August 31, 2010 — Healthcare professionals should be required to get vaccinated against seasonal influenza or else lose their jobs and professional privileges, the Society for Healthcare Epidemiology of America (SHEA) says in a position paper released today.
The paper, endorsed by the Infectious Diseases Society of America,
argues that allowing healthcare workers to go unvaccinated except for
recognized medical contraindications is just as unacceptable as
allowing physicians and nurses to forgo scrubbing before a surgical
"SHEA views influenza vaccination of HCP [healthcare personnel] as a
core patient and HCP safety practice with which non-compliance should
not be tolerated," according to the position paper, published in this
month's Infection Control and Healthcare Epidemiology. "SHEA
endorses a policy in which annual influenza vaccination is a condition
of both initial and continued HCP employment and/or professional
The goal of HCP vaccination is not only preventing virus transmission
to patients, but also reducing the risk for infection of HCPs, which
in turn preserves an adequate healthcare workforce, the position paper
notes. At the same time, HCPs who get vaccinated contribute to "herd
immunity" and set a good example.
The position paper, which updates a SHEA statement issued in 2005,
recommends mandatory vaccination of all HCP working in all healthcare
settings, regardless of whether they come into contact with patients and
whether they are directly employed by the facility. The
recommendation extends to students, volunteers, and contract workers.
Mandated Vaccination Has Met Resistance
The recommendations from SHEA come on the verge of the 2010-2011
influenza season and follow a previous season in which seasonal
influenza vaccination among HCP reached an all-time high
of 62% as of mid-January 2010, according to the US Centers for
Disease Control and Prevention. Physicians, physician' assistants,
nurse practitioners, and dentists posted the highest immunization rate
as a group among HCP — 77%. In contrast, the immunization rate among
all HCP against the H1N1 influenza virus stood at 37%.
SHEA believes a voluntary approach will not dramatically increase HCP
immunization rates. Its position paper points to several healthcare
organizations such as Virginia Mason Medical Center (VMMC) in Seattle,
Washington, and BJC Healthcare in St. Louis, Missouri, that have
achieved immunizations rates surpassing 98% by mandating vaccination
The success of institutions like VMMC and BJC notwithstanding, some HCP have not taken kindly to vaccine mandates.
During the H1N1 influenza pandemic of 2009-2010, for example, the
state of New York ordered its healthcare workers to get vaccinated
against both seasonal and pandemic influenza only to rescind the requirement
several months later. At the time, New York Gov. David Patterson said
the mandate turned out to be impractical in light of a shortage of
pandemic influenza vaccine, but the state also had encountered several
lawsuits and opposition from a large healthcare union.
Noting the possibility of continued resistance by labor unions to
vaccine mandates, the SHEA position paper states that requiring HCPs
to get immunized is just as reasonable as requiring them to wear
appropriate attire in the operating room or to care for patients
"regardless of underlying disease, even when they have disease that
might place the HCP at some risk."
"One hopes that, in the interests of protecting both patients and
their members, these organizations will not oppose mandatory programs
that are developed in collaboration with employees," the position paper
One author reports that he is a consultant
for Joint Commission Resources. He and some other authors report
various financial relationships with Avianax, BD Diagnostics, Care
Fusions, CSL, Cubist, EMD Serono, Emergent BioSolutions,
GlaxoSmithKline, Human Genome Sciences, Liquidia Technologies,
MedImmune, Merck, Novartis Vaccines and Therapeutics, Novavax,
OrthoMcNeil, PaxVax, Pfizer, Rymed Technology, Sage, Sanofi Pasteur,
Theraclone Sciences (formally Spaltudaq Corporation), Vaxxinate, and/or
Wyeth. All other authors have disclosed no relevant financial
Infect Control Hosp Epidemiol. Published online August 31, 2010.
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