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Canadian Journal of Public Health

, Volume 105, Issue 4, pp e312–e316 | Cite as

Mandatory seasonal influenza vaccination or masking of British Columbia health care workers: Year 1

  • Doran S. Ksienski
Public Health Intervention

Abstract

OBJECTIVE: The Influenza Prevention Policy (“the Policy”) aims to increase seasonal influenza vaccination coverage among British Columbia (BC) health care workers (HCWs).

PARTICIPANTS: HCWs who work in publicly funded facilities and attend patient care areas.

SETTING: The Policy was announced in August 2012 and took effect province-wide during the 2012/13 flu season.

INTERVENTION: BC HCWs are required to receive seasonal influenza vaccination by the start of the flu season (December 1) or wear a mask while at work until the flu season ends (March 30). Vaccinated HCWs need to wear a green dot on their identification tag. HCWs are expected to report noncompliant coworkers. As initially proposed, continued noncompliance with the Policy could result in termination of employment (ultimately this component was put in abeyance).

OUTCOME: For the 2012/13 flu season, 74% of HCWs (35,889/48,818) at acute care facilities received influenza vaccination compared with 40% (23,375/58,212) in 2011/12 (difference in proportion=0.33, 95% confidence interval [CI]: 0.33-0.34, p<0.001). Similarly, staff vaccination rates at residential care facilities increased from 57% (21,535/37,700) for the 2011/12 flu season to 75% (27,617/36,620) in 2012/13 (difference in proportion=0.18, 95% CI: 0.18-0.19, p<0.001). Health care unions claimed that the Policy was coercive, and they launched an unsuccessful grievance with the BC Labour Relations Board.

CONCLUSION: Implementation of the Policy was associated with increased HCW vaccination; the Policy was upheld by an independent arbitrator. Further research is required to correlate HCW vaccination coverage rates with changes in influenza incidence and its complications. Continued stakeholder engagement is vital to achieve a collaborative decision-making process.

Key Words

Healthcare worker vaccination influenza 

Résumé

OBJECTIF : Une politique de prévention de l’influenza (« la Politique ») vise à accroître la couverture vaccinale contre l’influenza saisonnière chez les travailleurs de la santé (TS) de la Colombie-Britannique.

PARTICIPANTS : Les TS qui travaillent dans des établissements subventionnés par l’État et qui sont présents dans les zones de soins aux patients.

LIEU : La Politique a été annoncée en août 2012; elle est entrée en vigueur à l’échelle de la province durant la saison grippale 2012–2013.

INTERVENTION : Les TS de la Colombie-Britannique sont tenus de recevoir le vaccin contre l’influenza saisonnière avant le début de la saison grippale (le 1er décembre) ou de porter un masque au travail jusqu’à la fin de la saison (le 30 mars). Les TS vaccinés portent une pastille verte sur leur étiquette d’identité. Les TS sont censés dénoncer leurs collègues contrevenants. Selon ce qui était proposé au départ, le non-respect continu de la Politique pouvait entraîner un congédiement (mais cet élément a été mis en suspens).

RÉSULTAT : Pour la saison grippale 2012–2013, 74 % des TS (35 889 sur 48 818) des établissements de soins actifs ont reçu le vaccin contre l’influenza, contre 40 % (23 375 sur 58 212) en 2011–2012 (écart proportionnel=0,33, intervalle de confiance de 95 % [IC]: 0,33-0,34, p<0,001). Les taux de vaccination du personnel des établissements de soins résidentiels ont aussi augmenté, passant de 57 % (21 535 sur 37 700) pendant la saison grippale 2011–2012 à 75 % (27 617 sur 36 620) en 2012–2013 (écart proportionnel=0,18, IC de 95 %: 0,18-0,19, p<0,001). Les syndicats de travailleurs de la santé ont prétendu que la Politique était coercitive et ont logé un grief auprès de la Commission des relations de travail de la province, qui l’a rejeté.

CONCLUSION : La mise en oeuvre de la Politique a été associée à une vaccination accrue des TS; la Politique a été défendue par un arbitre indépendant. Il faudrait pousser la recherche pour corréler les taux de couverture vaccinale des TS avec l’évolution de l’incidence de l’influenza et de ses complications. Il est vital de continuer à mobiliser les acteurs pour en arriver à un processus décisionnel concerté.

Mots Clés

personnel sanitaire vaccination grippe humaine 

References

  1. 1.
    Bryce E, Embree J, Evans G, Johnston L, Katz K, McGee A, et al. Mandatory influenza immunization of healthcare workers. Ottawa, ON: Association of Medical Microbiology and Infectious Disease Canada, 2012.Google Scholar
  2. 2.
    World Health Organization. Influenza vaccines. Wkly Epidemiol Rec 2005;80(33):279–87.Google Scholar
  3. 3.
    Salgado C, Farr B, Hall K, Hayden F. Influenza in the acute hospital setting. Lancet Infect Dis 2002;2(6):145–55.CrossRefGoogle Scholar
  4. 4.
    Molinari N, Ortega I, Meissonier M, Thompson W, Wortley P, Bridges C. The annual impact of seasonal influenza in the US: Measuring disease burden and cost. Vaccine 2007;25(27):5086–96.CrossRefGoogle Scholar
  5. 5.
    Sartor C, Zandotti C, Romain F, Jacomo V, Simon S, Atlan-Gepner C, et al. Disruption of services in an internal medicine unit due to a nosocomial influenza outbreak. Infect Control Hosp Epidemiol 2002;23(10):615–19.CrossRefGoogle Scholar
  6. 6.
    Elder A, O’Donnell B, McCruden E, Symington I, Carman W. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993–4 epidemic: Results of serum testing and questionnaire. BMJ 1996;313(7067):1241–42.CrossRefGoogle Scholar
  7. 7.
    Weingarten S, Kiesinger M, Bolton L, Miles P, Ault M. Barriers to influenza vaccine acceptance. A survey of physicians and nurses. Am J Infect Control 1989;17(4):202–7.CrossRefGoogle Scholar
  8. 8.
    Carman W, Elder A, Wallace L, McAulay K, Walker A, Murray G, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: A randomized controlled trial. Lancet 2000;355(9198):93–97.CrossRefGoogle Scholar
  9. 9.
    Hayward A, Harling R, Wetten S, Johnson A, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programmed for care home staff to prevent death, morbidity, and health service use among residents: A cluster randomized controlled trial. BMJ 2006;333(7581):1241–47.CrossRefGoogle Scholar
  10. 10.
    Lemaitre M, Meret T, Rothan-Tondeur M, Belmin J, Lejonc J, Luquel L, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: A cluster-randomized trial. J Am Geriatr Soc 2009;57(9):1580–86.CrossRefGoogle Scholar
  11. 11.
    Potter J, Stott D, Roberts M, Elder A, O’Donnell B, Knight P, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175(1):1–6.CrossRefGoogle Scholar
  12. 12.
    Henry B. BC influenza Protection Policy: A Discussion of Evidence. Vancouver, BC: British Columbia Centre for Disease Control, 2013.Google Scholar
  13. 13.
    Thomas R, Jefferson T, Lasserson T. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions, 2013. Available at: http://www.ncbi.nlm.nih.gov (Accessed April 16, 2014).CrossRefGoogle Scholar
  14. 14.
    Van den Dool C, Banten M, Hak E, Wallins J. Modeling the effects of influenza vaccination of HCW in hospital departments. Vaccine 2009;21:6261–67.CrossRefGoogle Scholar
  15. 15.
    Public Health Agency of Canada. Final Report of Outcomes from the National Consensus Conference for Vaccine-preventable Diseases in Canada. Can Commun Dis Rep 2008;34(S2):28–32.Google Scholar
  16. 16.
    British Columbia Centre for Disease Control. Influenza vaccination coverage for staff of acute care facilities British Columbia, 2012/13. Vancouver, BC: BCCDC, 2013.Google Scholar
  17. 17.
    British Columbia Centre for Disease Control. Influenza vaccination coverage for staff of residential care facilities British Columbia, 2012/13. Vancouver: BCCDC, 2013.Google Scholar
  18. 18.
    Talbot T, Schaffner W. Commentary: On being the first. Infect Control Hosp Epidemiol 2010;31(9):889–92.CrossRefGoogle Scholar
  19. 19.
    Babcock M, Gemeinhart N, Jones M, Dunagan W, Woeltje K. Mandatory influenza vaccination of health care workers: Translating policy to practice. Clin Infect Dis 2010;50(4):459–64.CrossRefGoogle Scholar
  20. 20.
    Office of the Provincial Health Officer. Influenza Prevention Measures to Protect Patients. Victoria: British Columbia Ministry of Health, 2012.Google Scholar
  21. 21.
    Ministry of Health. Immunize BC: A Strategic Framework for Immunization in B.C. Vancouver: Government of British Columbia, 2007.Google Scholar
  22. 22.
    Diebolt R. Influenza control program policy grievance. Available at: http://www.heabc.bc.ca (Accessed November 1, 2013).Google Scholar
  23. 23.
    Hopper, T. Union cites possible ‘philosophical or religious objections’ as British Columbia nurses balk at forced flu vaccination. National Post Oct 22, 2012, Canada. Available at: http://news.nationalpost.com (Accessed November 1, 2013).Google Scholar
  24. 24.
    Jefferson T, Di Pietrantoni C, Rivetti A, Bawazeer G, Al-Ansary L, Ferroni E. Vaccines for preventing influenza in healthy adults, 2010. Available at: http://www.ncbi.nlm.nih.gov (Accessed October 21, 2013).CrossRefGoogle Scholar
  25. 25.
    Jefferson T. Scientist fires latest shot in mandatory flu vaccine debate. Vancouver Sun Nov 19, 2012; Opinion. Available at: http://www.vancouversun.com (Accessed November 1, 2013).Google Scholar
  26. 26.
    Osterholm M, Kelley N, Manske J, Ballering K, Leighton T, Moore K. The compelling need for game changing influenza vaccines. Minneapolis, MN: Center for Infectious Disease Research and Policy, 2012.Google Scholar
  27. 27.
    Centers for Disease Control and Prevention. Early estimates of seasonal influenza vaccine effectiveness–United States, January 2013. MMWR 2013;62:32–35.Google Scholar
  28. 28.
    Jefferson T, Del Mar B, Dooley L, Ferroni E, Al-Ansary L, Bawazeer G, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses, 2011. Available at: http://www.ncbi.nlm.nih.gov (Accessed November 1, 2013).CrossRefGoogle Scholar
  29. 29.
    Community Services Committee. Briefing on influenza vaccinations for paramedics. Toronto, ON: City of Toronto, 2002.Google Scholar

Copyright information

© The Canadian Public Health Association 2014

Authors and Affiliations

  1. 1.Department of Medical OncologyBritish Columbia Cancer AgencyVictoriaCanada

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