Groups Call for Mandatory Flu Vaccinations for Health Care Workers

Immunization Is Professional, Ethical Obligation, Say SHEA, AAP

September 15, 2010 03:00 pm David Mitchell

Influenza vaccination should be mandatory for health care workers, according to separate documents recently issued by the Society for Healthcare Epidemiology of America, or SHEA, and the American Academy of Pediatrics, or AAP. Both organizations contend that health care workers have a professional and ethical obligation to act in the best interest of their patients' health.

SHEA said in its position paper(, which appears in the October issue of Infection Control & Hospital Epidemiology, that it endorses a policy in which annual influenza vaccination is a condition of both initial and continued employment and/or professional privileges. The paper, which updates and serves as a companion piece to a 2005 SHEA position paper on flu vaccination of health care workers and vaccine allocation, has been endorsed by the Infectious Diseases Society of America, or IDSA.

According to a recent article in AAP News(, the AAP's new policy statement( reflects the organization's longstanding recommendation that heath care workers, including those in ambulatory care settings, be immunized annually against the flu virus. In taking this stance one step further and calling for implementation of mandatory vaccination programs, the AAP now joins other membership organizations that also have recommended this course, including the IDSA; the American College of Physicians, or ACP; the Association for Professionals in Infection Control and Epidemiology; and the National Foundation for Patient Safety.

Although the CDC's Advisory Committee on Immunization Practices, or ACIP; the American College of Obstetricians and Gynecologists, or ACOG; the ACP, and the AAFP have recommended for years that all health care workers receive annual influenza immunizations, less than half of health care workers are immunized against the flu each year(, according to the CDC.

Family physician Jonathan Temte, M.D., Ph.D., a member of the ACIP, said immunizing health care workers against the flu is a patient safety issue and should be a standard requirement similar to those used in many health care facilities for measles, mumps and rubella vaccination and tuberculin skin testing.

"The SHEA guidelines echo the sentiments of a vast number of people who have attempted, over the past 30 years, to improve vaccine coverage in health care workers," said Temte, a professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison. "Health care workers -- due to their close contact with patients and due to their high work ethic and lessened likelihood of staying home when ill -- really have the ability to transmit influenza in the workplace to vulnerable patients, their colleagues and their families. They also are easily exposed (to flu) in the workplace."

The SHEA recommendation applies to all workers -- regardless of whether they have direct patient contact and regardless of whether they are directly employed by a facility -- as well as to students and volunteers. The paper also recommends that exemptions be considered only among workers for whom the vaccine is contraindicated, such as those who are allergic to eggs or those who have had previous adverse reactions to flu vaccine.

Vaccination of health care workers serves the following purposes:

  • prevents transmission to patients, including those with a lower likelihood of mounting an effective vaccination response themselves;
  • reduces the risk that the worker will become infected with influenza;
  • creates herd immunity that protects both workers and patients who are unable to receive vaccine or unlikely to respond with a sufficient antibody response;
  • maintains a critical societal workforce during disease outbreaks; and
  • sets an example of the importance of vaccination for every person.

According to the AAP, influenza immunization rates of 80 percent or higher are necessary to provide the level of herd immunity necessary to substantially reduce health care-associated influenza infections.

The CDC has reported that employer immunization recommendations were associated with two- and fourfold increases in coverage rates for seasonal and H1N1 influenza vaccination, respectively, during the 2009-10 flu season. Coverage rates for both vaccines increased at least threefold when employers required influenza immunizations for health care workers.

The SHEA paper outlines options and processes for dealing with health care workers who refuse vaccination or are contraindicated for vaccination, including the use of surgical masks and declination statements.