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Department: Ask an Expert

Mandatory flu vaccination

Lockhart, Lisa MHA, MSN, RN, NE-BC

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doi: 10.1097/01.NME.0000613636.82702.dd
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Q: What's the evidence for mandatory flu shots for healthcare workers?

A: The CDC strongly recommends the adoption of mandatory vaccination policies for healthcare workers. This includes all staff members in a healthcare setting with potential exposure to infectious material and/or patients. The purpose of the recommendation is to protect healthcare workers and those exposed to preventable infectious diseases. Currently, the CDC recommends that healthcare workers receive the hepatitis B; influenza; measles, mumps, and rubella; varicella; tetanus, diphtheria, and pertussis; and meningococcal vaccines. Although some states don't make these vaccinations mandatory, the benefit is so strongly supported that some hospitals and healthcare organizations choose to adopt a mandatory guideline. Many states do have laws requiring mandatory vaccinations for specific populations and this has become a point of discussion for some members of the healthcare community.

The main arguments that promote mandatory flu vaccination for healthcare workers are based largely on patient safety and the risk of staff exposure. However, there are healthcare workers who are opposed to mandatory vaccinations; they argue that universal precautions and proper handwashing should be sufficient, mask usage and isolation for known or suspected patient cases are easily accomplished, and the vaccines may have adverse reactions and varying degrees of efficacy. Some point to mandatory vaccinations as a civil rights issue around freedom of choice. It should be noted that rarely does an organization choose to terminate an employee who declines vaccination; options are typically available for employees choosing not to vaccinate such as signing a declination form and agreeing to wear a mask. Other options may include an alternative work assignment.

The American Nurses Association (ANA) has also weighed in on the topic by recommending vaccinations for nurses, including the flu vaccine every fall. The ANA, along with the CDC, indicates that community support and confidence are the keys to successful vaccination compliance. Yet the debate continues. Vaccinate or not? State regulations or federal regulations? Do the risks outweigh the benefits?

What we do know about the flu is that it's spread primarily by exposure to droplets from flu-positive individuals via coughing, sneezing, or talking. Once airborne, these droplets deposit in the air passages of people who are up to 6 feet away. Healthy adults can be contagious starting the day before symptoms appear and for 5 to 7 days after. Children may pass the virus for longer. Some people can be infected with the flu virus but have no symptoms; during this time, these individuals may still spread the virus to others.

During the 2018 to 2019 flu season in the US, there were 37.4 to 42.9 million flu illnesses, 17.3 to 20.1 million healthcare provider visits and 531,000 to 647,000 hospitalizations related to the flu, and 36,400 to 61,200 flu-related deaths, according to the CDC. Virulence, exposure rates, and reported complications are compelling data. As a healthcare professional, why place yourself, your loved ones, your coworkers, and your patients at risk?

REFERENCES

American Nurses Association. Vaccines. http://www.nursingworld.org/practice-policy/work-environment/health-safety/immunize/vaccines.
    Centers for Disease Control and Prevention. 2018-2019 US flu season: preliminary burden estimates. 2019. http://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm.
      Centers for Disease Control and Prevention. What vaccinations are recommended for you. http://www.cdc.gov/vaccines/adults/rec-vac.
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