Megan C. Lindley, MPHDeputy Associate Director for ScienceImmunization Services DivisionCDC

Mandates Improve With Influenza Vaccination Rates of Hospital Personnel

Megan C. Lindley, MPHDeputy Associate Director for ScienceImmunization Services DivisionCDC

Megan C. Lindley Interview with:
Megan C. Lindley, MPH

Deputy Associate Director for Science
Immunization Services Division
CDC What is the background for this study?

Response: Despite longstanding recommendations from the Advisory Committee on Immunization Practices, healthcare personnel influenza vaccination coverage remains below the Healthy People 2020 target of 90%. Healthcare employers use a variety of strategies to promote influenza vaccination among healthcare personnel, including facility-level mandates for vaccination. Several U.S. states have also enacted laws related to healthcare personnel influenza vaccination, but the effect of these laws on vaccination uptake is unclear.

Our study used influenza vaccination coverage data reported by over 4,000 U.S. hospitals to examine three kinds of laws:
(1) Assessment laws, which require hospitals to assess healthcare personnel influenza vaccination status;
(2) Offer laws, which require hospitals to offer the influenza vaccine to healthcare personnel; and
(3) Ensure laws, which require hospitals to require healthcare personnel to demonstrate proof of influenza vaccination. What are the main findings?

Response:  Facility-level vaccination mandates had the strongest effect on reported influenza vaccination coverage in our multivariable models, resulting in an 11-12 percentage point increase in mean vaccination coverage for hospitals in states with no laws related to healthcare personnel influenza vaccination. Using interaction terms, we found that facility-level mandates were estimated to increase mean reported influenza vaccination coverage among all healthcare personnel by 4.2 percentage points in states with assessment laws, 6.6 percentage points in states with offer laws, and 3.1 percentage points in states with ensure laws. Results were similar in analyses restricted only to employee healthcare personnel, whose vaccination status is easier for hospitals to track. What should readers take away from your report?

Response: The observed effect of hospital-level vaccination mandates was lesser in states with healthcare personnel influenza vaccination laws, possibly because these laws positively influence healthcare personnel vaccination uptake such that there is less room for improvement in response to facility requirements. Our findings suggest state laws may help increase influenza vaccination coverage among hospital-based healthcare personnel in facilities with or without vaccination requirements. Previous research has identified multiple other strategies that can be used to increase healthcare personnel influenza vaccination uptake. Hospitals should implement and amplify evidence-based strategies that are appropriate for their institution to increase influenza vaccination among healthcare personnel and protect their staff and patients from the burden of influenza disease. What recommendations do you have for future research as a result of this work? 

Response: The effect of any law is dependent in part on how it is monitored and enforced, something we were unable to measure in this study. Future research on how state laws impact influenza vaccination uptake among healthcare personnel could attempt to analyze how these laws are implemented – for example, by examining enforcement provisions written into the laws as well as the extent to which these provisions are applied by the state. 

The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.


Association of State Laws With Influenza Vaccination of Hospital Personnel
Lindley, Megan C. et al.
American Journal of Preventive Medicine , Volume 56 , Issue 6 , e177 – e183 

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Last Updated on May 29, 2019 by Marie Benz MD FAAD