Seven Truths About Influenza Vaccination of Healthcare Workers
The time has come to require influenza vaccines for all healthcare workers (HCWs) -- as the following seven truths demonstrate.
On this page:
1. Influenza infection is a serious illness causing significant morbidity and mortality adversely affecting the public health on an annual basis.
2. Influenza-infected healthcare workers can transmit this deadly virus to vulnerable patients.
3. Influenza vaccination of healthcare workers saves money for employees and employers and prevents workplace disruption.
4. Influenza vaccination of healthcare workers is already recommended by CDC and is the standard of care.
5. Immunization requirements are effective and work in increasing vaccination rates.
6. Healthcare workers and healthcare systems have an ethical and moral duty to protect vulnerable patients from transmissible diseases.
7. The healthcare system will either lead or be lambasted.
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1. Influenza infection is a serious illness causing significant morbidity and mortality adversely affecting the public health on an annual basis.
- Influenza is the sixth leading cause of death among adults in the US, killing an average of 36,000 Americans annually.
- Influenza kills as many or more people than breast cancer (40,000) and three times as many as HIV/AIDS.
- One of 20 deaths in persons 65 or older is related to influenza.
- The direct annual cost of influenza infection is approximately $3 to 5 billion in the US.
2. Influenza-infected healthcare workers can transmit this deadly virus to vulnerable patients.
- You can transmit influenza virus whether youre symptomatic and asymptomatic.
- Simply staying home from work is insufficient for preventing nosocomial transmission.
- Multiple studies have shown that HCWs continue to work despite being ill with influenza!
- One study of a 1998 influenza A outbreak in a neonatal unit found:
- Nineteen of 54 patients tested positive for influenza A.
- Six were symptomatic, one died.
- Of the 150 medical staff, only 15% had received the flu vaccine (67% of physicians and 9% of nurses).
- Only 29% of staff with symptomatic influenza took time off work!
- Another example: A Scottish study in 2000 compared mortality rates between long-term care hospitals that offered influenza vaccination to HCWs (51% vaccinated) with those that did not (5% vaccinated). It found a 40% reduction in all-cause mortality among the patients cared for by HCWs in the hospitals with higher levels of HCW vaccination. (Carman WF et. al, Lancet 2000)
3. Influenza vaccination of healthcare workers saves money for employees and employers and prevents workplace disruption.
Healthy working adults who receive influenza vaccination have:
- 25% fewer upper respiratory infections
- 44% fewer doctor visits
- 43% fewer sick days off
This represents a saving of $47 per person annually. (Nichols KL et. al, N Engl J Med 1995)
Studies of three different cohorts of 25,000 adults followed over three years found:
- Pneumonia hospitalizations reduced by 48-57%
- Acute and chronic respiratory conditions reduced by 27-39%
- All-cause mortality reduced by 39-52%
- Direct savings per year averaging $117/person immunized
(Nichols KL et. al, N Engl J Med 1994)
Influenza disease has a substantial impact on acute care. To assess its impact on acute care hospitals, CDC surveyed 221 hospitals from December 2003 to February 2004 and found:
- 35% reported staffing shortages during flu peak
- 28% reported bed shortages
- 43% reported ICU bed shortages
- 9% reported diversion of patients to other facilities for a mean of 6 days
4. Influenza vaccination of healthcare workers is already recommended by CDC and is the standard of care.
Since 1981, CDC has recommended HCW vaccination as part of the ACIP recommendations for influenza vaccination.
What about contraindications to vaccination?
Even with a small percentage of individuals unable to be vaccinated, herd immunity will still protect unimmunized HCWs and their patients.
5. Immunization requirements are effective and work in increasing vaccination rates.
- Rubella and hepatitis requirements have been successful in achieving nearly universal HCW vaccination against these pathogens.
- Requirements for MMR vaccination and TB screening have resulted in improved patient safety.
- School entry requirements have resulted in childhood immunization rates often exceeding 90-95%.
- On the other hand, healthcare organizations have held voluntary programs to provide influenza vaccine to HCWs since the early 1980s -- and the response thus far has been dismal: Only 36% received flu vaccination in the US in 2002.
6. Healthcare workers and healthcare systems have an ethical and moral duty to protect vulnerable patients from transmissible diseases.
- Healthcare workers are vectors for influenza.
- The medical community has an ethical obligation to act with the safety of its patients as its foremost interest.
- OSHA and JCAHO support the idea of protecting HCWs and patients by vaccination.
- Influenza vaccination of HCWs protects patients from influenza and decreases mortality. Moreover, the influenza vaccine is safe. Knowing these facts and not acting upon them is a dereliction of the responsibilities of the medical community to the safety of the public with whose care they are entrusted.
7. The healthcare system will either lead or be lambasted.
Reports of nosocomial influenza outbreaks have begun to surface in the popular media. As the public becomes aware that HCWs are largely unvaccinated the healthcare system will lose credibility. The healthcare profession has the opportunity to demonstrate that we WILL do the right thing for our patients.
Influenza vaccination of HCWs is the right thing to do.
So, are YOU going to get vaccinated against influenza?
Do the right thing - Get vaccinated!
- Protect vulnerable patients
- Dont bring disease home to your family and community
- Improve patient safety
- Significantly decrease morbidity and mortality
Adapted from Dr. Greg Poland, Mayo Clinic.