Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

Abstract

OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.

A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence

“…We identified 8 observational studies of moderate to lower moderate quality [19] , [20] , [21] , [22] , [23] , [26] , [27] , [30] , 5 of which found a vaccine benefit to HWs or employers and 3 which found no benefift or inconclusive results. A study in a large Italian hospital found an increase in absenteeism [19] from 2.99 days/person (outside of flu season) to 5.06 days/person (during flu season), which translated to 11,000 attributable absent days/year.…”

“…The study also found that vaccinated HWs had fewer excess sick days compared to non-vaccinated HWs (1.45 days/person vs. 2.09). A retrospective study in the United States (4063 subjects) compared absenteeism in mandatory vs. non-mandatory vaccination sites [21] and found that vaccinated HWs had fewer symptomatic days absent {2012/2013, OR = 0.82 (95% CI, 0.72–0.93); 2014/2015, OR = 0.81 (95% CI, 0.69–0.95)} and concluded that mandatory vaccination would reduce symptomatic absenteeism.…”

“… 7 [11] , [12] , [13] , [14] , [15] , [16] , [17] What is the evidence that vaccinating staff in healthcare settings against influenza reduces influenza in HWs, absenteeism and/or the wider economic impact of influenza in the healthcare workforce? 14 [11] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] 2 The Impact of HW Influenza Vaccination on their patients What is the evidence that HWs transmit influenza (asymptomatic or symptomatic) to inpatients in healthcare settings? 11 [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] Does influenza vaccination of HWs provide a protective effect for inpatients in healthcare settings?…”

“… Proportion of asymptomatic infection (recall + serology) Yes for asymptomatic infection Imai [18] 5 SR and meta -analysis Mixed 13 studies total 3 RCTs, 2PC, 8RC N = 20,282; 5,083 vaccinated 15,199 not Seasonal Vaccine only Pooled n = RR, Lab-confirmed flu, ILI, absenteeism, mean difference, cost-effectiveness Does vaccine benefit HWs or their employers? Yes/No High Yes Dini [11] 4 High Moderate Review Mixed 6 systematic reviews relevant to this question/ 28 studies Didn’t pool Influenza Vaccine Lab-confirmed flu, ILI, absenteeism Yes Gianino [20] 2 Low moderate OS-RC Italy Hospital Hospital health workers ∼ 5000 Seasonal vaccine Absenteeism during influenza epidemic periods Yes Pereira [21] 3 Moderate OS- RC England 223 health trusts each season Hospital, primary care, inpatient, outpatient, specialist ∼800,000 Seasonal vaccine Sickness absence rate, Relationship between sickness absence rate and uptake Yes Frederick [25] 3 Moderate OS-RC USA Hospitals & Outpatient Health workers ∼3000 Mandatory vaccine policy Incidence/length of absenteeism mandatory vs. non-mandatory sites Yes Study Maryland Quality Score and classification Study Design Country Setting Included Studies/or Population type # of par...…”

Vaccines for Health Care Personnel

“…79 Despite its modest VE, the benefits of vaccination to HCP are clear, with reductions in both illness and absenteeism. 80 Overall evidence supportsdand the CDC recommendsdaiming for universal annual immunization of HCP. 81 Naturally, there is interest in whether HCP vaccination benefits their patients.…”