The Centers for Disease Control and Prevention (CDC) recommend that certain priority groups, such as healthcare providers, receive the influenza vaccine each year, and it is becoming more common that healthcare institutions mandate that nurses employed in direct patient care settings receive annual influenza immunizations. I strongly support the position that all nurses involved in direct patient care should be required to receive the annual immunization.

Each year in the United States an average of 5% to 20% of the population contract influenza, resulting in more than 200,000 hospitalizations and 36,000 deaths. Children younger than 5 years and individuals over 65 years of age are most likely to require hospitalization as a result of contracting the illness (Thompson et al., 2004). Despite nurses' understanding the importance of preventing the transmission of communicable diseases through immunization, compliance with recommendations such as the influenza vaccine for healthcare workers is still very low. Only about 36% of healthcare workers received the vaccine for the 2004-2005 influenza season (CDC, 2005). Despite a shortage of vaccine last year, the percentage of vaccinated workers was no different from previous years when supplies of the vaccine were readily available. Within the last 10 years, the morbidity and mortality rates associated with influenza infections have greatly increased, and these are likely to continue to escalate unless vaccination rates among healthcare workers increase (Thompson et al., 2004). One way to increase vaccination rates is to mandate that nurses receive the vaccine.

Nurses can easily transmit influenza to patients. The incubation period for influenza is about 2 days, and the ability to transmit the infection to another individual occurs 1 day prior to the onset of symptoms, and for up to 5 days after symptoms begin (Olsen, Steinberg, & Ley, 2005). Therefore, nurses caring for infected patients can not only acquire the virus and become ill, but they can also pass the virus to others before they are even aware they are infected. In my practice, it also is not uncommon to see nurses continue to come into work ill (and presumably contagious) to care for high-risk patients. This places our patients at great risk for developing the illness. Therefore, preventing influenza and its transmission should be a priority for all nurses, and annual vaccination is the primary means of preventing the spread of influenza.

Another important consideration in this debate is that of absenteeism. If nurses are not immunized, the likelihood of them contracting influenza during times of outbreaks and then being absent from work is high. Tied to this are increased health-care costs, which are yet another consequence of both the transmission of influenza from nurses to their patients as well as the influenza-associated absenteeism.

Morbidity and mortality rates associated with influenza have greatly increased, and are likely to continue unless vaccination rates among healthcare workers increase.

Healthcare institutions are right to mandate annual influenza vaccination for all nurses who provide direct patient care, since infection control is a priority. Mandates already exist for other immunizations (e.g., the hepatitis B vaccine) and for disease screening (annual tuberculosis screening) among nurses. The influenza vaccine is highly effective and has few side effects, and the benefits of receiving the vaccine greatly outweigh the risks involved in vaccination. As is the case with the hepatitis B vaccine, nurses exempt from receiving the vaccine would include those in whom the vaccine is contraindicated (e.g., due to allergy) and those who decline vaccination after being fully informed about the procedures.

It is the primary obligation of nurses to do no harm to patients. Influenza is a highly contagious disease, and nurses should do everything in their power to help control the spread of the disease. Mandatory vaccination could do just that.

References