Control of seasonal influenza in healthcare settings: mandatory annual influenza vaccination of healthcare workers

Aim: The aim of this review is to emphasise the burden and transmission of nosocomial seasonal influenza, discuss the influenza vaccine and the need for annual influenza vaccination of all healthcare workers, discuss common attitudes and misconceptions regarding the influenza vaccine among healthcare workers and means to overcome these issues, and highlight the need for mandatory annual influenza vaccination of healthcare workers. Methods: A literature review was carried out; Medline, PubMed and The Cochrane Collaboration were searched for primary studies, reviews and opinion pieces pertaining to influenza transmission, the influenza vaccine, and common attitudes and misconceptions. Key words used included "influenza", "vaccine", "mandatory", "healthcare worker", "transmission" and "prevention". Results: Seasonal influenza is a serious disease that is associated with considerable morbidity and mortality and contributes an enormous economic burden to society. Healthcare workers may potentially act as vectors for nosocomial transmission of seasonal influenza. This risk to patients can be reduced by safe, effective annual influenza vaccination of healthcare workers and has been specifically shown to significantly reduce morbidity and mortality. However, traditional strategies to improve uptake consistently fail, with only 35 to 40% of healthcare workers vaccinated annually. Mandatory influenza vaccination programs with medical and religious exemptions have successfully increased annual influenza vaccination rates of healthcare workers to >98%. Exemption requests often reflect misconceptions about the vaccine and influenza, and reflect the importance of continuous education programs and the need for a better understanding of the reasons for compliance with influenza vaccination. Conclusion: Mandatory annual influenza vaccination of healthcare workers is ethically justified and, if implemented appropriately, will be acceptable. Traditional strategies to improve uptake are minimally effective, expensive and inadequate to protect patient safety. Therefore, low voluntary influenza vaccination rates of healthcare workers leave only one option to protect the public: mandatory annual influenza vaccination of healthcare workers