George Washington University, School of Public Health and Health Services, Department of Health Policy, Washington, DC 20006, United States.
Vaccine. 2013 Jan 21;31(5):827-32. doi: 10.1016/j.vaccine.2012.11.063. Epub 2012 Dec 6.
Nosocomial influenza outbreaks, attributed to the unvaccinated health care workforce, have contributed to patient complications or death, worker illness and absenteeism, and increased economic costs to the health care system. Since 1981, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended that all HCP receive an annual influenza vaccination. Health care employers (HCE) have adopted various strategies to encourage health care personnel (HCP) to voluntarily receive influenza vaccination, including: sponsoring educational and promotional campaigns, increasing access to seasonal influenza vaccine, permitting the use of declination statements, and combining multiple approaches. However, these measures failed to significantly increase uptake among HCP. As a result, beginning in 2004, health care facilities and local health departments began to require certain HCP to receive influenza vaccination as a condition of employment and annually. Today, hundreds of facilities throughout the country have developed and implemented similar policies. Mandatory vaccination programs have been endorsed by professional and non-profit organizations, state health departments, and public health. These programs have been more effective at increasing coverage rates than any voluntary strategy, with some health systems reporting coverage rates up to 99.3%. Several states have enacted laws requiring HCEs to implement vaccination programs for the workforce. These laws present an example of how states will respond to threats to the public's health and constrain personal choice in order to protect vulnerable populations. This study analyzes laws in twenty states that address influenza vaccination requirements for HCP who practice in acute or long-term care facilities in the United States. The laws vary in the extent to which they incorporate the six elements of a mandatory HCP influenza vaccination program. Four of the twenty states have adopted a broad definition of HCP or HCE. While 16/20 of the laws require employers to "provide," "arrange for," "ensure," "require" or "offer" influenza vaccinations to HCP, only four states explicitly require HCEs to cover the cost of vaccination. Fifteen of the twenty laws allow HCP to decline the vaccination due to medical contraindication, religious or philosophical beliefs, or by signing a declination statement. Finally, three states address how to sanction noncompliant HCPs. The analysis also discusses the development of a model legal policy that legislators could use as they draft and revise influenza prevention guidelines in health care settings.
医院内流感暴发归因于未接种疫苗的医护人员，导致患者病情加重或死亡、医护人员患病和缺勤，以及增加医疗系统的经济成本。自 1981 年以来，疾病控制与预防中心（CDC）免疫实践咨询委员会（ACIP）建议所有 HCP 每年接种流感疫苗。医疗保健雇主（HCE）已采取各种策略鼓励医疗保健人员（HCP）自愿接种流感疫苗，包括：赞助教育和宣传活动、增加季节性流感疫苗的可及性、允许使用豁免声明，并结合多种方法。然而，这些措施未能显著提高 HCP 的接种率。因此，从 2004 年开始，医疗机构和当地卫生部门开始要求某些 HCP 在就业和每年接受流感疫苗接种。如今，全国各地有数百个设施制定并实施了类似的政策。专业和非营利组织、州卫生部门和公共卫生部门都认可了强制性疫苗接种计划。这些计划在提高覆盖率方面比任何自愿策略都更有效，一些卫生系统报告的覆盖率高达 99.3%。几个州已经颁布法律，要求 HCE 为劳动力实施疫苗接种计划。这些法律为各州如何应对公众健康威胁以及为保护弱势群体而限制个人选择提供了一个范例。本研究分析了美国 20 个州的法律，这些法律涉及在美国急性或长期护理机构执业的 HCP 流感疫苗接种要求。这些法律在纳入强制性 HCP 流感疫苗接种计划的六个要素的程度上有所不同。20 个州中有 4 个采用了广义的 HCP 或 HCE 定义。虽然 20 个法律中的 16 个要求雇主“提供”、“安排”、“确保”、“要求”或“提供”流感疫苗接种给 HCP，但只有 4 个州明确要求 HCE 支付疫苗接种费用。20 个法律中的 15 个允许 HCP 因医疗禁忌症、宗教或哲学信仰或签署豁免声明而拒绝接种疫苗。最后，三个州规定了如何制裁不遵守规定的 HCP。该分析还讨论了制定一个模型法律政策的问题，立法者可以在起草和修订医疗保健环境中的流感预防指南时使用该政策。
