IDSA urges mandatory flu shots for health workers

Jul 16, 2010 (CIDRAP News) – The Infectious Diseases Society of America (IDSA) has formally asked federal health officials to recommend making influenza vaccination mandatory for healthcare workers (HCWs), saying this is probably the best way to protect patients from contracting flu in healthcare facilities.

The IDSA made the recommendation in a letter commenting on proposed revisions in the Centers for Disease Control and Prevention's (CDC's) guidance for controlling flu in healthcare settings.

In the revised guidance, released in June, the CDC stresses the importance of flu shots for HCWs but does not call for requiring them. The proposed guidance also relaxes the CDC's respiratory protection advice somewhat, saying that workers should wear a surgical mask during routine care of flu patients, rather than an N-95 respirator as recommended previously.

In a Jul 15 letter to CDC Director Thomas Frieden, IDSA President Richard Whitley, MD, said the proposed guidance doesn't go far enough on flu shots for HCWs. "We feel the CDC should provide a definitive recommendation for mandatory influenza vaccination of healthcare providers," he wrote.

"IDSA supports universal immunization of HCWs against seasonal influenza by health care institutions (inpatient and outpatient) through mandatory vaccination programs, as these programs are likely to be the most effective means to protect patients against the transmission of seasonal influenza by HCWs," Whitely stated.

Employees who can't be vaccinated because of medical contraindications or who decline for religious reasons should be required to wear masks or be reassigned to duties not involving direct patient care, he said.

His letter cites several reasons for the IDSA stand, including evidence that organizations that require vaccination have much higher immunization rates than those with voluntary programs and that immunizing staff members helps protect patients from flu.

Voluntary approaches, including education programs, declination policies, and easy access to flu shots have modestly improved immunization coverage in many healthcare systems but have not effected "acceptable levels of coverage," Whitley wrote. Most successful education programs bring coverage only to between 40% and 70%, he said.

He also said mandatory immunization policies have drawn support from other professional societies, including the American College of Physicians, the Association for Professionals in Infection Control and Epidemiology (APIC), and the Society for Healthcare Epidemiology of America (SHEA), as well as a number of healthcare systems and hospitals.

"Mandating such a policy emphasizes that this is a patient safety issue," Whitley concluded in his letter. "CDC should consider, at a minimum, a stronger statement in favor of mandatory influenza vaccination in the revised guidelines."

In the CDC's proposed guidance, flu vaccinations for HCWs top the list of recommendations. The guidance suggests several strategies for improving voluntary coverage, including requiring worker who refuse vaccination to sign a declination form showing they are aware of the risks.

Last year one of the largest unions in New York state sued the state over its requirement that HCWs get flu shots. In October the pandemic vaccine shortage prompted the state to suspend the requirement shortly before a scheduled court hearing in the lawsuit.

Apart from the immunization issue, the IDSA praised the CDC's proposed revised guidance. In particular, the letter welcomed the recommendation that HCWs wear face masks for routine care for confirmed or suspected flu patients but wear respirator devices during aerosol-generating procedures.

The IDSA, along with APIC and SHEA, had taken issue with the 2009 CDC guidance on use of N-95 respirators during all contact with flu patients. The groups had argued that the approach was uncomfortable for workers and impractical.

See also:

Jul 15 IDSA letter to the CDC
http://www.idsociety.org/WorkArea/DownloadAsset.aspx?id=16790

Jun 23 CIDRAP News story "CDC proposes new flu guidance for healthcare facilities"

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