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October 2009
Vol. 19 No. 10
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IDSA Strengthens Mandatory Influenza Immunization Policy for HCWs

To better protect patients and health care workers (HCWs), IDSA recently strengthened its policy on mandatory immunization of HCWs. The strengthened statement applies to both seasonal influenza and 2009 H1N1 influenza. It further specifies that employees who cannot be vaccinated due to medical contraindications, because vaccine is in short supply, or who decline in writing for religious reasons, should be required to wear masks or be reassigned from direct patient care. The policy, which is directed at health care institutions, is available on IDSA’s website.

“We believe immunization is the most effective thing we as HCWs can do to protect our patients – and our ourselves – from influenza, including the 2009 novel H1N1 virus,” IDSA President Anne Gershon, MD, FIDSA said in an e-mail announcing the stronger policy earlier this month. “All of us and all of our colleagues who work in direct patient care should be immunized. We owe it to our patients.”

IDSA’s original policy was part of the Society’s 2007 report, Pandemic and Seasonal Influenza Principles for U.S. Action. The IDSA Board of Directors voted in September to strengthen the policy to address 2009 H1N1, remove the option of declining immunization for philosophical reasons, and specify the steps that should be taken to protect patients from unvaccinated HCWs, including requiring unvaccinated workers to wear masks.

Unvaccinated HCWs can spread influenza to patients, co-workers, and family members without exhibiting symptoms. Surgical masks have been shown to prevent the spread of infection by patients with confirmed cases of influenza, and it makes sense that masks should reduce the risk of unvaccinated HCWs spreading infection to patients or other workers.

The new IDSA policy cites several rationales for the Society’s expanded position, including:

  • Several studies demonstrate that immunizing HCWs against influenza reduces patient morbidity and mortality.
  • Immunizing HCWs against both seasonal and H1N1 influenza protects HCWs against falling ill from these infections as well as missing work, which could further hurt patient care during influenza outbreaks.
  • Decades of scientific data demonstrate that influenza vaccines are safe, effective, and reduce costs.
  • Several large health care systems and hospitals have adopted similar mandatory immunization policies.
  • Physicians and other health care providers have an ethical and moral obligation to prevent the transmission of infectious diseases to their patients.

Although IDSA supports educating HCWs about the benefits and risks of influenza vaccination, even the most successful educational programs still average only 40 to 70 percent coverage, well below acceptable levels.

The Society understands that health care institutions will not be able to fully implement mandatory immunization programs immediately, particularly before the H1N1 vaccine is broadly available, Dr. Gershon said. Last week, New York state officials suspended that state’s requirement that all health care workers be immunized against influenza, citing the currently limited supplies of H1N1 vaccine. Institutions “will need to balance multiple priorities in implementing such policies, taking into account vaccine supply and distribution, mask supplies, the use and content of declination forms, staffing needs, and other local situations, particularly in this challenging influenza season,” Dr. Gershon noted in her e-mail announcing IDSA’s strengthened policy.

IDSA offers many immunization resources on the 2009 H1N1 and seasonal influenza webpage, including links to vaccination information statements, question-and-answer documents explaining vaccine safety and other related issues, and vaccination guidance for state and local health officials. This page is updated regularly.
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