ACP Calls For Health Care Worker Immunizations

 

Photo Credit – CDC PHIL

# 5854

 

Today the American College of Physicians (ACP) – the second largest physician group in the United States – issued a statement supporting the immunization of all health care workers against influenza, along with a variety of other vaccine-preventable communicable diseases (including diphtheria; hepatitis B; measles, mumps, and rubella; pertussis (whooping cough); and varicella.

 

Their policy recommendations fall short of calling for across-the-board `mandatory’ vaccinations, as they do allow for exemptions due to medical reasons or religious objections to immunization.

 

You may recall that last October the  CMAJ (Canadian Medical Association Journal) endorsed requiring HCWs (Health Care Workers) to get a seasonal flu shot (see CMAJ On Mandatory Flu Shot For HCWs).

 

While strongly advocating influenza vaccination for HCPs, the CDC has stopped short of mandating them. I blogged on this back in June of 2010 (see CDC: Proposed Influenza Infection Control Guidance).

 

Many professional medical organizations have taken a stronger stance, adopting policies calling for mandatory vaccination of health care workers (HCWs).  A few earlier blogs on this include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

This latest call for flu vaccination comes as the first state-mandated flu vaccine requirement for HCWs – see Rhode Island Adopts New Flu Vaccination Requirements For HCPs - is being contested by a healthcare worker’s union in court. 

 

This from AMEDNEWS.COM.

 

First state flu shot mandate at center of legal battle

A union is suing Rhode Island over a regulation requiring all health workers to receive influenza vaccine or wear masks while they’re working.

By Alicia Gallegos, amednews staff. Posted Jan. 14, 2013.

The Rhode Island Dept. of Health is asking a federal judge to throw out a lawsuit challenging its recently issued mandate that health care employees receive the influenza vaccine.

(Continue . . . )

 

While many infection control experts see mandatory immunization a necessary and long overdue step in patient and co-worker protection, this is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

Despite recent studies showing that flu shots provide only about 60% protection against influenza, many hospitals see this as both a liability and an economic issue, on top of their concerns over patient welfare.

 

Which is why – despite protests from some employees – an increasing number of hospitals and medical offices are making flu vaccination mandatory over the past few years. A couple of recent examples include:

 

Mandatory Flu Shots For Children's Medical Center Employees

Hospital's 'Cocoon Strategy' Aimed At Protecting Young Patients

 

Local health system mandates flu vaccine for upcoming season

 

 

 

Here is the ACP link, and some excerpts, from today’s press release:

 

American College of Physicians calls for immunizations for all health care providers

40,000 to 50,000 adults die from vaccine-preventable diseases each year in the U.S.

PHILADELPHIA, January 14, 2013 -- The American College of Physicians (ACP) has approved a policy recommendation that all health care providers (HCPs) be immunized against influenza; diphtheria; hepatitis B; measles, mumps, and rubella; pertussis (whooping cough); and varicella (chickenpox) according to the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule. ACP’s policy exempts HCPs for medical reasons or a religious objection to immunization.

 

“These transmissible infectious diseases represent a threat to health care providers and the patients we serve, who are often highly vulnerable to infection,” said David L. Bronson, MD, FACP, president, ACP. “Proper immunization safely and effectively prevents a significant number of infections, hospitalizations, and deaths among patients as well as preventing workplace disruption and medical errors by absent workers due to illness.”

 

With a severe flu season underway, ACP urges all adults to get a flu shot if they haven’t already and to talk with their internist about other immunizations they might need. Only 39 percent of adults received the flu vaccine during the 2011-12 season. People who cannot get a flu shot or other immunizations for medical reasons should talk to their internist about other ways of protecting themselves.

 

ACP is committed to improving public health through encouraging appropriate immunization of adults. In August 2012, ACP was awarded an initial $175,000 of a total $525,000 grant for 2012-13 from the Centers for Disease Control and Prevention (CDC) to create a three-year, evidence-based program to increase adult immunization rates in five states. In addition, the American Board of Internal Medicine (ABIM) approved practice improvement credit for the Medical Home Builder adult immunization module for recertifying physicians.

 

(Continue . . . )

Popular among HCWs or not  – short of an overturn in the courts – the requirement for annual flu vaccinations in HCPs continues to gain traction across the country, and around the world.

 

»» Read More

CMAJ On Mandatory Flu Shot For HCWs

Photo Credit – CDC PHIL

# 6676

 

In an editorial today, the CMAJ (Canadian Medical Association Journal) endorsed requiring HCWs (Health Care Workers) to get a seasonal flu shot, thus joining a growing list of medical associations around the world calling for similar policies.

 

First, the press release followed by a link to the editorial, then I’ll return with more.

 

Canadian Medical Association Journal

Mandatory flu vaccine for health care workers to protect patients

All health care workers in health care institutions should be vaccinated with the annual influenza vaccine to protect patients, argues an editorial in CMAJ (Canadian Medical Association Journal).

 

Each season, 20% of health care workers get influenza, and 28% of young healthy adults who get it have asymptomatic or subclinical infections," writes Dr. Ken Flegel, Senior Associate Editor, CMAJ. "Some of them may shed virus up to a day before symptoms appear. It is time that all people who work in a health care institution be vaccinated."

 

In Canada, there are approximately 20 000 hospital admissions related to influenza and an estimated 4000 to 8000 deaths attributed to the illness. However, 55%% of physicians do not get vaccinated against the flu and are putting patients at risk of illness and death.

 

Dr. Flegel argues that flu vaccination for health workers must be compulsory, although there could be exemptions for medical or religious reasons. A vaccination rate above 90% is required to prevent outbreaks in hospitals. Mandatory programs for health care workers in many US institutions have resulted in participation rates of about 95%.

 

"Our schools have shown us the way. During measles outbreaks, access to schools has been successfully denied to nonvaccinated children and staff. The time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change," Dr. Flegel concludes.

 

You can read the entire editorial at this link:

 

EDITORIAL

Health care workers must protect patients from influenza by taking the annual vaccine

October 29, 2012

We know that health care workers import and transmit seasonal influenza to patients. We know that many patients get seriously ill from it and that some die. We know that the annual influenza vaccine can interrupt most of this imposed disease burden. It is time that we act on our knowledge and require all health care workers to be vaccinated. 

Full article

 

 

Despite vocal resistance from some HCWs and their unions, calls for mandatory flu vaccination for health care workers have been coming from many professional organizations for several years.

 

A few earlier blogs on these include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

In 2011, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

This perspective was penned by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, and addresses the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Caplan argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argued, are violated when HCWs fail to accept a yearly flu vaccination.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

And earlier this month we saw Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Although many infection control experts see this as a long overdue step in patient and employee protection, compulsory vaccination remains a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered some of the HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

While their concerns over the vaccine’s safety may be overblown, one of their arguments that does carry some weight is the relative effectiveness of the flu vaccine.

 

It simply isn’t as good as with other vaccines.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

Having a better flu vaccine would remove at least one of the objections that many HCWs have voiced.

 

Popular with HCWs or not, hospitals are increasingly looking at this as both a liability and an economic issue. Unless the courts intervene, the momentum increasingly appears to be moving towards mandating yearly flu shots for many Health Care Workers down the road.

»» Read More

Rhode Island Adopts New Flu Vaccination Requirements For HCPs

 

HCW Flu Vaccine Survey – Credit MMWR

 

# 6611

 

Last week (Sept 28th) the CDC’s MMWR carried a report on the level of seasonal flu vaccination among Health Care Personnel (HCPs) based on a pair of relatively small Internet Surveys.

 

Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States

(Excerpt)

. . .  overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%.

 

 

While the numbers are considerably higher than we’ve seen in previous years, this survey was subject to a number of limitations and may overstate the percentage of HCPs who actually accepted the flu shot last year.

 

It recruited its small sampling (n=2348) via emails and pop up ads from two websites (Medscape & SurveySpot) – so this was not a random sampling.

 

Additionally, the responses were based on self-reporting, and were not verified by employee records.

 

Still, this survey indicated fully 1/3rd of health care workers refused the flu shot last year.  According to this survey, the top three reasons for doing so were:

 

1) a belief that they did not need it (28.1%)

2) concern about vaccination effectiveness (26.4%)

3) concern about side effects (25.1%).

 

Regardless of the exact percentage, millions of health care workers in the U.S. choose not to be vaccinated against influenza each year, a number that worries many infectious disease specialists.

 

While strongly advocating influenza vaccination for HCPs, the CDC has stopped short of mandating them. I blogged on this back in June of 2010 (see CDC: Proposed Influenza Infection Control Guidance).

 

Many professional medical organizations have taken a stronger stance, adopting policies calling for mandatory vaccination of health care workers (HCWs).  A few earlier blogs on this include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

 

Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the flu virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

Some facilities are offering employees an alternative to taking the vaccine. This from a July 2011 edition of Infection Control and Hospital Epidemiology.

 

An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle

 

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

 

 

 

Which brings us to a press release from Rhode Island’s Department of Health, announcing the mandating (with some exemptions) seasonal flu vaccinations for all health care workers, students, trainees and volunteers who are likely to have direct contact with patients in a healthcare facility.

 

 

HEALTH Adopts Regulations to Require Flu Shots for Healthcare Workers in Rhode Island

Release date: 10-05-2012

PROVIDENCE – The Rhode Island Department of Health (HEALTH) has announced that it has adopted new amendments to its Rules and Regulations for Immunization and Testing For Healthcare Workers that will make flu immunizations mandatory for all workers, students, trainees and volunteers who may have routinely anticipated face-to-face interaction, also known as "direct contact," with patients at a healthcare facility.

 

"HEALTH listened closely to all stakeholders and used that feedback to craft amendments that addressed the concerns of healthcare workers and volunteers, while protecting patients from the threat of influenza," said Michael Fine, MD, director of HEALTH.

 

Healthcare workers and volunteers who have a medical reason for not getting a flu shot may obtain a medical exemption from their doctor, licensed physician's assistant or licensed nurse practitioner. This exemption must be renewed annually and submitted to the employing facility by December 15 each year.

 

Healthcare workers and volunteers who are opposed to having a flu shot but are not medically exempt must submit a form annually by December 15 that states their refusal to be immunized against influenza and indicates their understanding that they are obligated to wear a surgical face mask during each routinely anticipated direct patient contact during any declared period in which the flu is widespread. That determination will be made by the Director of Health, and healthcare facilities will notify all workers that "a period in which flu is widespread" has been declared for the facility.

 

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

 

These regulations do not apply to patient family members or to friends who visit or otherwise assist in the care of that patient in a healthcare facility.

 

To read the newly-amended rules and regulations, visit

http://sos.ri.gov/documents/archives/regdocs/released/pdf/DOH/7083.pdf

 

 

While this move will likely be applauded by many infectious disease specialists, many HCP will be less than pleased.  Mandatory flu shots have evoked a contentious debate among health care workers for years.

 

According to an AP article RI health workers now required to get flu shots by Erika Niedowski last night, union officials opposed to mandatory vaccination are already considering how they will respond to this requirement.

 

New York State, you may recall, attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

In recent years an increasing number of hospitals have moved aggressively towards implementing mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

The Immunization Action Coalition (IAC) maintains a terrific website with extensive information on vaccines, and includes a growing `Honor Roll’ of organizations and practices that have adopted a mandatory flu shot policy (some exemptions may apply).

 

Of course, legal challenges still lie ahead.

Hospitals increasingly are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare.

 

Love the idea or hate it – short of an overturn in the courts – the requirement for annual flu vaccinations in HCPs appears to be gaining traction across the country.

»» Read More

Downton Abbey Rekindles An Old HCW Debate

 

 

 

# 6150

 

I must confess that like a great many other Americans, I’ve become quite the fan of the British TV series Downton Abbey, just as I was of its 1970-1975 predecessor – Upstairs Downstairs. 

 

Both series start in the Edwardian period (1901-1910) and chronicle the lives of the upstairs aristocracy and downstairs servants through the WWI years, and into the 1920s.

 

Both series, incidentally, featured a Spanish Flu episode that claims a major cast member.

 

As Crof noted in his blog this morning (see 'Downton Abbey' gets the flu — but does it get it right?), the final episode of season two ended last Sunday (here in the States) with the Spanish Flu, sparking a newspaper article that asks CIDRAP Director Michael Osterholm if the show got the details right.

 

This episode has also reignited a vigorous discussion on the allnurses.com forum over whether nurses, techs, and other HCWs (Health Care Workers) have a duty to report for work during a pandemic.

 

Since Sunday the discussion thread If There Was A Major Epidemic / Pandemic Would You Report For Duty? has generated more than 60 comments; highly recommended reading for any hospital administrator, nurse manager, or emergency planner.

 

All along, government planners have assumed that up to 40% of HCWs might be absent due to illness or staying home to care for ill family members.

 

But to this attrition rate we must also account for those who – for a variety of reasons – would decline to work during a severe infectious disease outbreak. 

 

Not surprisingly, one of the major concerns of HCWs during a pandemic is the level of protection they will be afforded against infection.

 

As we saw during the opening weeks of the 2009 H1N1 pandemic, many hospitals had an inadequate supply of PPEs (Personal Protective Equipment) on hand, which led to a number of protests (see Nurses Protest Lack Of PPE’s , Report: Nurses File Complaint Over Lack Of PPE).

 

 

Ideally, the well-protected HCW (Health Care Worker) working in an infectious environment would be wearing an N95 respirator, gloves, gown and eye protection.

 

• In some cases nurses reported they were issued only one N95 mask to be used for an entire 8 hour shift, and told to don it only when in direct contact with a potentially infected patient.
• In other venues, HCWs were issued surgical masks in lieu of N95s, despite the recommendation at the time from the CDC that N95 masks were the preferred level of protection.

 

Their concerns were far from unfounded.

 

Last December we saw a study published in the SHEA journal Infection Control and Hospital Epidemiology that shows that the inadequate use of masks by healthcare workers during the opening days of the 2009 pandemic put them at greater risk of contracting the virus.

 

Transmission of 2009 Pandemic Influenza A (H1N1) Virus among Healthcare Personnel-Southern California, 2009.

Jaeger JL, Patel M, Dharan N, Hancock K, Meites E, Mattson C, Gladden M, Sugerman D, Doshi S, Blau D, Harriman K, Whaley M, Sun H, Ginsberg M, Kao AS, Kriner P, Lindstrom S, Jain S, Katz J, Finelli L, Olsen SJ, Kallen AJ.

Source

Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

We’ve a press release from SHEA with the details.

Study finds inadequate mask use among health care workers early in 2009 H1N1 outbreak

Inadequate use of masks or respirators put health care workers at risk of 2009 H1N1 infection during the earliest stages of the 2009 pandemic in the U.S., according to a study published in the December issue of Infection Control and Hospital Epidemiology, the journal of the Society of Healthcare Epidemiology of America.

 

Over the years we’ve seen a number of studies that suggest anywhere from 25% to 40% of hospital staff may elect not to work during a severe pandemic.

 

In 2008, in a blog called Australia: Will Doctors Work In A Pandemic? we looked at a study that found that 30% of the doctors they asked expressed reluctance to work during a pandemic.

This appears in the eMJA, the Medical Journal of Australia.

How will Australian general practitioners respond to an influenza pandemic? A qualitative study of ethical values

Olga Anikeeva, Annette J Braunack-Mayer and Jackie M Street

ABSTRACT (excerpt)

A number of GPs said they would not practise in the event of a pandemic, as they felt their responsibility to their families outweighed that to their patients.

 

 

In a blog from 2009 called And The New Survey Says . . . we looked at a couple of studies, including this one that indicated that a significant percentage of hospital and home nursing staff might not work during a severe pandemic outbreak.

 

 

How would Australian hospital staff react to an avian influenza admission, or an influenza pandemic?

Authors: Martinese, Franco; Keijzers, Gerben; Grant, Steven; Lind, James

Source: Emergency Medicine Australasia, Volume 21, Number 1, February 2009 , pp. 12-24(13)

 

Researchers found that up to 38% of personnel would not report to work unless antivirals, vaccines, and adequate PPEs were immediately available.

 

They write in their conclusion:

 

Conclusion:

High absenteeism among hospital staff should be anticipated if patients are admitted with either avian or pandemic influenza, particularly if specific antiviral preventative measures are not immediately available.

 

Measures to maximize the safety of staff and their families would be important incentives to attend work.

 

 

And in 2009, we saw a study that appeared in journal BMC Public Health (see UK Poll: Will HCW’s Work In A Pandemic?)  that suggests during a severe pandemic, up to 85% of hospital personnel may be absent.

 

While adequate PPEs, antiviral medications, hospital security (often mentioned as a concern in what would likely be a chaotic environment) and (eventually) vaccines may not be enough to coax all reluctant HCWs to report to work, a failure to provide them will all but guarantee higher levels of employee absence.

 

Just as we cannot expect a firefighter to rush into a burning building without bunker gear, we should not expect HCWs to work in an infectious and dangerous environment without proper protection.

 

The catch-22 to all of this is, even if they were willing to valiantly work without protection, the attrition rate of HCWs due to infection and illness would quickly reduce their numbers and effectiveness.

 

Prior to the 2009 H1N1 pandemic there was a lot of talk about stockpiling large quantities of PPEs in anticipation of a bird flu pandemic. 

 

In 2008 OSHA even issued Proposed Guidance On Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza that recommended that every nurse with direct patient contact would need roughly 480 - N95 respirators for a 12 week pandemic wave.

 

 

Over the past three years, I’ve rarely seen the subject publically addressed.  It’s as if preparing for a pandemic today is so 2006.

 

You have to wonder - after the shortages we saw in the opening weeks of the 2009 outbreak -  how many hospitals today are well enough stocked with PPEs to last even a couple of weeks into a severe pandemic wave.  

 

With a surge in global demand for PPEs all but assured, timely resupply is hardly guaranteed.

 

This is one of those `elephant in the living room’ problems that everyone knows exists, but because of the costs and logistics of addressing, no one wants to talk about.

 

But if healthcare systems hopes to stay functional during a severe pandemic, they need to be taking steps now to protect their most valuable (and irreplaceable) asset.

 

The caregivers.

»» Read More

Three Would Make For A Crowded Viral Field

 

 

Will we have to add another Influenza A strain to this chart?

# 6034

 

 

Although our knowledge of what influenza viruses were in circulation prior to 1918 is very limited, we do know that from 1918 to 1977 only one influenza A virus seemed to circulate in humans at a time.

 

In 1918, the H1N1 virus appeared (although it wasn’t isolated until the 1930s), replacing whatever had been in circulation before it. And H1N1 reigned supreme for nearly 40 years, until a new upstart virus – called H2N2 – appeared with the pandemic of 1957, driving H1N1 into obscurity.

 

Eleven years later, another pandemic virus – called H3N2 – arrived with the Hong Kong Flu of 1968, and H2N2 followed H1N1 into the viral dustbin.

 

So naturally scientists assumed that the natural order of things was to have only one influenza A virus dominant at a time. True, there might be small isolated outbreaks of differing strains, but it appeared that only one could be king of the viral mountain.

 

Then in 1977, the H1N1 virus mysteriously reappeared after an absence of 20 years (possibly escaping from a Russian or Chinese research lab) . . .  and this time, it did not drive out the currently circulating H3N2 virus.

 

Since those over the age of 20 had some immunity to the H1N1 virus, it mainly affected children. Some scientists believed that this left a substantial reservoir of adults susceptible to the H3N2 virus, allowing its survival. 

 

Suddenly we had two influenza A viruses (H1N1 & H3N2) co-circulating - along with a couple of B strains -  and that status quo continued until the spring of 2009 when a new H1N1 swine flu virus arrived on the scene.

 

While the new H1N1 virus supplanted the old seasonal H1N1 virus, it did not displace the H3N2 virus, which again left us with two co-circulating influenza A viruses.

 

Fast forward a couple of years, and today we are seeing some new variants of both H3N2 and H1N1 swine viruses popping up, apparently the result of the 2009 pandemic virus re-entering the swine population and reassorting with other swine flu viruses to produce hybrids.

 

 

While the number of human infections with these novel flu viruses remains small, the concern is that one (or perhaps more) of these variant viruses could end up adapting well enough to humans to begin to spread efficiently.

 

Most researchers are downplaying the pandemic potential for these variant viruses – at least in their present form – since there is probably a fair amount of community immunity to them, particularly among adults.

 

While the future of these variant viruses is impossible to see, the possibility exists that we could end up seeing three influenza A viruses co-circulating. 

 

Helen Branswell of the Canadian Press brings us more on this possibility in her report from last night. As always with a Branswell story, you should follow the link and read it in its entirety.

 

U.S. finds new human infection with swine H3N2 flu

Updated: Fri Dec. 23 2011 17:16:22
The Canadian Press

U.S. public health officials have found another case of human infection with a swine-origin H3N2 virus, this time in a child from West Virginia. And they also reported finding a human infection with a new swine influenza virus never before seen in humans, in a person in Wisconsin who had contact with pigs.

(Continue . . . )

 

 

Yesterday the CDC prepared and released a small avalanche of guidance documents on these emerging variant viruses.

 

Yesterday I linked to Guidance For People Involved In Raising Swine and the early release MMWR on H3N2v Transmission and Guidelines.

 

Today, you’ll find links to interim guidance documents designed for Healthcare professionals.

 

• Prevention Strategies for Seasonal and Influenza A(H3N2)v in Health Care Settings

• Interim Guidance for Influenza Surveillance: Additional specimen collection for detection of Influenza A(H3N2)v Virus infections

• Interim Guidance on Specimen Collection, Processing, and Testing for Patients with Suspect Influenza A(H3N2)v Virus Infection

• Interim Guidance on Case Definitions to be Used For Investigations of Influenza A(H3N2)v Virus Cases

 

 

The public health risk from these variant viruses appears low at this time, but the CDC reminds us:

 

While there is no evidence that sustained human to human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread.

 

Which makes maintaining good flu hygiene this winter (washing/sanitizing your hands, covering coughs & sneezes, staying home when sick), and getting your seasonal flu shot, your best strategies to avoid getting sick during holiday season.

»» Read More

Flu Shot Ethics

 

 

Photo Credit – CDC PHIL

# 5866

 

This week I’ll stop by my local pharmacy and get my seasonal flu shot. No, I don’t particularly like taking the time, or spending the $30 (my insurance doesn’t cover it), to do this every year.

 

And I usually end up with a sore arm for a couple of days.

 

But I get the shot not only to protect my own health, I do it to protect those around me; family, friends, and even casual contacts I might meet.

 

People like my Dad, who will be 87 in November.

 

Last year he contracted an ILI (influenza-like-illness) over the Christmas holidays which evolved into pneumonia, and we almost lost him. 

 

I don’t know for sure that his flu-cum-pneumonia was vaccine preventable (for reasons why, see BMC Study: A Crowded Viral Field), but when the stakes are this high, I consider it my duty to try to reduce the risks as much as I possibly can.

 

While I can’t do much (beyond practicing good flu hygiene) about catching the various adenoviruses, rhinoviruses, coronaviruses, Parainfluenzas, or Human metapneumoviruses out there, I can significantly reduce my odds of catching . . . and spreading the flu.

 

And yes, Dad got the flu vaccine last year.  But at the age of 86, his immune system doesn’t mount as robust of a response to the vaccine as would a younger person.

 

          *       *       *      *      *      *      *

Earlier this year, NFID - the National Foundation for Infectious Diseases - convened a panel of experts to address the issues of influenza and the elderly that included such familiar names in public health as Arnold Monto, MD; Kristin Nichol, MD, MPH; H. Keipp Talbot, MD, MPH; and William Schaffner, MD.

 

From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.

 

Although the elderly generally see less protection from the flu vaccine, older individuals may still mount a robust immune response. In populations 65 and older, the brief points out that:

 

• Hospitalization rates for influenza and pneumonia are lower in community-dwelling adults who received the seasonal influenza vaccine.
• Immunization is associated with reduced hospitalization of older patients for cardiac, respiratory, and cerebrovascular diseases.

 

While the goal of vaccinating the younger population is to prevent infection, the authors point out that:

 

. . . the goal in older adults is to prevent severe illness, including exacerbation of underlying conditions, hospitalization, and mortality.

 

In other words, even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.

          *       *       *      *      *      *      *

 

 

But it isn’t just the elderly (and myself) that my flu shot helps to protect. 

 

By denying the virus a susceptible host, I help limit its ability to spread in my community. And that means I’m helping to protect younger adults, children, and even infants (who, under 6 mos. of age can’t be vaccinated). 

 

Unfortunately, based on the most recent flu vaccination numbers published by the CDC’s MMWR (see FluVaxView Report ), last year only a little over 1/3rd of the residents in my state took it upon themselves to do the responsible thing and get vaccinated.

 

 

Even in the top five states (Maryland, Hawaii, Massachusetts, Rhode Island, and South Dakota) coverage was less than 60%.

 

And among healthcare workers (HCWs) – who have the opportunity to spread the flu to the most vulnerable members of our society – uptake of the vaccine in the United States last year was reported recently to have been just over 60%.

 

Despite resistance from some HCWs, calls for mandatory flu vaccination among health care workers have been coming from many directions. Earlier this year, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Numerous professional medical organizations, however, have adopted policies calling for mandatory vaccination of HCWs.  A few earlier blogs on that include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

Today, with another flu season approaching, Katherine Harmon writing for Scientific American asks a number of infectious disease experts:

 

Are Health Care Workers Who Decline Flu Shots Irresponsible?

More than a third of U.S. health care employees were not vaccinated last flu season. Research shows that the unvaccinated staff have a decent chance of getting sick--and passing that infection on to at-risk patients

 

 

While the answers vary in terms of diplomacy, the consensus is that HCWs who do not get vaccinated against influenza are putting their patients at unreasonable (and unnecessary) risk.

 

Which is why – despite protests from some employees – an increasing number of hospitals and medical offices are making flu vaccination mandatory this year. A few recent headlines illustrating this growing trend include:

 

Mandatory Flu Shots For Children's Medical Center Employees

Hospital's 'Cocoon Strategy' Aimed At Protecting Young Patients

 

Local health system mandates flu vaccine for upcoming season

 

Hospitals Making Flu Vaccine Mandatory for Employees

 

 

Increasingly, hospitals are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare. 

 

But no matter your job description, unless you live alone in a cave somewhere, you have the potential to spread the serious – and sometimes life-threatening – influenza virus.

 

Getting a flu shot every year can significantly reduce (but not completely eliminate) that risk.

 

That, and practicing good flu hygiene (covering coughs, sneezes, washing hands, staying home when sick), can literally save lives.

 

Which makes getting the flu shot not only smart in terms of protecting your own health, but it also makes it, without a doubt, the ethical thing do do. 

»» Read More

Lancet Perspective: Mandatory Flu Vaccination For HCWs

 

 

Photo Credit – CDC PHIL

# 5709

 

 

A perspective appears today in The Lancet by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, on the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Arthur Caplan is the author and/or editor of nearly 25 books, and more than 500 journal articles. He writes a regular column on bioethics for MSNBC.com, and is a frequent guest commentator on NPR, CNN, MSNBC, and for major newspaper outlets, including the New York Times and Washington Post.

 

In 2008, Discover Magazine named him one of the 10 most influential people in science.

 

Not known for mincing words (see Arthur Caplan On `Flunking The Swine Flu Test’ for an earlier example), Caplan states that: “Vaccination is a duty that one assumes in becoming a health-care provider.”

 

He argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argues, are violated when HCWs fail to accept a yearly flu vaccination.

 

Yet every year, despite awareness campaigns and the endorsement by many medical organizations, less than half of all healthcare providers in the United States and the UK voluntarily agree to take the vaccine.

 

You can read the entire piece at the link below, after which I’ll return with more.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

 

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Numerous professional medical organizations have adopted policies calling for mandatory vaccination of HCWs, however.  A few earlier blogs on that include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, this is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

In recent years an increasing number of hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

 

The Immunization Action Coalition (IAC) maintains a terrific website with extensive information on vaccines, and includes a growing `Honor Roll’ of organizations and practices that have adopted a mandatory flu shot policy (some exemptions may apply).

 

As we saw last month in SHEA: Improving HCW Flu Vaccine Uptake, some facilities are offering employees an alternative to taking the vaccine. This from a recent edition of Infection Control and Hospital Epidemiology.

 

An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle

 

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

 

 

Increasingly, hospitals are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare. 

 

Of course, legal challenges still lie ahead.

 

But love the idea, or hate it, the momentum appears to be moving in the direction of mandatory influenza vaccinations for Health Care Workers.

»» Read More

SHEA: Improving HCW Flu Vaccine Uptake

 

 

# 5635

 

 

Hospital acquired infections are the bane of modern health care, with MRSA, C. Diff, garden variety staph, various pneumonias, and other infections estimated to cost tens of thousands of lives and add billions of dollars to healthcare costs each year. 

 

And while we tend to think of bacterial infections in this context most of the time, every year there are legitimate concerns over the spread of influenza in healthcare facilities as well.

 

These concerns have sparked repeated calls for mandatory yearly vaccination of HCWs (Health Care Workers) against the flu.

 

A few recent blogs on that contentious subject include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

 

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Given that hospitalized patients are often at increased risk of serious illness or death from influenza, reasonable measures that can reduce the spread of the virus – such as improved vaccination rates and better infection control measures - are vital areas that many healthcare facilities need to review and improve.

 

In recent years a few large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  (see here and here).

 

However, it is possible to achieve high vaccination rates without mandating vaccination, as the following article published in the current edition of Infection Control and Hospital Epidemiology points out.

 

An Alternate Approach To Improving Healthcare Worker Influenza Vaccination Rates

Lisa M. Esolen, Kimberly Kilheeney, Richard E. Merkle

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

 

 

Although full access to the article is available only to SHEA members (the first page is available to all), the Society for Healthcare Epidemiology in America has published a press release with the details.

 

Society for Healthcare Epidemiology of America

Health system achieves high flu vaccination rates by mandating masking

CHICAGO (June 15, 2011) – Geisinger Health System vaccinated more than 92% of all employees against influenza this season, with a modification of a mandatory program. On average, fewer than half of all healthcare workers receive flu vaccinations.

 

In an article published in July's Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, Dr. Lisa Esolen demonstrated the effectiveness of Geisinger's influenza vaccination that helped achieve high rates of vaccine compliance for two consecutive years. This past season, 2010-2011, Geisinger had vaccinated 95% of clinical employees and 92% of all employees by mid-December. Since hospitals continue to release vaccine until the end of March, final vaccination rates were not known at that the time of this publication.

 

"Influenza vaccination rates among hospital employees has received extensive attention in recent years," said Lisa Esolen, MD, Systems Director, Infection Control Geisinger Health System "Healthcare workers are critical to limiting the spread of influenza since they are exposed to numerous sick patients and can readily spread the infection from patient to patient."

 

To increase vaccination rates among staff, some hospitals have embraced a mandatory approach – get vaccinated or lose your job. However, Geisinger Health System chose a slightly different approach. The 14,000-employee system decided to allow staff members to opt out of receiving the flu vaccine for ethical or medical reasons, but required that those who did opt out would need to wear a facemask for the entire flu season, extending from November 1 to March 31. All vaccinated employees were known by a campaign sticker placed on their identification badge – no sticker meant the employee needed to wear a mask whenever they were within five or six feet of any other person throughout the entire day.

 

"We're proud of the success we had and the team building it inspired, encouraging each unit to act as a team to achieve full vaccination." said Dr. Esolen.

 

 

This idea is one I actually wrote about (and advocated) during the pandemic as being a reasonable compromise to mandatory vaccination (see Public Support For Mandatory HCW Vaccination).

 

Although some HCWs may consider wearing a mask as onerous, they should help reduce in-hospital influenza transmission, while being a considerably less draconian solution than mandating employees either accept the flu vaccine or risk losing their jobs.

 

It’s not a perfect solution (neither are vaccines, btw), but compromises rarely are. 

»» Read More

APIC Calls For Mandatory Flu Vaccination For HCWs

 

 

# 5282

 

 

APIC (the Association for Professionals in Infection Control and Epidemiology, Inc.) has joined the chorus of other professional infection control and medical organizations (including SHEA, IDSA, & AAP) who are calling for mandatory yearly flu vaccinations for healthcare workers (HCWs).

 

If this story sounds a bit like Deja Flu, you probably recall that in October of 2008 APIC released a similar statement (see APIC Seeking Mandatory Flu Shot For HCWs), but in that case provided for an informed `opt out clause’ if HCWs signed a declination form saying they understood the risks to patients.

 

The new statement eliminates that escape clause, recommending that that hospitals, nursing homes, and other facilities employing HCWs:

 

“require influenza immunization as a condition of employment unless there are compelling medical contraindications."

 

You can read the entire 4-page position paper, outlining their recommendations and rationale behind them, on the APIC home page.

 

APIC Position Paper:  Influenza Vaccination Should Be a Condition of Employment for Healthcare Personnel, Unless Medically Contraindicated

 

The paper also calls for those who are exempted for medical reasons to:

 

“. . .  be educated on the importance of careful adherence to all of the non-vaccine related HICPAC prevention strategies, including hand hygiene and cough etiquette.

Further, they may be  required to wear a surgical mask when contact with patients or susceptible employees is likely. “ 

 

Over the past year several other professional medical organizations have made similar calls for mandatory vaccinations.

 

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Similarly, a UK Department of Health report issued in June 2010 called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

 

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

There will almost certainly be legal challenges, and possibly labor disputes as well. I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Only a few large hospitals have thus far managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here

.

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

 

Over the past 5 years Virginia Mason MC has maintained a 98% vaccination rate, and has vigorously promoted the uptake of flu shots not only in the workplace, but the greater community as well.

 

An abstract from a study that appeared in the August 2010 Infection Control and Hospital Epidemiology journal concludes that a policy of mandatory HCW vaccination is feasible, sustainable, and effective.

 

DOI: 10.1086/656210

Mandatory Influenza Vaccination of Healthcare Workers: A 5‐Year Study

Robert M. Rakita, MD; Beverly A. Hagar, BSN, COHNS; Patricia Crome, MN; Joyce K. Lammert, MD, PhD

(EXCERPT)

Results.

In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.

 

Impressive results. 

 

And, when combined with increased calls from infection control organizations to adopt similar practices, likely to inspire other facilities to follow suit.

»» Read More

Mandatory HCW Vaccinations: The Survey Says . . .

 

 

# 4961

 

 

One of the most contentious subjects among Health Care Workers (HCWs) today is the growing move towards making annual seasonal influenza vaccinations a requirement for employment.

 

 

Over the past two years several infection control and medical professional organizations have come forth in support of the idea, including APIC, SHEA, IDSA, and most recently the AAP (American Academy of Pediatrics).  

 

A few of my recent blogs on the subject include:

 

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

Despite this recent push towards mandatory vaccination for HCWs, only a handful of large hospitals have managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Healthcare of St. Louis, Missouri  which I blogged about here.

 

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

Earlier this week CIDRAP reported on several Health Care Facilities in and around Chattanooga that are now requiring annual vaccinations.

 

More health facilities require flu immunization for staff

Two health systems and a hospital near Chattanooga, Tenn., are now requiring flu vaccination for healthcare workers, the Chattanooga Times Free Press reported today.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd in  CDC: Proposed Influenza Infection Control Guidance.

 

Similarly, a UK Department of Health report issued in June called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

Although viewed as an important patient safety, infection control, and liability issue by management, many HCWs see this as an infringement upon their rights to decide what they will have injected into their bodies.

 

I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

All of which brings us to today’s report on a survey of Infection Control professionals working in Health Care Facilities across the country on their views on requiring mandatory flu vaccinations for HCWs.

 

 

Infect Control Hosp Epidemiol 2010;31:1063–1065

© 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.

0899-823X/2010/3110-0012$15.00

DOI: 10.1086/656382

 

Results of a National Survey of Infectious Diseases Specialists regarding Influenza Vaccination Programs for Healthcare Workers

Philip M. Polgreen, MD, MPH; Edward Septimus, MD; Thomas R. Talbot, MD, MPH; Susan E. Beekmann, RN, MPH; Charles Helms, MD, PhD

 

A minority of infectious diseases consultants currently work in healthcare institutions requiring influenza vaccination for healthcare workers, and in approximately half of these institutions, the healthcare workers who refuse vaccination do not face substantial consequences for their refusal.

 

Although true mandatory policies are not common, a majority of infectious diseases consultants support such policies.

 

The IDSA sent a 14 question survey to 1326 members of their Emerging Infections Network in December of 2009, followed by a couple of email reminders. 

 

Roughly half of the members responded.

 

Among the respondents, 80% agreed or strongly agreed that HCWs should be required to get a yearly flu vaccination and that HCWs refusing vaccination should be required to sign a declination statement.

 

The survey showed that 74% agreed or strongly agreed that influenza vaccination rates should be reported publicly as a measure of patient safety.

 

Only 37% reported that their healthcare institutions currently required influenza vaccination of HCWs. Of the remaining 63% that did not require vaccination, roughly half (51%) stated they were considering implementing a mandatory vaccination policy.

 

Among those hospitals requiring vaccination, most (91%) allowed exceptions including medical contraindication [84%], religious beliefs [47%], and personal beliefs  [37%].

 

 

While mandatory, serious consequences for refusing vaccination were rarely reported.  The survey indicated that 54% of respondents reported no consequences while 22% were unsure that consequences existed. 

 

Only 3% required that unvaccinated HCWs wear masks during patient care; and 2% reported that job evaluations were affected. Termination or suspension was reported by only 9% of respondents.

 

 

The authors point out that this survey, from a scientific viewpoint, has some limitations; it was not a population-based survey and the response rate may have been higher among those whose facilities have instituted mandatory vaccination programs.

 

Still this gives us a pretty good sense of the mood among infection control physicians across the country, and the growing move towards `mandatory’ vaccination for health care workers.

 

Despite the early success of a few mandatory vaccination policies across the country, the ultimate goal of achieving near-universal vaccination of HCWs in America and reducing the burden of influenza in health care facilities remains elusive.

 

The  authors sum up the situation with this closing paragraph:

 

. . .  given that the meaning of “mandatory” appears to have different interpretations in different institutions, the success of mandatory influenza vaccination programs may depend largely on the enforcement mechanisms implemented and the consequences for HCWs refusing influenza vaccination.

 

 

Whether accidental or intentional, I was surprised (and delighted) to find that a link to the entire PDF comes up at the top of a Google search on the study’s title. [PDF] Results of a National Survey of Infectious Diseases Specialists ...

»» Read More