Data Behind Mandatory Flu Vaccinations for Health Care Workers in Tertiary Care Hospitals is Inconclusive

Background: Mandatory influenza vaccination of health care workers (HCWs) has generated significant controversy over the last several years. Many health care organizations have implemented mandatory policies in order to boost vaccination rates of health care workers due to failed attempts at voluntary strategies. The trivalent influenza vaccine has been proven to be a relatively safe and cost effective tool in mitigating influenza. However, it has also demonstrated a varied efficacy rate from season to season and person to person. There have been previous studies evaluating influenza vaccination for HCWs who work with the elderly, but little data is available on tertiary care hospitals. The object of this review is to determine if there is sufficient data behind the effectiveness of influenza vaccination of HCWs in preventing nosocomial infections in tertiary care hospitals to justify a mandate with negative associated consequences such as termination, relocation, or mask wearing for a non-compliant HCW. Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, CINAHL, Medline-PubMed, NIH clinical trials website, and the Center for Disease Control and Prevention website, using the keywords: health personnel, cross infection, nosocomial, influenza human, influenza vaccine, and tertiary care hospital. Relevant articles were assessed for quality using GRADE. Results: Two studies met the inclusion criteria and were featured in this systematic review. A prospective observational study demonstrated an inverse association between HCW vaccination rates and nosocomial influenza rates among patients. A nested case-control investigation indicated a protective effect on hospital-acquired influenza (HAI) when more than 35% of healthcare workers were vaccinated. Conclusion: The two studies included in this review demonstrate a protective effect in preventing nosocomial infections in tertiary care hospitals. However, these studies have multiple limitations and biases. Based on these studies, the data is inconclusive and does not support a strong recommendation for mandatory influenza vaccination of HCWs for prevention of nosocomial infections in tertiary care hospitals. Keywords: Health care workers, influenza vaccine, nosocomia