Intended for healthcare professionals

Head To Head

Should influenza vaccination be mandatory for healthcare workers?

BMJ 2013; 347 doi: (Published 12 November 2013) Cite this as: BMJ 2013;347:f6705
  1. Amy Behrman, medical director, occupational medicine1,
  2. Will Offley, casualty nurse 2
  1. 1University of Pennsylvania Health System, 3400 Spruce St Philadelphia, PA 19104, USA
  2. 2Emergency Department, Vancouver General Hospital, Vancouver, Canada
  1. Correspondence to: A Behrman behrman{at}, W Offley willo{at}

Amy Behrman believes that mandatory vaccination is needed to protect vulnerable patients, but Will Offley argues that evidence on effectiveness is not sufficient to over-ride healthcare workers’ right to choose

Yes—Amy Behrman

Advocacy for influenza vaccination begins with recognising the impact of the disease. Globally, seasonal influenza causes an estimated 300 000-500 000 deaths and 3-5 million cases of severe disease every year.1 Methods that distinguish between influenza and other viruses causing influenza-like illnesses estimate that influenza infections and complications cause an average 226 000 hospital admissions annually in the United States, including 3000-49 000 deaths, depending on seasonal severity.2 Influenza vaccines are estimated to prevent thousands of admissions and millions of illnesses annually with current usage.3 4 5

Complications and deaths from influenza are highest in elderly people, infants, and patients with compromised cardiopulmonary or immune systems.1 2 6 These vulnerable populations are most likely to enter healthcare settings and least likely to mount effective immune responses to vaccination.2 6 Influenza vaccines have excellent safety records6 and are most effective (59% reduction in laboratory proved influenza6 and 47-73% reduction in influenza-like illness2) in healthy non-elderly adults, precisely the demographic of most healthcare workers.

Nosocomial transmission is well documented.7 Influenza infection control should include, in addition to vaccination, hand hygiene, isolation of infected patients, targeted masking, and leave of absence for healthcare workers with influenza-like illness.8 Vaccination is a keystone intervention, differing from others by reducing risk in all encounters without repeated effort or time from busy healthcare workers.

Annual vaccination is therefore widely recommended to reduce the risk of healthcare acquired influenza.2 8 9 10 11 12 13 Advocates and opponents of mandatory vaccination share goals of enhancing patient and staff safety. Disagreements centre on evidence of efficacy, ethical concerns, and how best to …

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