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Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

Published online by Cambridge University Press:  02 January 2015

Thomas R. Talbot
Department of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Hilary Babcock
Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
Arthur L. Caplan
Department of Medical Ethics, University of Pennsylvania, Philadelphia
Deborah Cotton
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts liaisons from the Infectious Diseases Society of America
Lisa L. Maragakis
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Gregory A. Poland
Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota liaisons from the Infectious Diseases Society of America
Edward J. Septimus
Department of Hospital Corporation of America, Nashville, Tennessee Texas A & M Health Science Center, Houston
Michael L. Tapper
Lenox Hill Hospital and the New York University School of Medicine, New York
David J. Weber
Departments of Medicine and Pediatrics, University of North Carolina at Chapel Hill
E-mail address:
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Executive Summary

This document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.” In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the Society's official statement on that issue.

Shea Position Paper
Copyright © The Society for Healthcare Epidemiology of America 2010


1.Talbot, TR, Bradley, SE, Cosgrove, SE, Ruef, C, Siegel, JD, Weber, DJ. Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol 2005;26(11):882890.CrossRefGoogle ScholarPubMed
2.Interim within-season estimate of the effectiveness of trivalent inactivated influenza vaccine—Marshfield, Wisconsin, 2007-08 influenza season. MMWR Morb Mortal Wkly Rep 2008;57(15):393398.Google Scholar
3.Shugarman, LR, Hales, C, Setodji, CM, Bardenheier, B, Lynn, J. The influence of staff and resident immunization rates on influenza-like illness outbreaks in nursing homes. J Am Med Dir Assoc 2006;7(9):562567.CrossRefGoogle ScholarPubMed
4.van den Dool, C, Bonten, MJ, Hak, E, Wallinga, J. Modeling the effects of influenza vaccination of healthcare workers in hospital departments. Vaccine 2009;27(44):62616267.CrossRefGoogle ScholarPubMed
5.van den Dool, C, Bonten, MJ, Hak, E, Heijne, JC, Wallinga, J. The effects of influenza vaccination of healthcare workers in nursing homes: insights from a mathematical model. PLoS Med 2008;5(10):e200.CrossRefGoogle ScholarPubMed
6.Burls, A, Jordan, R, Barton, P, et, al. Vaccinating healthcare workers against influenza to protect the vulnerable—is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. Vaccine 2006;24(19):42124221.CrossRefGoogle ScholarPubMed
7.Chicaiza-Becerra, LA, Garcia-Molina, M, Ballesteros, M, Gamboa, O, Diaz, J, Vega, R. Economie evaluation of influenza vaccine applied to health personnel attending hospitalised oncological patients [in Spanish]. Re-vista de Salud Publica (Bogota) 2008;10(5):756766.Google Scholar
8.Carman, WF, Elder, AG, Wallace, LA, et al.Effects of influenza vaccination of healthcare workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355(9198):9397.CrossRefGoogle ScholarPubMed
9.Potter, J, Stott, DJ, Roberts, MA, et al.Influenza vaccination of healthcare workers in long-term care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175(1):16.CrossRefGoogle ScholarPubMed
10.Hayward, AC, Harling, R, Wetten, S, et al.Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006;333(7581):1241.CrossRefGoogle ScholarPubMed
11.Lemaitre, M, Meret, T, Rothan-Tondeur, M, et al.Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009;57(9):15801586.CrossRefGoogle ScholarPubMed
12.Thomas, RE, Jefferson, T, Lasserson, TJ. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database Syst Rev 2010;2:CD005187.Google Scholar
13.Elder, AG, O'Donnell, B, McCruden, EA, Symington, IS, Carman, WF. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMf 1996;313(7067):12411242.Google Scholar
14.Weingarten, S, Riedinger, M, Bolton, LB, Miles, P, Ault, M. Barriers to influenza vaccine acceptance: a survey of physicians and nurses. Am J Infect Control 1989;17(4):202207.CrossRefGoogle ScholarPubMed
15.Bridges, CB, Thompson, WW, Meitzer, MI, et al.Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomized controlled trial. JAMA 2000;284(13):16551663.CrossRefGoogle ScholarPubMed
16.Nichol, KL, Lind, A, Margolis, KL, et al.The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med 1995;333(14):889893.CrossRefGoogle ScholarPubMed
17.Kane, RL, Shamliyan, T, Mueller, C, Duval, S, Wilt, TJ. Nurse staffing and quality of patient care. Evid Rep Technol Assess (Full Rep) 2007;(151):1115.Google ScholarPubMed
18.Hugonnet, S, Chevrolet, JC, Pittet, D. The effect of workload on infection risk in critically ill patients. Crit Care Med 2007;35(1):7681.CrossRefGoogle ScholarPubMed
19.Harris, KM, Maurer, J, Lurie, N. Influenza vaccine use by adults in the USA: snapshot from the end of the 2008-2009 vaccination season. Rand Health. 270.pdf. Published 2009. Accessed February 19, 2010.Google Scholar
20.Harris, KM, Maurer, J, Lurie, N. Seasonal influenza vaccine use by adults in the US: a snapshot as of mid-November 2009. Rand Health, Published 2009. Accessed February 19, 2010.Google Scholar
21.Caban-Martinez, AJ, Lee, DJ, Davila, EP, et al.Sustained low influenza vaccination rates in US healthcare workers. Prev Med 2010;50(4):210212.CrossRefGoogle ScholarPubMed
22. Paper presented at: 42nd NIC National Immunization Conference— Mandatory Influenza Vaccination: The Virginia Mason Story, March 18, 2008; Atlanta, Georgia, Accessed March 31, 2009.Google Scholar
23.Rakita, RM, Hagar, BA, Crome, P, Lammert, JK. Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 2010;31(9):881888.CrossRefGoogle ScholarPubMed
24.Babcock, HM, Gemeinhart, N, Jones, M, Dunagan, WC, Woeltje, KF. Mandatory influenza vaccination of healthcare workers: translating policy to practice. Clin Infect Dis 2010;50(4):459464.CrossRefGoogle ScholarPubMed
25.Cormier, SB, Septimus, E, Moody, JA, Hickok, JD, Perlin, JB. Implementation of a successful seasonal influenza vaccine strategy in a large healthcare system. In: Program and abstracts of Fifth Decennial International Conference on Healthcare-Associated Infections; March 20, 2010; Atlanta, Georgia. Abstract 385.Google Scholar
26. Immunization Action Coalition Web site. Honor roll for patient safety. Accessed August 18, 2010.Google Scholar
27. New York Department of State, Codes, Rule, and Regulations: 10NYCRR 66-3. Accessed February 22, 2010.Google Scholar
28. New York State Department of Health. Dear administrator letter: suspension of flu vaccine mandate for health care workers, http://www.ny Revised August 2009. Accessed February 22, 2010.Google Scholar
29.Douville, LE, Myers, A, Jackson, MA, Lantos, JD. Healthcare worker knowledge, attitudes, and beliefs regarding mandatory influenza vaccination. Arch Pediatr Adolesc Med 2010;164(1):3337.CrossRefGoogle ScholarPubMed
30.Poland, GA, Ofstead, CL, Tucker, SJ, Beebe, TJ. Receptivity to mandatory influenza vaccination policies for healthcare workers among registered nurses working on inpatient units. Infect Control Hosp Epidemiol 2008;29(2):170173.CrossRefGoogle ScholarPubMed
31.deSante, JE, Caplan, A, Shofer, F, Behrman, AJ. Physician attitudes towards influenza immunization and vaccine mandates. Vaccine 2010;28(13):251721.CrossRefGoogle ScholarPubMed
32.Lautenbach, E, Saint, S, Henderson, DK, Harris, AD. Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs. Clin Infect Dis 2009;50(4):523527.CrossRefGoogle Scholar
33. American College of Occupational and Environmental Medicine (ACOEM) guidance statement: seasonal influenza prevention in healthcare workers. = 5362. Published 2010. Accessed March 31, 2009.Google Scholar
34.Lugo, NR. Will carrots or sticks raise influenza immunization rates of healthcare personnel? Am J Infect Control 2007;35(1):16.CrossRefGoogle ScholarPubMed
35.Anikeeva, O, Braunack-Mayer, A, Rogers, W. Requiring influenza vaccination for healthcare workers. Am J Public Health 2009;99(1):2429.CrossRefGoogle Scholar
36.Helms, CM, Polgreen, PM. Should influenza immunisation be mandatory for healthcare workers? Yes. BMJ 2008;337:a2142.CrossRefGoogle ScholarPubMed
37.Isaacs, D, Leask, J. Should influenza immunisation be mandatory for healthcare workers? No. BMJ 2008;337:a2140.CrossRefGoogle Scholar
38.Steckel, CM. Mandatory influenza immunization for healthcare workers—an ethical discussion. AAOHN J 2007;55(1):3439.CrossRefGoogle Scholar
39.Stewart, AM. Mandatory vaccination of healthcare workers. N Engl J Med 2009;361(21):20152017.CrossRefGoogle Scholar
40.Tilburt, JC, Mueller, PS, Ottenberg, AL, Poland, GA, Koenig, BA. Facing the challenges of influenza in healthcare settings: the ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics. Vacane 2008;26(suppl 4):D2730.Google ScholarPubMed
41.van Delden, JJ, Ashcroft, R, Dawson, A, Marckmann, G, Upshur, R, Verweij, MF. The ethics of mandatory vaccination against influenza for healthcare workers. Vacane 2008;26(44):55625566.Google Scholar
42.Talbot, TR. Do declination statements increase healthcare worker influenza vaccination rates? Clin Infect Dis 2009;49(5):773779.CrossRefGoogle Scholar
43. Ohio Administrative Code. Chapter 3701-14. Hospital DRG and performance measures reporting requirements, Accessed February 22, 2010.Google Scholar
44. “America's Best Children's Hospitals” 2010 methodology. US News and World Report, Updated June 30, 2010. Accessed February 22, 2010.Google Scholar
45.Polgreen, PM, Polgreen, LA, Evans, T, Helms, C. A statewide system for improving influenza vaccination rates in hospital employees. Infect Control Hosp Epidemiol 2009;30(5):474478.CrossRefGoogle ScholarPubMed
46.Johnson, DF, Druce, JD, Birch, C, Grayson, ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 2009;49(2):275277.CrossRefGoogle ScholarPubMed
47.Aiello, AE, Murray, GF, Perez, V, et al.Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial. J Infect Dis;201(4):491498.CrossRefGoogle Scholar
48.Cowling, BJ, Chan, KH, Fang, VJ, et al.Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med 2009;151(7):437446.CrossRefGoogle ScholarPubMed
49.Wicker, S. Unvaccinated health care workers must wear masks during flu season—a possibility to improve influenza'vaccination rates? Vaccine 2009;27(20):26312632.CrossRefGoogle ScholarPubMed
50. IDSA policy on mandatory influenza immunization of healthcare workers. 14220. Published 2009. Accessed January 19, 2010.Google Scholar
51.Bertin, M, Scarpelli, M, Proctor, AW, et al.Novel use of the intranet to document healthcare personnel participation in a mandatory influenza vaccination reporting program. Am J Infect Control 2007;35(1):3337.CrossRefGoogle Scholar
52.Borlaug, G, Newman, A, Pfister, J, Davis, JP. Factors that influenced rates of influenza vaccination among employees of Wisconsin acute care hospitals and nursing homes during the 2005-2006 influenza season. Infect Control Hosp Epidemiol 2007;28(12):13981400.CrossRefGoogle ScholarPubMed
53.Polgreen, PM, Septimus, EJ, Parry, MF, et al.Relationship of influenza vaccination declination statements and influenza vaccination rates for healthcare workers in 22 US hospitals. Infect Control Hosp Epidemiol 2008;29(7):675677.CrossRefGoogle ScholarPubMed
54.Ribner, BS, Hall, C, Steinberg, JP, et al.Use of a mandatory declination form in a program for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2008;29(4):302308.CrossRefGoogle Scholar
55.Buchta, WG, Verdoon, CA, Schultz, GL. Effectiveness of declination statements in influenza vaccination programs for healthcare workers. In: Program and abstracts of the International Commission on Occupational Health (ICOH) Conference on Health Care Worker Health / 2007 State-of-the-Art Conference; October 26-28, 2007; Vancouver, British Columbia, Canada. Abstract 348217.Google Scholar
56.Polgreen, PM, Chen, Y, Beekmann, S, et al.Elements of influenza vaccination programs that predict higher vaccination rates: results of an emerging infections network survey. Clin Infect Dis 2008;46(1):1419.CrossRefGoogle ScholarPubMed
57.Lindley, MC, Yonek, J, Ahmed, F, Perz, JF, Williams Torres, G. Measurement of influenza vaccination coverage among healthcare personnel in US hospitals. Infect Control Hosp Epidemiol 2009;30(12):11501157.CrossRefGoogle ScholarPubMed
58.Talbot, TR, Dellit, TH, Hebden, J, Sama, D, Cuny, J. Factors associated with increased healthcare worker influenza vaccination rates: results of a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol 2010;31(5):456462.CrossRefGoogle ScholarPubMed
59.Omer, SB, Salmon, DA, Orenstein, WA, deHart, MP, Halsey, N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med 2009;360(19):19811988.CrossRefGoogle ScholarPubMed
60.Palmore, TN, Vandersluis, JP, Morris, J, et al.A successful mandatory influenza vaccination campaign using an innovative electronic tracking system. Infect Control Hosp Epidemiol 2009;30(12):11371142.CrossRefGoogle ScholarPubMed
61. Policy for mandatory seasonal influenza immunization for civilian health care personnel who provide direct patient care in Department of Defense military treatment facilities. Published April 4, 2008. Accessed February 19, 2010.Google Scholar
62. APIC position paper: influenza immunization of healthcare personnel. = Search8csection = Position_Statementsl8ttemplate = /CM/ContentDisplay.cfm&Content FileID = 11049. Published October 1, 2008. Accessed June 2, 2009.Google Scholar
63. National Patient Safety Foundation. National Patient Safety Foundation supports mandatory flu vaccinations for healthcare workers. http://www Published November 18, 2009. Accessed January 19, 2010.Google Scholar

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