Healthcare Personnel Vaccination Policies

Receiving the influenza (flu) vaccine is the single best way to prevent contracting or spreading influenza, a contagious respiratory illness caused by viruses that infect the nose, throat and lungs.

• According to current national guidelines, unless medically contraindicated, all people age 6 months and older should be vaccinated against influenza every year.
   
• Those most susceptible to complications from the flu include young children, adults age 65 years and older, pregnant women, and people with chronic health conditions and/or weakened immune systems. However, flu can be severe in healthy persons of any age.
   
• Each year, the flu contributes to more than 220,000 hospitalizations and from 12,000 to 79,000 deaths in the United States.
   
• Healthcare personnel (HCP) connect with unvaccinated people daily, making it especially important for HCP to be vaccinated against the flu and reduce risk of spreading the viruses. Data from the Michigan Care Improvement Registry (MCIR) indicates only 30.4% flu vaccination coverage for all Michiganders aged 6 months and older for the 2018-2019 influenza season.
   
  • MCIR can be used to assist in assessing immunization history and to document all vaccinations administered to HCP and patients.
     
• The Centers for Disease Control and Prevention (CDC) has developed many resources to educate providers and their patients on the importance of influenza vaccination.

Flu vaccines are FDA-approved and the safest, most effective way to protect people from the flu.

• Vaccination is the most effective means to prevent the flu. Every year influenza vaccines prevent thousands of hospitalizations and deaths. The CDC and the Food and Drug Administration (FDA) monitor the safety of all vaccines licensed in the United States. Flu vaccines have been safely produced and administered since the 1940s.
   
• There are several vaccine options for the 2019-2020 flu season. For many vaccine recipients, more than one type or brand of vaccine may be used depending on the CDC and Advisory Committee on Immunization Practices recommendations. Visit the 2019-2020 flu vaccine presentation chart provided by the Michigan Department of Health & Human Services (MDHHS) for more information.

• The influenza vaccine cannot cause the disease. Flu vaccines work by priming the body's defenses if a person is exposed to an actual flu virus. Injected vaccine contains dead viruses that are unable to produce illness. It takes about two weeks after receiving flu vaccine to develop full immunity, so it is possible for a person to contract the flu during the time immediately after being vaccinated.

• Side effects from the flu vaccine are generally uncommon and may include short-term soreness and/or redness at the injection site. Serious adverse reactions are extremely rare, and the benefits of receiving a flu vaccine far outweigh any risks.

Achieving high influenza vaccination rates of HCP is a critical step in preventing transmission of flu between HCP and patients.

• Since 1984, the CDC has recommended that all HCP receive the influenza vaccine every year.

• Influenza vaccination for HCP is an important part of patient safety and a comprehensive infection control program. Unvaccinated HCP can expose patients to the flu virus.

• The flu virus can be transmitted by both symptomatic and asymptomatic individuals. Only about 50% of infected people will develop the classic clinical symptoms of influenza; but 100% of infected people can spread the disease.

• Employees of healthcare organizations have both ethical and professional obligations to act in the best interests of their patients’ health.

• Multiple studies have shown that HCP influenza vaccination has reduced patient mortality.
   
• While presenteeism is common, healthcare professionals are also obliged to stay home from work when they are ill to avoid transmitting to their patients.

Hospitals are individually best positioned to understand the unique needs of their patients and communities. Requiring HCP vaccination is a local decision, made with the best interests of patients in mind.

• Hospitals have increased voluntary HCP influenza vaccination rates since 1981. An estimated 95.2% of hospital-based HCP nationwide reported receiving influenza vaccination in the 2018-2019 influenza season.
   
• A 2016 MDHHS survey showed that 77% of Michigan hospitals had mandatory flu vaccination policies for all staff.

• Multifaceted, employer-mandated vaccination programs have been found to be the single most effective strategy to increase HCP flu vaccination rates. Nationally, self-reported flu vaccination coverage among those required to be vaccinated was 97.7% compared with 42.1% among those not subject to a requirement.
   
• Mandating immunization is not a new concept. Many healthcare facilities have long required specific vaccines and a tuberculin skin test as conditions for employment or for working in specific areas of the facility.

Pertussis Facts

• Pertussis, or whooping cough, is a highly contagious respiratory disease with secondary attack rates as high as 80% in susceptible individuals. It can cause severe debilitating disease in people of all ages.
   
  • Pertussis can be prevented, or result in an illness that is much less severe, with vaccination.  
     
• People with mild disease can transmit infection.
   
• Symptoms can be difficult to distinguish from other causes of upper respiratory infections.
   
• Infants are at greatest risk for disease and death, especially during the first few months of life when they are too young to be protected by vaccination. Approximately half of babies less than 1 year of age who get pertussis are hospitalized.  
   
• It is estimated that pertussis causes nearly 161,000 deaths per year worldwide and is one of the most commonly occurring vaccine-preventable diseases.
   
• In Michigan, the number of reported cases of pertussis varies from year to year, usually with a cyclical peak every three to five years. Cases peaked in 2010 with more than 1,500 reported cases and in 2014 with more than 1,400. As of Sept. 18, 2019, there were 320 cases of pertussis reported in Michigan for 2019.
   
• The cyclical pattern of pertussis is not completely understood, but vaccination plays an important role in limiting spread of the disease.
   
• The Centers for Disease Control and Prevention recommends whooping cough vaccines for people of all ages.

Pertussis in Healthcare Settings

• Nosocomial spread of pertussis has been documented in various healthcare settings, including hospitals and emergency departments serving pediatric and adult outpatient clinics, nursing homes, and long-term-care facilities.
   
• Vaccination of healthcare personnel (HCP) reduces the risk of hospital-based outbreaks and costs associated to nosocomial transmission of pertussis.
   
• Patients with the disease require droplet precautions.
   
• Exposed HCP should be monitored daily for 21 days (infectious three weeks after cough onset).
   
• If HCP become ill, they must be excluded from work until completing at least five days of antibiotics.
   
• Post-exposure antimicrobial prophylaxis is recommended for all HCP who have unprotected exposure to pertussis and are likely to expose a patient at risk for severe pertussis (e.g. hospitalized neonates and pregnant women).

Vaccinating Healthcare Personnel Protects Patients

• HCP are considered to be at risk for acquiring or transmitting hepatitis B, influenza, measles, mumps, rubella, pertussis and varicella.
   
• Healthcare personnel have been recommended to receive Tdap vaccine since 2005. The 2017 National Health Interview Survey reported that 57.5% of HCP were vaccinated with Tdap.
   
• HCP Recommendations were updated in November 2011.
   
• Employees of healthcare organizations have both ethical and professional obligations to act in the best interests of their patients’ health.

Tdap (Tetanus, Diphtheria and Acellular Pertussis) Vaccination

• Pregnant women are recommended to receive a Tdap vaccine during each pregnancy. Just as HCP should urge pregnant patients to be appropriately vaccinated against tetanus, diphtheria, and acellular pertussis, it is important that any HCP who are pregnant receive the Tdap vaccine.
   
• Tdap vaccination during pregnancy protects babies after birth, lowering risk of:
   
  • Whooping cough in babies less than 2 months old by 78%.
     
  • Hospitalization due to whooping cough in babies less than 2 months old by 91%.
     
• If Tdap vaccination status cannot be confirmed, individuals are considered unvaccinated and, therefore, eligible to be vaccinated. 
   
• Additional recommendations for Tdap vaccine are indicated in a 2018 MMWR from the Advisory Committee on Immunization Practices (ACIP).
   
• Vaccine side effects include pain and redness at the injection site (common), fever, headache, nausea or vomiting (less common) and anaphylaxis (very rare). (Epidemiology and Prevention of Vaccine-Preventable Diseases)

Establishing Vaccination Policies in Healthcare Settings

• Hospitals are individually best positioned to understand the unique needs of their patients and communities. Vaccination coverage is highest among HCP who work in a facility with a required vaccination policy.     

• Tdap is becoming a standard vaccine for HCP entering the healthcare field. Current ACIP recommendations indicate that HCP should be assessed for vaccination and immunity status at the time of hire and at least annually to ensure they are up-to-date with recommended vaccines.
  • Use the Michigan Care Improvement Registry to assist in assessing immunization history and to document all vaccinations administered to HCP and patients. 
     
• A survey conducted by the Michigan Department of Health and Human Services showed 41% of Michigan’s hospitals had mandatory employee Tdap vaccination policies in place as of September 2016.