Flu Vaccines for Hospital Workers: Should They Be Required?
Off to its latest start in 29 years, according to Joseph Breese, MD, chief of the Epidemiology Prevention Branch at the Centers for Disease Control and Prevention (CDC), the flu season has finally begun. November vaccination rates for 2011 were higher than for the year before, so that may be one reason for the milder season so far, says Dr. Breese. But the late start doesn’t indicate how severe the flu season will be, so the CDC is still recommending that anyone six months or older who hasn’t had a flu shot, make sure they get one. The American Lung Association’s Vaccine Finder still shows supplies throughout the country, but it's helpful to call clinics first to make sure they have vaccine on hand.
But should that flu shot recommendation be a little more forceful for some groups in order to protect patients, some of whom may be vulnerable to severe flu-related health outcomes because of weakened immune systems? An increasing number of hospitals around the country now require workers to get a flu shot. Professional associations including the American Academy of Pediatrics and the American College of Physicians recommend that hospital workers get flu shots. The National Business Group on Health, which advises large employers on health benefits and policies, issued a “strong recommendation” last month urging hospitals and health care facilities to require flu vaccines for all of their employees.
“Transmission of seasonal influenza between health care workers and patients is a significant patient and worker safety issue,” says Helen Darling, president and CEO of the Business Group. “Failure to prevent the transmission of seasonal flu between health care workers and patients also increases health costs.”
The Business Group’s statement adds that employees who opt out for medical or religious exemptions should not have direct patient care if they have flu symptoms, and they should be reassigned to non-patient care or be required to wear masks during flu season when caring for patients, a position taken by many hospitals and by associations that are urging workers to get the flu shot.
According to the CDC, only 63.5 percent of health care workers reported that they got flu shots during the last flu season. And according to the Business Group, other studies found that one in four health care workers shows evidence of having the flu each year and that 70 percent of health care personnel continue to work despite having flu-like symptoms.
While there is strong evidence for the health benefits, work is underway to examine the legal basis for requiring health workers to be vaccinated against the flu. That very topic was the subject of a presentation at last month’s annual meeting of the Public Health Law Research Program, a program of the Robert Wood Johnson Foundation.
Patricia Sweeney, JD, MPH, RN, Associate Director for Law and Policy at the University of Pittsburgh Center for Public Health Practice, says she hasn’t yet seen a state requirement that workers must have the shot, but has seen state regulations that require that shots be provided for workers and residents at long-term care facilities. Together with Richard Zimmerman, MD, a professor of family medicine at the University of Pittsburgh School of Medicine, Sweeney has received funding from the Public Health Law Research Program to look at the text of state laws and policies and is coding their content in order to analyze which components are associated with higher rates of health care worker immunization rates. The goal is to let policymakers know which components of policies might be likely to get the highest rate of immunized workers. “It will provide the evidence base for which policy works best,” says Sweeney.
Dr. Zimmerman says that courts have generally been sympathetic to hospital efforts to protect patients from flu transmission by workers. “Court systems are recognizing that in contrast to a construction worker, say, a free vaccine offered to protect patients is not an unreasonable position. While [the courts] want to protect the rights of workers, they also want to protect the rights of patients.”
Weigh In: Should flu shots for health workers be required?