Influenza Vaccine Coverage of Healthcare Workers at a Midwestern Children's Hospital Using a Mandatory Vaccination/Declination Policy

Background: Since 1981 annual influenza vaccination has been recommended for healthcare workers (HCWs). Despite this recommendation, overall rates of HCW influenza vaccination remain low, typically around 40% nationally. While immunization rates at hospitals caring for children exceed the national rate, a 2004 study revealed very low rates in some hospitals and among HCWs in some high-risk units.  Following the 2006 recommendations from the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices, national rates continue to vary and are mostly inadequate despite the introduction of significant resources and multiple interventions to improve coverage.

Objective: To increase influenza vaccination rates of HCWs by adopting a mandatory vaccination/declination policy

Methods: During this year's influenza vaccination campaign, a mandatory vaccination/declination policy was implemented with an established deadline for compliance. 

Results: Between 2004 and 2009, employee influenza vaccination rates improved from 63% to 90.5% with the introduction of a mandatory vaccination/declination policy. For the current season 98.8% of HCWs complied with the policy. 402/5622 employees (7.2%) declined vaccine overall, 9.5% were not immunized. Underimmunized (<85%) HCWs by unit included those in transport, radiology, sedation, cardiac surgery, and pain management.

Conclusions: HCW influenza vaccine coverage has improved over six seasons with a dedicated occupational health and infection control staff.  Highest coverage was seen this season with the adoption of a mandatory vaccination/declination policy. Mandatory influenza vaccine policies without declinations must be considered to further increase influenza vaccination rates.