A systematic review of mandatory influenza vaccination in healthcare personnel

Samantha I. Pitts, Nisa M. Maruthur, Kathryn R. Millar, Trish M. Perl, Jodi Segal

Research output: Contribution to journalReview article

18 Citations (Scopus)

Abstract

Context: Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates. Evidence acquisition: MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk. Evidence synthesis: Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94%. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p<0.001 for all comparisons). Two single-institution studies reported limited, inconclusive results on absenteeism among HCP. No studies reported on clinical outcomes among patients. Medical and religious exemptions and terminations or voluntary resignations were rare. Conclusions: Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.

Original languageEnglish (US)
Pages (from-to)330-340
Number of pages11
JournalAmerican Journal of Preventive Medicine
Volume47
Issue number3
DOIs
StatePublished - Jan 1 2014

Fingerprint

Human Influenza
Vaccination
Delivery of Health Care
Vaccines
Observational Studies
Absenteeism
Influenza Vaccines
MEDLINE
Libraries
Nursing
Language
Outcome Assessment (Health Care)
Morbidity
Health

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

A systematic review of mandatory influenza vaccination in healthcare personnel. / Pitts, Samantha I.; Maruthur, Nisa M.; Millar, Kathryn R.; Perl, Trish M.; Segal, Jodi.

In: American Journal of Preventive Medicine, Vol. 47, No. 3, 01.01.2014, p. 330-340.

Research output: Contribution to journalReview article

Pitts, Samantha I. ; Maruthur, Nisa M. ; Millar, Kathryn R. ; Perl, Trish M. ; Segal, Jodi. / A systematic review of mandatory influenza vaccination in healthcare personnel. In: American Journal of Preventive Medicine. 2014 ; Vol. 47, No. 3. pp. 330-340.
@article{0bfe7e4c9a644d35b164a6026d0da904,
title = "A systematic review of mandatory influenza vaccination in healthcare personnel",
abstract = "Context: Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates. Evidence acquisition: MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk. Evidence synthesis: Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94{\%}. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p<0.001 for all comparisons). Two single-institution studies reported limited, inconclusive results on absenteeism among HCP. No studies reported on clinical outcomes among patients. Medical and religious exemptions and terminations or voluntary resignations were rare. Conclusions: Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.",
author = "Pitts, {Samantha I.} and Maruthur, {Nisa M.} and Millar, {Kathryn R.} and Perl, {Trish M.} and Jodi Segal",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.amepre.2014.05.035",
language = "English (US)",
volume = "47",
pages = "330--340",
journal = "American Journal of Preventive Medicine",
issn = "0749-3797",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - A systematic review of mandatory influenza vaccination in healthcare personnel

AU - Pitts, Samantha I.

AU - Maruthur, Nisa M.

AU - Millar, Kathryn R.

AU - Perl, Trish M.

AU - Segal, Jodi

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Context: Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates. Evidence acquisition: MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk. Evidence synthesis: Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94%. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p<0.001 for all comparisons). Two single-institution studies reported limited, inconclusive results on absenteeism among HCP. No studies reported on clinical outcomes among patients. Medical and religious exemptions and terminations or voluntary resignations were rare. Conclusions: Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.

AB - Context: Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates. Evidence acquisition: MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk. Evidence synthesis: Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94%. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p<0.001 for all comparisons). Two single-institution studies reported limited, inconclusive results on absenteeism among HCP. No studies reported on clinical outcomes among patients. Medical and religious exemptions and terminations or voluntary resignations were rare. Conclusions: Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.

UR - http://www.scopus.com/inward/record.url?scp=84906324289&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906324289&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2014.05.035

DO - 10.1016/j.amepre.2014.05.035

M3 - Review article

C2 - 25145618

AN - SCOPUS:84906324289

VL - 47

SP - 330

EP - 340

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

SN - 0749-3797

IS - 3

ER -