Universal Influenza Vaccination Among Healthcare Personnel: Yes We Should

Abstract

At the start of this century, despite tremendous efforts to promote healthcare personnel (HCP) influenza vaccination by government agencies, professional societies, and visible vaccine champions, the HCP influenza vaccination rate remained unacceptably low (~45%). Subsequently, the perception of HCP influenza immunization evolved from an employee health benefit to an important measure of a healthcare facility’s quality and patient safety program, moving an increasing number of facilities to mandate influenza vaccination. The rationale for these policies centers upon several core concepts: (1) the role HCP play in healthcare-associated pathogen transmission, (2) the lack of clear symptoms of influenza in many HCP, and (3) the vulnerability of patients to complications from influenza. Since 2005, when Virginia Mason Medical Center required influenza immunization as a condition of employment [1], leading to vaccination rates of 98.9%, more institutions have implemented similar programs [2–7], including all Veteran’s Administration hospitals in 2017 [8]. Based on an annual survey of HCP conducted by the Centers for Disease Prevention and Control, the percentage of HCP working under an employer vaccination requirement increased from 20.9% during the 2011–2012 influenza season to 44.1% during the 2017–2018 season [9]. Mandatory programs do have some implementation differences, including mask use for unvaccinated HCP during the influenza season, allowed exemptions (eg, only medical vs allowance for personal belief exemption), and consequences for noncompliance. It is important to note that although a few HCP have had their employment terminated due to vaccine refusal, the actual reported number of HCP dismissed is very small compared with the thousands of HCP encompassed by these policies.