Flu truth for health care: Lead or be lambasted

Flu truth for health care: Lead or be lambasted

Making the case for mandatory flu shots

The authors of a recently published provocative paper advocating mandatory influenza vaccinations for health care workers underscored "seven primary truths" to support the controversial recommendation.¹ The truths are summarized as follows:

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 United States, killing an average of 36,000 Americans annually. Influenza kills as many or more Americans each year than breast cancer (40,000), and three times as many as HIV/AIDS (14,000).
2. Influenza-infected health care workers can transmit this deadly virus to their vulnerable patients. Complications of nosocomial influenza are particularly burdensome on the elderly, the immunocompromised, critically ill patients, and young children — the very populations congregated in hospitals and medical clinics. Influenza infection in these populations can often result in severe, prolonged, devastating illness, death, increased length of stay, and added costs. The virus can be transmitted to patients and other employees by both symptomatic and asymptomatic health care workers —hence, simply "staying home from work" is an insufficient strategy for preventing nosocomial transmission. Worse yet, multiple studies have shown that health care workers continue to work despite being ill with influenza, increasing exposure of patients and co-workers.
3. Influenza vaccination of health care 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, and 43% fewer sick days off, saving an average of $47 per person annually.
4. Influenza vaccination of health care workers is already recommended by the Centers for Disease Control and Prevention and is the standard of care. This recommendation has been in place by the CDC since 1981. Since that time, hospitals, clinics, and health organizations have developed influenza immunization programs and have devoted resources to it. However, these programs are passive, voluntary systems that fail to recognize the current data and realities. The result is a failed and incomplete system reaching an average of only 36% of U.S. health employees annually.
5. Immunization requirements are effective and work in increasing vaccination rates. A requirement for vaccination is not unique to influenza. Childhood immunization rates vastly improved in the United States once mandatory school-entry immunization requirements were put into place. Similarly, health care worker requirements for measles, mumps, varicella vaccinations, and annual screening for tuberculosis, have worked and result in improved patient safety.
6. Health care workers and health care systems have an ethical and moral duty to protect vulnerable patients from transmissible diseases. It is now known that health care workers are vectors for the spread of influenza to vulnerable patients whom the disease would most jeopardize. It is also known that influenza vaccination of health care workers protects patients from influenza infection and decreases mortality. Finally, the vaccine is safe. Knowing these facts and not acting upon them with a comprehensive, effective, expeditious, and reasonable manner is a dereliction of the responsibilities of the medical community to the safety of the public whose care they are entrusted with.
7. The health care system will either lead or be lambasted. Reports of nosocomial influenza outbreaks have already started to surface in the popular media, making the headlines of major newspapers last influenza season. As these reports become widely disseminated and as the public becomes aware that health care workers are largely unvaccinated, the health care system will lose trust and credibility. Once this is the case, the ability of the medical community to make its own policy decisions may be diminished, with the duty instead falling to enforcement organizations and legislative policy-makers.

Reference

1. Poland GA, Tosha P, Jacobson RM. Requiring influenza vaccination for health care workers: Seven truths we must accept. Vaccine 2005; 23:2,251-2,255.