One strategy suggested for the control of influenza is the mandatory annual immunization of healthcare workers, specifically nurses. I strongly disagree with this strategy, and feel it is misguided. Some institutions have attempted to make annual influenza immunizations a condition of employment for nurses, stating that nurses' jobs would be in jeopardy if they did not comply. Nurses, like all individuals, have a right to self-determination. Mandating that nurses receive annual influenza immunizations removes the right of nurses to choose for themselves whether to obtain the immunization.

Rather than mandating influenza immunization, healthcare institutions would be wise to establish ongoing education programs to adequately inform nurses about influenza transmission and the serious consequences associated with the transmission of the virus to high-risk individuals. Education programs also should include information about the safety and effectiveness of the vaccine. Low vaccination rates among providers have been attributed to concerns about adverse events, the most well known being the side effect of Guillain-Barre syndrome associated with the swine flu vaccine of 1976 (Katz et al., 2004). In addition, having on-site immunization and providing the vaccine as an employment benefit would be helpful in promoting the immunization to nurses.

I think that most nurses would agree that protecting themselves against influenza and decreasing the transmission of the disease to patients is of utmost importance. Most nurses accept that when they care for the sick, they place themselves in a position of increased exposure to infectious diseases. Universal precautions, handwashing, and other infection control procedures are standard practice. Immunization against infectious diseases is only one weapon in the arsenal to protect patients and their healthcare providers. During the most recent influenza season, vaccine was in very short supply, and many health-care institutions adopted a universal respiratory hygiene strategy to prevent the spread of the disease. Masks were distributed to patients and providers who had respiratory symptoms, facial tissues and alcohol-based hand gels were made available in patient care areas and waiting rooms, and providers were encouraged to abstain from patient care if they were ill (Centers for Disease Control and Prevention [CDC], 2004). This strategy was successful and should be used whenever outbreaks of influenza occur.

Nurses, like all individuals, have a right to self-determination; they have the ability to control their own lives without the imposition of external controls.

From a population perspective, other groups should be considered when mandating influenza immunizations. Children, not nurses, are at highest risk for influenza infection and are overwhelmingly the agents by which influenza is spread within households (Weycker et al., 2005). During the influenza season of 2004, 33% more children than adults experienced influenza symptoms (CDC, 2004). Therefore, immunizing children would greatly reduce the number of influenza cases occurring each year, and would also decrease the transmission of the virus to other segments of the population. Simulation models of influenza transmission have projected that if 20% of U.S. children received annual influenza vaccinations, a 46% reduction in cases would occur. If 80% of the children received annual vaccinations, the reduction in the number of cases would exceed 90% (Weycker et al., 2005). Other countries such as Japan have adopted routine influenza immunizations of all children, with dramatic decreases observed in the number of flu cases, the number of transmissions, and the number of complications from the disease requiring hospitalization. I believe that this strategy should be the major one in any comprehensive plan to control the spread of influenza.

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