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502 Get a Flu Shot or You're Fired!: Sound Policy or Sound Bite?

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Michael B. Edmond, MD, MPH, MPA , Virginia Commonwealth University Medical Center, Richmond, VA
Gonzalo M.L. Bearman, MD, MPH , Virginia Commonwealth University Medical Center, Richmond, VA
Michael P. Stevens, MD , Virginia Commonwealth University Medical Center, Richmond, VA
Background: In August 2010, SHEA revised its position on influenza vaccination of healthcare workers (HCWs) to recommend that annual influenza vaccination be a condition of initial and continued employment and/or professional privileges.

Objective: To determine the impact of mandating influenza vaccination for HCWs on the number of HCWs who report to work with influenza-like illness (ILI) and compare that to the strategy of discouraging presenteeism (reporting to work while ill).

Methods: This analysis utilizes the following assumptions: (1) a hypothetical hospital has 5,000 HCWs; (2) a nonpandemic influenza season in which 7% of the population (including HCWs) develop ILI, of which 7% is due to influenza; (3) baseline HCW influenza vaccination rate is 70%; (4) the efficacy of influenza vaccine is 75%; (5) baseline HCW presenteeism is 70%; (6) mandating vaccinination results in 98% of HCWs vaccinated. The outcome is the number of HCWs with ILI at work. Two alternative strategies will be compared to the status quo: mandating influenza vaccine vs maintaining influenza vaccine compliance at 70% while achieving an absolute 5% reduction in presenteeism.

Results:
Baseline    

Mandatory vaccination    

Reduced presenteeism

Vaccinated (%) 70 98 70
Presenteeism (%) 70 70 65
Total HCWs 5,000 5,000 5,000
Vaccinated HCWs 3,500 4,900 3,500
Unvaccinated HCWs 1,500 100 1,500
HCWs with non-flu ILI 325 325 325
Unvaccinated with flu 8 1 8
Vaccinated with flu 4 6 4
Total HCWs with ILI 337 332 337
HCWs at work with ILI  
236 232 219

A modest absolute (5%) reduction in presenteeism results in fewer HCWs with ILI at work than mandating influenza vaccination. In fact, a 1% absolute reduction in presenteeism is equivalent to mandating vaccination (i.e., in a workforce of 5,000, 70% of whom are vaccinated, having 4 HCWs with ILI stay at home has the same impact as mandating influenza vaccination).

Conclusions: SHEA’s policy calling for firing HCWs who refuse influenza vaccination is short-sighted, punitive, and less effective than alternative, horizontal (nonpathogen-specific) strategies with less potential for adverse unintended consequences.