance with vaccination programs, but standing alone do not consistently achieve adequate vaccine coverage levels.
- The provision of immunizations at no cost in the occupational setting increases HCP immunization compliance.
- Physicians and other health care providers are obligated "to do good or to do no harm" when treating patients, and they have an ethical moral obligation to prevent transmission of infectious diseases to their patients.
Flu proves mandates work
Voluntary programs are "somewhat successful, but they don't reach the level of universality," says W. Charles Huskins, MD, MSc, consultant in pediatric infectious diseases at the Mayo Clinic in Rochester, MN, and a liaison from SHEA to the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC). "When you make something mandatory, it happens."
That has been clear from the dramatic effects of mandatory influenza vaccination policies. Infection preventionists pushed for mandates, and several organizations issued position statements in 2010 and 2011 calling for influenza immunization to be a condition of employment for health care workers.
Hospitals responded either by creating a mandate or putting greater resources into voluntary programs, and the vaccination rates of health care workers rose dramatically. In the 2012-2013 flu season, 30% of hospitals had a mandatory influenza vaccination policy, and the overall vaccination rate in hospitals was 83%.1
Recent outbreaks of measles, mumps and pertussis have placed a greater emphasis on other vaccines for health care workers. State laws vary, but most do not require hospital employees to be vaccinated.
By 2011, only about one in four (26.8%) health care workers had received a Tdap booster to protect against pertussis, according to the CDC.2 Yet pertussis is a growing problem nationally, including nosocomial outbreaks in which health care workers were infected and transmitted pertussis to vulnerable patients.
- Centers for Disease Control and Prevention. Influenza vaccination coverage among health-care personnel — United States, 201213 Influenza Season. MMWR 2013;62:781-786.
- CDC. Non-influenza vaccination coverage among adults United States, 2011. MMWR 2013;62:66-72.
