Mandatory Influenza Vaccination Policies Research Articles

Influenza Vaccination Programs for Healthcare Personnel: Organizational Issues and Beyond.

Healthcare personnel (HCP) are a high priority group for influenza vaccination aiming to protect them but also to protect vulnerable patients and healthcare services from healthcare-associated influenza and HCP absenteeism. Multi-component influenza vaccination programs targeting behavioral, organizational, and administrative barriers are critical, if influenza vaccination rates among HCP are to be raised on a sustained basis. Mandatory influenza vaccination policy is the only single intervention that can achieve high and sustainable vaccination rates in HCP in short term. In this article, we provide an overview of issues pertaining to influenza vaccination of HCP, with an emphasis on organizational issues of influenza vaccination programs.

Impact of mandatory vaccination of healthcare personnel on rates of influenza and other viral respiratory pathogens.

The implementation of mandatory influenza vaccination policies among healthcare personnel (HCP) is controversial. Thus, we examined the affect of mandatory influenza vaccination policies among HCP working in outpatient settings. Four Veterans' Affairs (VA) health systems and three non-VA medical centers. We analyzed rates of influenza and other viral causes of respiratory infections among HCP working in outpatient sites at 4 VA health systems without mandatory influenza vaccination policies and 3 non-VA health systems with mandatory influenza vaccination policies. Influenza vaccination was associated with a decreased risk of influenza (odds ratio, 0.17; 95% confidence interval [CI], 0.13-0.22) but an increased risk of other respiratory viral infections (incidence rate ratio, 1.26; 95% CI, 1.02-1.57). Our fitted regression models suggest that if influenza vaccination rates in clinics where vaccination was not mandated had equalled those where vaccine was mandated, HCP influenza infections would have been reduced by 52.1% (95% CI, 51.3%-53.0%). These observations, their possible causes, and additional strategies to reduce influenza and other viral respiratory illnesses among HCP working in ambulatory clinics warrant further investigation.

Medico-legal considerations of mandatory COVID-19 vaccination for high risk workers.

Medico-legal considerations of mandatory COVID-19 vaccination for high risk workers.

Sex-specific effects of age and body mass index on antibody responses to seasonal influenza vaccines in healthcare workers

Healthcare institutions with mandatory influenza vaccination policies have over 90% vaccination rates among healthcare workers (HCWs) resulting in a population that has received the influenza vaccine in many, consecutive years. This study explored the impact of sex and other host factors in pre- and post-vaccination neutralizing antibody (nAb) titers and seroconversion against the H1N1 and H3N2 influenza A viruses (IAVs) among HCWs enrolled into a cross-sectional serosurvey during the annual Johns Hopkins Hospital employee vaccination campaign in the 2017–18 and 2018–19 seasons. The study enrolled 111 participants (male = 38, female = 73) in 2017–18 and 163 (male = 44, female = 119) in 2018–19. Serum samples were collected immediately prior to vaccination and approximately 28 days later and nAb titers to vaccine strains determined. An intersectional approach was used to disaggregate the combined effects of sex with age and body mass index (BMI) in the nAb response. Differences between the pre- or post-vaccination geometric mean nAb titers between male and female HCWs were not observed. Male HCWs were 2.86 times more likely to seroconvert compared to female HCWs in 2017–2018, but the same trend was not observed in the following year. When data were disaggregated by age and sex, older female HCWs had higher H1N1 pre- and post-vaccination nAb titers compared to male HCWs in the same age group for both vaccination campaign seasons. In both years, the decline in H3N2 pre-vaccination titers with increasing BMI was greater in female than male HCW. The sex-specific effects of age and BMI on nAb responses to seasonal influenza vaccines require greater consideration.

Support among healthcare workers for the new mandatory seasonal influenza vaccination policy and its effects on vaccination coverage

Introduction Finland was the first European country to introduce a nation-wide mandatory seasonal influenza vaccination policy for healthcare workers (HCWs) by mandating that administrators of health care institutions only employ vaccinated HCWs. In this study, we examine the effects of the new policy and the view of HCWs on the new policy. Methods A cross-sectional observational study was conducted in Kuopio University Hospital among HCWs working in close patient contact. The statistics on vaccination coverage were obtained from the hospital’s own databases, where employees were asked to self-report their suitability for work. An anonymous survey was sent to HCWs in 2015–2016 (n = 987) and 2018–2019 (n = 821). Results Vaccination coverage increased from 59.5 to 99.6%, according to the hospital’s own records. Among the survey respondents, the seasonal influenza vaccination coverage of HCWs increased from 68.2 to 95.4%. 83.8% of doctors and 49.4% of nurses supported the new policy. 12.7% of doctors and 41.5% of nurses found the new mandate coercive or that it restricted their self-determination. Conclusions Our study confirms the positive effects of mandating the administrators of health care institutions to only employ vaccinated HCWs. The majority (57.9%) of all HCWs supported the new policy, with doctors being more compliant than nurses. Key messages Finland became the first European country to mandate influenza vaccination for HCWs by mandating that administrators of health care institutions only employ vaccinated HCWs. After the new act, the vaccination coverage of HCWs increased close to 100%. Most of the HCWs supported the new act and did not find it coercive.

Mandatory Influenza vaccination policy implementation in a rural US community hospital

Mandatory Influenza vaccination policy implementation in a rural US community hospital

Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review.

Uptake of influenza vaccination reduces staff absenteeism as well as mortality of patients and healthcare workers (HCWs); however, adherence of HCWs to annual influenza vaccination is poor and some healthcare facilities are now considering mandatory influenza vaccination policies. The purpose of this study was to identify the perceived and reported barriers to the implementation of a mandatory influenza vaccination policy for HCWs. An integrative review of the literature was conducted. Databases including CINAHL, Cochrane Library, Medline and PubMed were searched using key terms. The quality of papers was assessed utilising the Standard Quality Assessment Criteria for Evaluating Primary Research papers for a Variety of Fields which consisted of 10 questions with a possible total score of 20. PRISMA guidelines were used to report the search outcomes. A total of 68 papers were identified from the database search. Seven papers were relevant, following screening. The quality scores of these were in the range of 15-20. A number of barriers are reported to prevent the effective implementation of mandatory influenza vaccination policies including ethical and legal considerations, logistics, healthcare burden, leadership and management, and human factors such as HCWs' perspectives. By comprehensively identifying these, barriers can be addressed to allow effective implementation of such policies in healthcare facilities to ensure improved outcomes. The results of the review indicated the need for further research to ensure that barriers are addressed cohesively.

Implementation of a Mandatory Influenza Vaccine Policy: A 10-Year Experience.

Influenza vaccination of healthcare workers (HCWs) has been recommended for more than 30 years. In 2009, HCWs were designated as a priority group by the Centers for Disease Control and Prevention. Current HCW vaccination rates are 78% across all settings and reach approximately 92% among those employed in hospital settings. Over the last decade, it has become clear that mandatory vaccine policies result in maximal rates of HCW immunization. In this observational 10-year study, we describe the implementation of a mandatory influenza vaccination policy in a dedicated quaternary pediatric hospital setting by a multidisciplinary team. We analyzed 10 years of available data from deidentified occupational health records from 2009-2010 through the 2018-2019 influenza seasons. Descriptive statistics were performed using Stata v15 and Excel. Sustained increases in HCW immunization rates above 99% were observed in the 10 years postimplementation, in addition to a reduction in exemption requests and healthcare-associated influenza. In the year of implementation, 145 (1.6%) HCWs were placed on temporary suspension for failure to receive the vaccine without documentation of an exemption, with 9 (0.06%) subsequently being terminated. Since then, between 0 and 3 HCWs are terminated yearly for failure to receive the vaccine. Implementation of our mandatory influenza vaccination program succeeded in successfully increasing the proportion of immunized HCWs at a quaternary care children's hospital, reducing annual exemption requests with a small number of terminations secondary to vaccine refusal. Temporal trends suggest a positive impact on the safety of our patients.

To Be or Not to Be Vaccinated? The Ethical Aspects of Influenza Vaccination among Healthcare Workers.

Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. Sometimes there is a significant sign of improvement, only if numerous measures are taken. Is ‘the evidence’ and ‘rationale’ sufficient enough to support mandatory influenza vaccination policies? Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates? Whether (semi)mandatory policies are justified is an ethical issue. By means of a MEDLINE search, we synthesized the most relevant publications to try to answer these questions. Neither the ‘clinical’ Hippocratic ethics (the Georgetown Mantra: autonomy, beneficence, non-maleficence, and justice), nor the ‘public health’ ethics frameworks resolve the question completely. Therefore, recently the ‘components of justice’ framework was added to the ethical debate. Most options to increase the uptake arouse little ethical controversy, except mandatory policies. The success of vaccination will largely depend upon the way the ethical challenges like professional duty and ethics (deontology), self-determination, vaccine hesitance, and refusal (‘conscientious objector’) are dealt with.

Maximizing influenza vaccination uptake among healthcare personnel in Israel: lessons learned from mandatory vaccination policy in the United States

BackgroundMaximizing vaccination uptake is crucial in generating herd immunity and preventing infection incidence (Quach et al., Am J Infect Control 11:1017–23, 2013). Vaccination of healthcare personnel (HCP) against influenza is vital to influenza infection control in healthcare settings, given the consistent exposure of HCP to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, Curr Opin Infect Dis 24: 363–369, 2011). Influenza vaccination uptake among HCP remains suboptimal: in 2017–18, 47.6% of HCP who worked in settings where influenza vaccination was not mandatory were vaccinated against influenza in United States (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (94.8% vs. 47.6%) (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018).GoalsThe Israel Journal of Health Policy Research has published articles focused on the issues of influenza vaccination (Yamin et al., Isr J Health Policy Res 3: 13, 2014), improving influenza vaccination coverage of HCP (Weber et al., Isr J Health Policy Res 5: 1–5, 2016), influenza vaccination motivators among HCP (Nutman and Yoeli, Isr J Health Policy Res 5: 52, 2016), legal imposition of vaccination (Kamin-Friedman, Isr J Health Policy Res 6:58, 2017), and mandatory vaccination (Gostin, Cell Biosci 8: 1-4, 2018). Each article explores factors influencing disease prevention from different angles within an Israeli context. This article attempts to fuse these topics by investigating how to apply aspects of American mandatory influenza vaccination policy targeted at HCP in an Israeli context.MethodsCritical document analysis was conducted on relevant literature and policy discussing influenza prevention interventions among HCP within the United States. Mandatory vaccination policies were highlighted. A discussion of the professional responsibility of HCP to vaccinate against influenza serves as background. Case studies of hospitals in the United States that implemented mandatory vaccination policies for their employees are analyzed. The article concludes with analysis exploring how qualities of mandatory influenza vaccination policy of HCP could take shape in Israel, giving contextual limitations, urging Israeli health policy makers to reflect on lessons learned from the American case study.Main findings and conclusionMandatory HCP influenza vaccination policies in comparison to non-mandatory interventions are most effective in obtaining maximum influenza vaccination uptake among HCP (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns. The ethical responsibility of HCP to their patients and work environments to prevent and lower influenza infection incidence arguably overrules such individual objections. Mandatory HCP influenza vaccination policies are an effective method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settings. Still, cultural, social and political sensitivity must be taken into consideration when implementing both full-on mandatory HCP influenza vaccination policies and/or aspects of mandatory policies, especially within an Israeli context.

Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons.

OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.

Mandatory influenza vaccination for all healthcare personnel: a review on justification, implementation and effectiveness.

As healthcare-associated influenza is a serious public health concern, this review examines legal and ethical arguments supporting mandatory influenza vaccination policies for healthcare personnel, implementation issues and evidence of effectiveness. Spread of influenza from healthcare personnel to patients can result in severe harm or death. Although most healthcare personnel believe that they should be vaccinated against seasonal influenza, the Centers for Disease Control and Prevention (CDC) report that only 79% of personnel were vaccinated during the 2015-2016 season. Vaccination rates were as low as 44.9% in institutions that did not promote or offer the vaccine, compared with rates of more than 90% in institutions with mandatory vaccination policies. Policies that mandate influenza vaccination for healthcare personnel have legal and ethical justifications. Implementing such policies require multipronged approaches that include education efforts, easy access to vaccines, vaccine promotion, leadership support and consistent communication emphasizing patient safety. Mandatory influenza vaccination for healthcare personnel is a necessary step in protecting patients. Patients who interact with healthcare personnel are often at an elevated risk of complications from influenza. Vaccination is the best available strategy for protecting against influenza and evidence shows that institutional policies and state laws can effectively increase healthcare personnel vaccination rates, decreasing the risk of transmission in healthcare settings. There are legal and ethical precedents for institutional mandatory influenza policies and state laws, although successful implementation requires addressing both administrative and attitudinal barriers.

Knowledge, attitudes and practices of Australian medical students towards influenza vaccination

BackgroundAnnual influenza vaccination is recommended but not compulsory for healthcare workers in Australia, including medical students. A quarter of healthcare workers are estimated to have an influenza infection in any given year, with a subsequent transmission risk to colleagues and patients. During clinical placements, medical students are also at risk of influenza. While compliance with other vaccination requirements are high, influenza vaccine uptake of healthcare workers and medical students remain low globally. We aimed to explore medical students’ influenza vaccination rates, attitudes, knowledge and intended practices at a large Australian university. MethodA 35 item self-administered online survey was distributed to medical students enrolled at a large Australian university (UNSW Australia) in April/May 2014. The survey examined the knowledge, attitudes and practices of medical students towards influenza vaccination and identified factors associated with vaccine uptake. ResultsOf the 606 students, 53.8% (95%CI 49.8–57.8%) receiving their most recent influenza vaccine in 2014. Self-protection was the most common motivator (83%) and inconvenience (64%) the most common barrier to vaccination, despite access to on campus clinics. Students generally held positive attitudes to the influenza vaccine and vaccination recommendations, though some misconceptions existed. The majority (61%) were in support of mandatory influenza vaccination policies for medical students. Significant predictors of influenza vaccination included living on campus, clinical experience, awareness of vaccination recommendations and agreeing that vaccination was important for medical students, while those with perceived time constraints were less likely to be vaccinated. ConclusionMisconceptions and access to influenza vaccine were barriers to uptake of influenza vaccine by medical students. Medical programs need to emphasise the benefits of influenza vaccination in the protection of healthcare workers and patient safety across the medical education program. Our results suggesting majority support for mandatory influenza vaccination may represent a shifting perspective in the medical community.

Electronic solutions to enhance tracking and compliance with mandatory influenza vaccination for all hospital staff.

In implementing a hospital mandatory influenza vaccination policy, we developed an automated, real-time tracking and reminder system. Of 6,957 policy-covered individuals automatically identified, automated reminders left only 5 requiring counseling. This decreased Occupational Health workload in contacting noncompliant individuals and hosting vaccination events while simultaneously facilitating a 96% vaccination rate.

Mandatory influenza vaccination of healthcare workers: is it necessary or sufficient to protect patients?

Abstract In response to recent calls for mandatory influenza vaccination policies, we argue that these policies are neither necessary nor sufficient to protect patients from healthcare-associated respiratory viral infection.

Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: A survey to assess employee perception

The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009–2010 influenza season during the highly publicized pandemic of the H1N1 “Swine Flu.” Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach.

Health care workers, mandatory influenza vaccination policies and the law.

Over the last few years, there has been increasing discussion about the importance of influenza vaccination for health care workers. There is consensus that all health care workers should receive the influenza vaccine annually,[1][1]–[4][2] but the actual vaccination rates in this group remain

Sustained Effectiveness of a Mandatory Employee Influenza Vaccination Policy at a Cancer Center

Objectives: Despite the well-known advantages associated with immunization, it has proven difficult to achieve high levels of influenza vaccination among Health Care Professionals (HCPs). This report describes results of an influenza vaccination program implemented within a comprehensive cancer center. Methods: Using records from calendar years 2005-2013, we completed a retrospective analysis of annual influenza vaccination rates at this center. A mandatory influenza vaccination policy was implemented in 2010, while prior to that vaccination was encouraged but not required. Vaccinations are free to employees and distributed at various locations. Annual influenza vaccination rates were examined by calendar year and by occupational group (medical, nursing, administrative, scientific, other support staff). Results: High levels of adherence with the mandatory influenza policy were observed for all employee groups. Prior to influenza vaccine mandates flu vaccination rates ranged from ~30% - 40% and increased to 85% - 89% with the mandate. Conclusions: Robust influenza vaccination rates have been sustained since implementation of a vaccination mandate supporting further expansion of policies requiring influenza vaccination for HCPs.

US School Morbidity and Mortality, Mandatory Vaccination, Institution Closure, and Interventions Implemented During the 2009 Influenza A H1N1 Pandemic

The 2009 H1N1 pandemic disproportionately affected school-aged children, but only school-based outbreak case studies have been conducted. The purposes of this study were to evaluate US academic institutions' experiences during the 2009 H1N1 pandemic in terms of infection prevention interventions implemented and to examine factors associated with school closure during the pandemic. An online survey was sent to school nurses in May through July 2011. Hierarchical logistic regressions were used to determine predictive models for having a mandatory H1N1 vaccination policy for school nurses and school closure. In all, 1,997 nurses from 26 states participated. Very few nurses (3.3%, n=65) reported having a mandatory H1N1 influenza vaccination policy; nurses were more likely than all other school employees (p<.001) to be mandated to receive vaccine. Determinants of having a mandatory H1N1 vaccination policy were being employed by a hospital or public health agency, and the school being located in a western or northeastern state. Factors related to school closure included being in a western or northeastern state, having higher H1N1-related morbidity/mortality, being a school nurse employed by a public health agency or hospital, and being a private school. The most commonly implemented interventions included encouraging staff and students to exercise hand hygiene and increasing classroom cleaning; least commonly implemented interventions included discouraging face-to-face meetings, training staff on H1N1 influenza and/or respiratory hygiene, and discouraging handshaking. Schools should develop and continue to improve their pandemic plans, including collaborating with community response agencies.

Seasonal Influenza and Tdap Vaccination Policies in Michigan Hospitals Progress Yet Substantial Capacity to Improve

We determined the prevalence of mandatory influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination policies for staff in Michigan hospitals and factors affecting policy implementation. Forty-one percent of responders reported a mandatory influenza vaccination policy, and 11% reported a mandatory Tdap vaccination policy. The support of hospital leadership is critical to policy implementation and overcoming barriers.