This year, The AAP issued a statement urging pediatric hospitals and clinics to require mandatory immunization against influenza for all health care workers. They stated it’s “ethically justified, necessary, and long overdue.” The Advisory Committee on Immunization Practices (ACIP) began recommending influenza immunization (flu shots/mist) for health care workers back in the early 1980s. Even after 3 decades of the recommendation, overall immunization rates for health workers remain around only 40%. Evidence suggests a clinic or hospital unit needs an 80% immunization rate to protect themselves and their patients from the flu. In the US, we’re nowhere near it. Last year for example, the CDC estimated that for health care workers, only 61% got seasonal influenza shots, 37% got the HINI shot, and only 34.7% of workers received both.
Totally unimpressive for a group of people committed to protecting patients, curing illness, and preventing disease.

I believe the mandate is long overdue. No one likes to be told what to do, but there is reason behind this policy. For example, in the statement, The AAP used patient safety as part of their rationale, citing 2 studies:

  1. In a NICU, 19 of 54 (35%) infants were infected with influenza A as a result of health care–associated transmission; 6 became ill, and 1 died. Only 15% of staff survey respondents in this NICU had received influenza vaccine—67% of physicians and 9% of nurses.
  2. During an outbreak of influenza in a bone marrow transplant unit, there were 7 cases of health care–associated influenza; 6 patients developed pneumonia, and 2 patients died. Surveys revealed a vaccination rate of 12% among unit staff. The hospital took measures the following influenza season to implement a multifaceted voluntary education program aimed at improving immunization rates. However, even with these aggressive measures, 42% of the staff on the bone marrow transplant unit remained unimmunized the following year.

Pediatric health care can be better. Yesterday I participated in The Everett Clinic’s mandatory flu shot clinic. Fortunately, you can bring a child to clinic this year and worry less about an exposure to H1N1 or seasonal influenza (at least from staff/providers). At Children’s, employees and staff have to sign a waiver if they don’t get the shot. Both of these regulations will improve the numbers of health care workers vaccinated, layer protection around children and hopefully decrease illness in children.

As you can clearly see (from the 3rd photo where the needle is in my arm) doctors don’t like getting shots, either. Or at least this one. But I am thrilled to work in health systems with high standards of excellence. I am happy to protect myself, my family, and my patients from H1N1 and seasonal influenza this year. Even as I lift my sore R arm.

What is your thought about pediatric hospitals and offices with/without mandatory flu shot policies?