THE low rate of seasonal influenza vaccination coverage among Australian health care workers has prompted a call to consider making vaccinations mandatory.

In the latest issue of the MJA, researchers analysed 10 studies conducted between 1997 and 2008, which found that overall vaccination rates of health care workers in hospitals varied between 16.3% and 58.7%. (1)

The study found that providing free vaccines to health care workers did not seem to affect vaccination rates.

There is no uniform policy for Australian hospitals in terms of providing seasonal influenza vaccines free of charge to health care workers, with each hospital or jurisdiction making its own policy decision.

However, two of the three studies which showed uptake rates greater than 50% were associated with active implementation policies or interventions.

The study showed uptake rates ranged from 29% to 58.3% for physicians; 19% to 56.4% for nurses; 23% to 57.7% for allied health professionals and 18% to 66.7% for ancillary or support staff.

Education and promotion of the benefits of the seasonal influenza vaccine was not working and perhaps it was time for state or institutional policies or mandates to increase uptake, lead author Dr Holly Seale, a research fellow at the University of NSW School of Public Health, told MJA InSight.

“This study shows that at the moment we’ve got such low uptake of the vaccine in some settings that it is time to look beyond the use of education and [promotion]. We just can’t get above these 30%–40% levels so we need to go to the next step of discussing mandatory vaccination”, she said.

Dr Seale said that there was a move towards mandatory flu vaccination in the US. Ten hospitals in Boston recently pledged to adopt policies to mandate seasonal flu vaccinations as a condition of employment. (2)

Most studies which looked at the attitudes of health care workers found that staff had similar misconceptions about the vaccine as the general public, such as questioning its potential side effects, Dr Seale said.

“They have concerns and they’re uncertain about the effectiveness of the vaccine”, she said, adding that research had shown that many health care workers believed that the vaccine could actually cause the flu.

The researchers also said that access issues may be creating a barrier to flu vaccination uptake, citing anecdotal evidence that clinics in hospitals were often only open during limited time periods and had long waiting periods.

One survey from a Victorian hospital that was included in the study found that, when asked what might facilitate and encourage them to receive the vaccination, almost half the doctors who responded said the vaccination service itself needed to be more convenient. (3)

The other most common reasons cited by doctors for not being immunised were being too busy and not being aware how to access the vaccine. The authors of the report said immunisation rates among doctors were inadequate.

– Linda McSweeney

1. MJA 2011; 195: 336-338
2. The Boston Globe, 14 September 2011

3. Commun Dis Intell 2008; 32: 443-448

Posted 19 September 2011

12 thoughts on “Mandatory flu vax for health workers?

  1. Horst Herb says:

    As a clinician, I am not that much interested in the absolute vaccination rates per se, but in the end result: is there any evidence that influenza-unvaccinated health care workers take more sick leave, or pose a greater health risk to their co-workers and/or patients than the vaccinated ones?
    It seems common sense that it is so, which is why I get vaccinated and vaccinate my family as well. However, I have a suspicion that the constant contact with infectious diseases throughout the year in a typical “coalface clinician” might already yield a similar degree of protection as the vaccine. After all, neither my colleagues in the area nor I appear to succumb to the seasonal viral infections that run through our community and affect a large percentage of the locals every year.
    Those not getting vaccinated already will not be convinced by merely stating the obvious or – worse – by antagonising them through compulsion. Hence I would welcome a proper study publishing the effects (if any) of non-vaccination among health care workers.

  2. Anonymous says:

    What? Compulsory vaccination?

    What happened to civil liberty? What happened to human rights?

  3. dr john says:

    I agree with all being immunised even if it requires mandating. The issue I have is that those of us at significant risk of contracting infections including serious infections [daily contact with infected and potentially infected patients] such as pneumococcus and meningococcus are not offered immunisation against these infections despite it is arguably an OH&S issue.
    Immunisation against these infections should be offered alonside the existing immunisations offered [hepatitis A&B, tetanus, pertussis, etc]

  4. Dr Sally says:

    I would like to see more vaccinations offered to health workers in hospitals. I work in an ED and have seen several cases of pertussis this year. Not only did my hospital not offer staff vaccination, the pharmacy actually refused to fill my script for the vaccine (which a colleague wrote out for me) because I was a hospital employee and not a patient. When I went to my local pharmacy they only had ADT and not Boostrix and suggested I go back to the hospital… IT SHOULD NOT BE THIS HARD for health care workers to get vaccinated!

  5. anonymous says:

    If there is evidence that flu vaccination is effective, compulsory vaccination would have been instituited long ago. The problem is the people pushing the issue has a different agenda (monetary, self glorification and so on).
    I believe vaccination should be voluntary. The current evidence say the effectiveness of the vaccine on laboratory confirmed virus is only 86% and non laboratory confirmed virus (new strains) is only 10%.
    A randomised, double-blind, placebo-controlled trial among 4561 healthy working adults aged 18-64 years assessed multiple endpoints, including reductions in self-reported respiratory tract illness without laboratory confirmation, absenteeism, healthcare visits, and medication use during peak and total influenza outbreak periods (Nichol et al., JAMA 1999; 282:137-44). The study was conducted during the 1997-98 influenza season, when the vaccine and circulating A (H3N2) strains were not well-matched. Vaccination was associated with reductions in severe febrile illnesses of 19%, and febrile upper respiratory tract illnesses of 24%.
    The weak efficacy and effectiveness does not mandate compulsory vaccination.

  6. anon says:

    As it is almost half the work force is not immunised. with mandatory vaccination, what happens if they still do not oblige. What are the repercussions on the hospital services.

  7. Dr Joe says:

    And here is the real question-what difference will compulsory vaccination make? Answer-none.It will increase profits for manufacturers and make those in public health smug from another “achievement” whereby their empires are enhanced.

  8. Anonymous says:

    How many non-vaccinated staff have been proven to have contracted those strains in the vaccines offered? Do Infection Control Units actually keep accurate data on useful data like that? Do they keep record of how many staff have adverse reactions or flu-like illness after vaccination? There is no need to blanket immunise everyone when you have a healthy functioning immune system. Shouldn’t health professionals make their own choice about their own health care?

  9. Sue Ieraci says:

    Interesting to see some of the classic arguments from the anti-vaccination movement come up from “anonymous” and “Dr Joe”. No, vaccines are not big value items for the pharmaceutical companies. Vitamins and “natural health products” are, though.

  10. anonymous says:

    It not about anti-vaccination. It is about effectiveness. If anti-flu jab works, I would have it regularly. The problem is that the flu jab is not proven to be more than 80% effective. As such, why should a healthy person interfere with his own immune system. Each person should weighs the risk and benefit for themselves rather than having a blanket rule. The benefits from Hep B, polio and TB vaccination far outweighs the risk of the disease. Even if you don’t ask, the evidence will convince the public to come forward to have the vaccination.
    This does not apply to the flu jab. On top of that, the vaccination is yearly.

  11. Steve Hambleton says:

    The evidence that vaccinating doctors and nurses protects patients from infection, morbidity, and death is well established.
    Take a look at the following published in the Lancet,
    Lets just get on with it.
    Steve Hambleton AMA President

  12. Horst Herb says:

    Steve, the reference you sent simply states that this “evidence is well established” without even bothering to reference that bold statement directly.
    However, among the references listed at the bottom, there was “Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial.”. It found that while there was a difference in non-adjusted overall mortality in the hospital where health worker vaccination rate was lower, neither PCR nor necropsy found any significant difference in influenza infections among the patients or the deads. No influenza vaccination causality of the difference in deaths/morbidity was shown (nor suggested).

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