by David Weber, M.D., M.P.H.
Each year approximately 10% to 20% of Americans develop viral influenza leading to thousands of deaths. The risk of severe illness and death is increased in persons who are very young, older, have comorbid conditions (e.g., obesity, diabetes, renal failure, cardiac disease), or are immunocompromised (e.g., HIV-infected, solid organ transplant, cancer). High coverage rates of influenza vaccine among healthcare personnel have been demonstrated to reduce the risk of acquisition of influenza by patients. For these reasons, the Centers for Disease Control and Prevention (CDC) and many professional organizations (e.g., SHEA, APIC) have recommended that all healthcare personnel, unless they have a medical contra-indication receive influenza vaccine. Furthermore, The Joint Commission (TJC) and CMS require that healthcare facilities track influenza vaccine coverage by healthcare personnel. Many interventions have been demonstrated to improve uptake of the vaccine including the following: providing vaccine at no cost to healthcare personnel, providing vaccine at convenient times and locations, strong support by senior administration, use of mobile carts, and rewards for taking vaccine. By using ALL these interventions healthcare facilities can often achieve immunization coverage of 70% to 80%. However, published papers have demonstrated that to exceed these levels, influenza immunization must be a condition of employment.
Each year approximately 10% to 20% of Americans develop viral influenza leading to thousands of deaths. The risk of severe illness and death is increased in persons who are very young, older, have comorbid conditions (e.g., obesity, diabetes, renal failure, cardiac disease), or are immunocompromised (e.g., HIV-infected, solid organ transplant, cancer). High coverage rates of influenza vaccine among healthcare personnel have been demonstrated to reduce the risk of acquisition of influenza by patients. For these reasons, the Centers for Disease Control and Prevention (CDC) and many professional organizations (e.g., SHEA, APIC) have recommended that all healthcare personnel, unless they have a medical contra-indication receive influenza vaccine. Furthermore, The Joint Commission (TJC) and CMS require that healthcare facilities track influenza vaccine coverage by healthcare personnel. Many interventions have been demonstrated to improve uptake of the vaccine including the following: providing vaccine at no cost to healthcare personnel, providing vaccine at convenient times and locations, strong support by senior administration, use of mobile carts, and rewards for taking vaccine. By using ALL these interventions healthcare facilities can often achieve immunization coverage of 70% to 80%. However, published papers have demonstrated that to exceed these levels, influenza immunization must be a condition of employment.
UNC
Health Care made receipt of influenza immunization a condition of employment
(or accreditation for professional staff) for the 2012-2013 influenza
season. We did accept religious
objections and medical contra-indications are valid reasons for not receiving
vaccine. Of 9,533 employees at UNC
Health Care, 9,529 were compliant with our policy (99.9%) and the other 4 were
terminated. Overall, 9,002 employees
(94.4%) were vaccinated, 116 (1.2%) had medical contra-indications, and 370
(3.88%) were granted a religious exemption; 1,048 employees provided
documentation of receipt of influenza vaccine by their own medical
provider. Our experience at UNC Health
Care demonstrates that receipt of influenza vaccine can successfully be made a
condition of employment. Influenza
vaccine protects our employees and our patients and healthcare facilities
should comply with CDC and TJC recommendations for use.
Also
of interest, at UNC Health Care we allow our healthcare personnel to choose
among inactivated influenza vaccine (IIV) which is given as an intra-muscular
injection (IM), attenuated inhaled influenza vaccine, and inactivated
intradermal influenza vaccine. Our
personnel made the following choices (numbers are an approximate): inactivated IM vaccine, 8600, attenuated
inhaled vaccine, 460, and inactivated intradermal vaccine, 580.
