Research doesn't support mandatory influenza vaccination / WMJ
Posted Dec 03 2012 10:03am
From the Mayo Clinic and Wisconsin Medical Journal comes the following letter from Preventive Medicine specialist William Buchta, M.D., MPH
While the intent of Aurora’s mandatory influenza vaccination1 of health care workers might be noble, ie, patient protection, the research on the subject is lacking. Only 2 studies have tracked hospital-acquired worker-to-patient influenza (a relatively simple infection control metric) and both reported cases in the single digits for an average-sized hospital over multiple complete flu seasons.2,3
In fact, the latter demonstrated that influenza made up only 23% of strains causing influenza-like illness (ILI), such that the rate for true worker-to-patient influenza infection for a 400-bed hospital is less than 1 case per year. Why? Influenza is a community-acquired disease, and standard infection control precautions (hand-washing, masking those with a cough, isolation, and visitor control) curb transmission in hospitals. Ironically, vaccination is possibly the least effective of these measures, and CDC data and at least 1 study cited below have demonstrated that over the recent past, influenza vaccine is between 40% and 63% effective, on average. Influenza is only one of a host of viruses that can sicken a hospitalized patient, but is the only one for which we have a vaccine. Yet the other control measures I mentioned are efficacious against ALL such organisms. Why don’t we make those measures mandatory?
Last year at Mayo Clinic Rochester, we instituted mandatory compliance with an influenza control program for all employees with patient contact: get vaccinated or sign an electronic declination that included education. With over 25,000 such employees, everyone complied, no one lost a job, and 93% chose vaccine vs declination. We emphasized personal, family, and patient protection, and it was perceived as a benefit. We also emphasized other control measures, such as handwashing and staying home when ill, to control the ILIs for which we have no vaccine. Call it "Minnesota nice," but it can be done. Influenza vaccination is important but not worth terminating employment or disgracing a worker by forcing him or her to wear a mask the entire flu season (an alternative control at other medical centers) when there is no evidence that it will prevent infections.
In due time, possibly the next 5 years, we will have a better influenza vaccine that targets common antigens on all strains of influenza and that may not require annual vaccination. Employees who choose not to be vaccinated are not lunatics; they have endured the long lines to be vaccinated, they have been turned away during rationing, they (or co-workers) have gotten influenza despite vaccination.
When we have a decent vaccine, like MMR or dT, we won't have to twist arms; everyone will get it. If we are going to regulate and scrutinize our dedicated health care workers any further, let's do it for the right reason. The American College of Occupational and Environmental Medicine’s guidance statement4 outlines a more balanced approach to this issue.
William G. Buchta, MD, MS, MPH Mayo Clinic Division of Preventive, Occupational, and Aerospace Medicine, Rochester, Minn
1. Smith DR, Van Cleave B. Influenza vaccination as a condition of employment for a large regional health care system. WMJ. 2012;111(2):68-71. 2. Salgado CD, Giannetta ET, Hayden FG, Farr BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Inf Control and Hosp Epid. 2006;25(11):923-928. 3. Vanhems P, Voirin N, Roche S, et al. Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004-2005, 2005-2006, and 2006-2007: a prospective study. Arch Intern Med. 2011;171(2):151-157. 4. American College of Occupational and Environmental Medicine. Seasonal Influenza Prevention in Health Care Workers. Guidance statement. November 17, 2008. http://www.acoem.org/ SeasonalInfluenzaPrevention_HealthCareWorkers. aspx. Accessed May 22, 2012.