Make flu shots a must for health-care workers: specialists

Health-care workers should be required either to have an annual flu shot or note their refusal in writing, a group representing infectious diseases specialists says in a report.

The Infectious Diseases Society of America called for the mandatory flu shots in a bid to protect vulnerable patients from being infected by those caring for them. Yet society officials insisted they aren't advocating that people receive shots against their will.

Instead, the idea is that doctors, nurses and other staffin hospitals and health-care facilities would have to sign a declination, if they refused flu shots.

The document would acknowledge they had refusedthe shot, "and they understand in so doing it may not be in the best interests of their patients' health," said Dr. Andrew Pavia, society chair and an infectious diseases specialist at the University of Utah.

Flu shotparticipation by health-care workers has traditionally been lower than the general public might expect. In the United States, it has hovered around 40 per cent, said Dr. Kathleen Maletic Neuzil, who chaired the panel that drew up the plan.

The Public Health Agency of Canada estimates about 64 per cent of health-care workers in this country had flu shots last winter.

But it should be higher, said Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai Hospital.

"Most of us know that patients get hospital-acquired influenza all the time, and most of that probably is from health-care workers," said McGeer, who was not involved in drafting the document.

The idea of mandatory immunization is not without precedent, Pavia said, noting workers have to prove they've been vaccinated against hepatitis, a virus they risk getting from patients.

A personal choice?

Still, talk of mandatory influenza vaccination is always contentious.

"Basically our position is that taking a flu shot… is a personal choice," said Linda Haslam-Stroud, a registered nurse and president of the Ontario Nurses Association.

She said thatin Ontario, collective agreements spell out a number of options for unvaccinated health-care workers when flu hits their institutions. Agreements vary, but in general terms the options are:

• Get a flu shot.
• Take antiviral drugs.
• Be reassigned to another part of the hospital or stay home without pay.

Haslam-Stroud said her organization would have concerns that nurses might find themselves in a compromised position if they signed a declination form. "We would never agree for a nurse to sign off any collective agreement rights."

Neuzil said this kind of system would be more about educating health-care workers of the risks of worker-to-patient flu transmission than about coercing anyone to do something against their will.

"Frequently it's simply that it's not a priority," Neuzil, an influenza expert at the University of Washington, said of some health-care workers' resistance to flu shots.

"And making somebody sign a piece of paper just puts it higher on the list of the 20 things that these poor overworked health-care workers have to do. It's almost more of a forced education than a forced 'You must take this vaccine.'"