1. The American Academy of Pediatrics (AAP) reaffirms its support for mandatory influenza vaccination for all health care personnel (HCP).
2. The AAP supports nationwide implementation of mandatory vaccination programs in accordance with the 2020 goal of reaching a 90% coverage rate among HCPs.
Rundown: Illness from influenza has an annual cost burden of approximately $87 billion, including more than 200,000 annual hospitalizations, as many as 49,000 annual deaths, and countless opportunity costs in decreased productivity and absenteeism. The influenza vaccine is the best preventative tool available for limiting the burden of influenza. When vaccines are well-matched to a seasonal strain, effectiveness reaches up to 75%. Vaccinating HCPs is important for cocooning patients that cannot receive the vaccine as well as for preventing transmission to a vulnerable population and other providers. Previous studies have shown variable effects of mandatory HCP vaccination, with some studies showing as much as a 29% reduction in all-cause death and 42% reduction in influenza-like illness. Mandatory programs are cost effective, substantially decreasing gross and opportunity cost associated with influenza infection compared with the minimal cost of implementing these programs. However, HCP vaccination rates remain suboptimal, with a high of 75% in the 2013-2014 season (81.8% in acute care facilities). Voluntary vaccination programs report coverage rates between 65% and 77%, while mandatory programs have coverage rates upwards of 96%, indicating a need to move away from voluntary programs and mandating vaccination in health care institutions. The AAP supports state-based influenza vaccination requirements for HCPs as it reduces the burden on individual institutions to create, justify, and enforce their own policies. In the 2012-2013 season, Rhode Island implemented a state-wide mandatory policy and vaccination rates climbed from 70% in the previous year to 87%. The AAP recommends several considerations when implementing a mandatory policy at a healthcare institution. To maximize success, institutions should receive full support of their healthcare leaders, customize institution-based programs, offer free vaccines given at a convenient time and place, and have clear and universal forms describing exemption and consequences for those who fail to get vaccinated.
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