NY mandates: HCWs get shots for the seasonal flu
In a likely prelude to a battle over mandating a swine flu vaccine, the New York State Health Department overrode nursing union protests recently in enacting an emergency regulation requiring seasonal flu shots for health care workers (HCWs).
Other states will no doubt scrutinize the New York regulation, and even in the absence of state laws, individual facilities may take up the mandate banner in a pandemic flu season when health care providers may need both seasonal and swine flu vaccinations. The Association for Professionals in Infection Control and Epidemiology (APIC) urges health care facilities to require annual flu vaccines for all employees with direct patient contact.
In New York, the State Hospital Review and Planning Council approved the regulation Aug. 6, 2009, with the mandate applying to all personnel working in hospitals, ambulatory surgery centers, diagnostic and treatment centers, certified home health agencies, long-term home health care programs, AIDS home care agencies, and hospices licensed under Article 28 of the New York State Public Health Law.
Facilities have been gearing up for the mandate as discussions surfaced, with health officials saying poor compliance with seasonal flu shots can no longer be ignored. "Many hospitals have been actively promoting influenza vaccine every year for their staff, but those who work in the field know that the uptake of the flu vaccine has been low," says Jane Zucker, MD, assistant health commissioner for immunization in New York City (NYC). "This mandate will help to dramatically increase the vaccination rate, and I think [health care facilities] view that as very positive."
Regardless, don't expect employee health and union groups that have long resisted a mandate to go gently into that good night. The New York State Nurses Association (NYSNA) fought the regulation, calling it a "scorched earth" approach that ignores risk assessment and alternative intervention measures. The NYSNA challenged the state's authority to enact such a regulation in hearings.
At a recent hearing on the regulation, Eileen Avery, MS, RN, associate director of NYSNA, said, "The nurses association questions the authority of this body to impose such a sweeping mandate as an emergency rule, without the declaration of a public health emergency."
One could argue that seasonal influenza actually fits those criteria with 36,000 deaths annually, though that would essentially mean reclassifying every flu season as a public health emergency. The prevailing opinion has been that of groups such as the American College of Occupational and Environmental Medicine, which argues in its position statement that patient safety data are not sufficient to justify a mandate that overrides the worker's autonomy to refuse vaccination. That argument is clearly under siege.
As New York State moves to mandate the seasonal flu vaccine for health care workers, the elephant in the room is this question: Will immunization against the H1N1 influenza A pandemic strain be required as well? The vaccine is expected to be available this month. A projected vaccine shortage means that only the highest-priority groups, including health care workers, are likely to be initially offered the shot. Two doses will be required per vaccinee.
Mandating immunization for the H1N1 influenza A pandemic strain when the vaccine becomes available is "something that is being discussed" by public health officials, Zucker confirmed.
While some doubt that a vaccine that has been fast-tracked would be mandated, a pandemic vaccine researcher emphasizes that the benefit to workers and patients will almost certainly outweigh the risk.
There was a time when people could only wish they had a SARS vaccine, recalls Donald Kennedy, MD, a professor of infectious diseases at Saint Louis University. "In Canada, health care workers were taking care of people, getting the disease, and dying from it," he says.
Kennedy is one of the researchers conducting H1N1 vaccine trials in humans at the Center for Vaccine Development at the university. "If we have a safe and effective vaccine, health care workers — particularly those who provide care to patients who would do poorly should they get H1N1 — should be vaccinated," he says.
Vaccinating high-risk patients does not provide complete immunity, Kennedy adds.
While conceding that risks are a legitimate issue for discussion, Kennedy reminds that the H1N1 vaccine was made with the same techniques used for seasonal virus. "We have been doing this for years without testing each seasonal flu vaccine every year," he notes. "This is not something we can sit around and debate for six months. Doing it two years from now probably won't help much. If we had a 1918 flu vaccine but gave it to everyone in 1920, it wouldn't have done much good."
In a likely prelude to a battle over mandating a swine flu vaccine, the New York State Health Department overrode nursing union protests recently in enacting an emergency regulation requiring seasonal flu shots for health care workers (HCWs).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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