Running head: MANDATORY INFLUENZA VACCINE
Mandatory Influenza Vaccination
Elizabeth Degelbeck
Ferris State University
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MANDATORY INFLUENZA VACCINE
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Mandatory Influenza Vaccination
Influenza is a highly contagious virus that spreads via droplets through sneezing or
coughing (FAAP, 2012). Clinical manifestations include fever, chills, headache, muscle aches,
and a nonproductive cough. Other subsequent manifestations include sore throat, nasal
congestion, and a more prominent cough (FAAP, 2012). Once a person becomes infected, that
person is able to shed the virus from one day before symptoms are noticed and for another five to
ten days following (Randall, Curran, & Omer, 2013; McLennan & Wicker, 2010). This virus is
considered one of the leading causes of death with an average of 36,000 deaths and over 200,000
hospitalizations per year in the US (Vondrak, Starling, & Guzman, 2013). The patients that are
at higher risk for developing complications from influenza virus include the elderly, the young,
and the immunocompromised (Randall, et. al, 2013) who will have a more severe, prolonged
illness that could ultimately lead to death (McLennan & Wicker, 2010).
The flu season typically begins in the fall and lasts until spring. Vaccines are offered
throughout this time and promise to give immunity to the latest influenza strains. The vaccines
are reformulated every year by epidemiologists based on which strain is the most active in other
parts of the world (FAAP, 2012). Health care workers are the first in line to help manage ill
patients, especially with influenza-like illnesses. Influenza vaccinations are not yet mandated
nationally, but most hospitals are moving toward that direction. This idea brings a controversial
topic to the table. Should influenza vaccinations be mandated for all health care workers?
Pro-Mandatory Influenza Vaccination
There are many reasons that employers are now moving towards mandatory influenza
vaccination. One study states unvaccinated healthcare workers have been linked to influenza
outbreaks. Employers believe that employees should have an ethical feeling to do no harm to
MANDATORY INFLUENZA VACCINE
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patients and protect both the safety of the patient and the public (Randall, et. al, 2013). Studies
also say that it is inherent that health care workers protect the older population, whom the
vaccine is not as effective on, and provide a sort of “herd immunity” to these patients
(McLennan & Wicker, 2010). Herd immunity also protects other staff that has received the
vaccine and reduces the risk for an outbreak. Outbreaks in a healthcare system have been
associated with a lower risk of influenza vaccination among employees (Vondrak, et. al, 2013).
Other studies have shown that influenza vaccination among healthcare workers increase
the vaccination rates among patients. Patients are more confident receiving the influenza
vaccination if their physician or nurse demonstrates positive healthy behaviors (Abramson,
2012). They accept guidance with more ease and trust that physicians are relaying the proper
information. Health care workers in return will not feel hypocritical when enforcing influenza
vaccinations among their patients (Deldon, et. al, 2008).
If a health care worker chooses to refuse the influenza vaccination, employers give the
health care workers options during the flu season. Declination forms are available to the health
care worker to fill out and explain why they are refusing the vaccine. This lets the health care
worker to achieve a sense of autonomy. It also allows the employer to educate in areas where
needed to improve vaccination rates among their facility (McLennan & Wicker, 2010). Other
hospitals have gone to the extreme with their mandated influenza vaccinations and will terminate
anyone who refuses (McLennan & Wicker, 2010; Vondrak, et. al, 2013). Some hospitals have
combined declination forms and allowing unvaccinated health care workers to work in other
areas where vulnerable patients are not cared for (McLennan & Wicker, 2013).
MANDATORY INFLUENZA VACCINE
Against Mandatory Influenza Vaccination
There are also many reasons circulating why not to mandate flu vaccines. One reason is
that the healthcare worker is allowed to practice autonomy and make their own decisions about
what products are going to be administered in their body (Randall, et. al, 2013; Vondrak, et. al,
2013). Some studies show that there is a lack of evidence to support that vaccinating healthcare
workers protects long-term care facility residents from contracting the virus (Gardam &
Lemieux, 2013; Evans, 2012). Also, other studies have shown that the influenza vaccine only
provides 60% protection in healthy adults (Gardam & Lemieux, 2013; Evans, 2012). In fact, in
January 2013, the US Centers for Disease Control and Prevention stated that for the 2012-2013
influenza season, the vaccination was 55% effective against laboratory confirmed influenza A
(Gardam & Lemieux, 2013). OSHA has also stated that the vaccination has an abundance of
variability in its effectiveness and preventing life threatening illnesses (Evans, 2012). Gardam
and Lemieux stated that influenza vaccinations are “based on expert and organizational opinion
rather than data” and “the system overestimation of vaccine effectiveness has hampered the
identification of better solutions” (2013).
There are many reasons why employees refuse to become vaccinated. These reasons
include fear of adverse reactions, doubts of vaccine efficacy, inconvenience, cost, and doubts
that they will be infected with the virus (Randall, et. al, 2013; Vondrak, et. al, 2013). Some
adverse reactions that health care workers are in fear of include nausea, vomiting, allergic
reaction, and influenza-like illness. Other more serious reactions include Stevens-Johnsons
syndrome, meningitis, paralysis of the face, Guillain-Barre syndrome, myelitis, and other
neurologic disorders (Hieb, 2013).
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One study has shown that vaccinating healthcare workers does not decrease the
transmission of the virus to patients (Offley, 2013). Thomas states in his statement that “flu
vaccines cannot cover all strains, so they are targeted to cover those strains that epidemiologists
expect to cause the most morbidity and mortality that season” (2012). So as one can see, it is no
wonder why employees feel that the vaccine is not worth the pain. Thomas also stated that a
health care worker should get the choice to protect themselves and their patients, not mandate it
(2012).
Conclusion
In conclusion, there are many reasons why a health care worker should and should not
receive the influenza vaccination. More research is needed to prove the effectiveness of
vaccination, but health care workers must also weigh the risks and benefits of the influenza
vaccination before receiving it. It is vital that health care workers educate themselves to ensure
that they are doing what is best for the patient, themselves, and the community.
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