A little over 3 weeks ago the CDC published their draft revised influenza infection control guidelines and requested public comment on the changes.
I blogged on this back on June 23rd in CDC: Proposed Influenza Infection Control Guidance.
In addition to changes to their recommendations on the use of surgical masks and N95 respirators, the guidance also dealt with the issue of yearly vaccination of HCWs (Health Care Workers) against influenza.
While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them.
Here is the passage from the proposed guidance:
Strategies to improve HCP vaccination rates include providing incentives, providing vaccine at no cost to HCP, improving access (e.g., offering vaccination at work and during work hours), and requiring personnel to sign declination forms to acknowledge that they have been educated about the benefits and risks of vaccination.
While some have mandated influenza vaccination for all HCP who do not have a Contraindication, it should be noted that mandatory vaccination of HCP remains a controversial issue.
As I pointed out at the time, not everyone was going to be happy with these guidelines.
Those advocating stricter infection control will see the vaccination recommendations as being tepid and short of the mark, while those concerned with individual rights will view this as a victory.
In response, Richard Whitley, MD president of the Infectious Diseases Society of America (IDSA), has written a letter to CDC director Thomas Frieden urging that these guidelines include mandatory influenza vaccination.
The `money quote’ from the letter appears on page two:
It is in one area, however, that IDSA feels the guidance does not go far enough. We feel the CDC should provide a definitive recommendation for mandatory influenza vaccination of healthcare providers. IDSA supports universal immunization of HCWs against seasonal influenza by health care institutions (inpatient and outpatient) through mandatory vaccination programs, as these programs are likely to be the most effective means to protect patients against the transmission of seasonal influenza by HCWs.
Employees who cannot be vaccinated due to medical contraindications, or because of vaccine supply shortages, or who sign a written declination choosing not to be vaccinated for religious reasons, should be required to wear masks or be re-assigned away from direct patient care.
The letter goes on to outline the IDSA’s rationale for mandating vaccination. By all means, read it in its entirety.
Last year New York State attempted to require vaccination as a requirement to work as a HCW, but in so doing aroused a hornet’s nest of protests.
Legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate (see New York Rescinds Mandatory Flu Shots For HCWs).
A few hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season. But it remains voluntary in most facilities.
And APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for over a year (see APIC Seeking Mandatory Flu Shot For HCWs).
But among the rank and file of health care workers, this remains a contentious and divisive subject.
Whether this appeal from the IDSA produces any changes to this year’s guidance is hard to say, but one thing is certain: with two major infectious disease organizations behind it, this issue isn’t going to go away.