Wang Tiffany L, Jing Ling, Bocchini Joseph A
aDivision of General Pediatrics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, New York bDepartment of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Curr Opin Pediatr. 2017 Oct;29(5):606-615. doi: 10.1097/MOP.0000000000000527.
As healthcare-associated influenza is a serious public health concern, this review examines legal and ethical arguments supporting mandatory influenza vaccination policies for healthcare personnel, implementation issues and evidence of effectiveness.
Spread of influenza from healthcare personnel to patients can result in severe harm or death. Although most healthcare personnel believe that they should be vaccinated against seasonal influenza, the Centers for Disease Control and Prevention (CDC) report that only 79% of personnel were vaccinated during the 2015-2016 season. Vaccination rates were as low as 44.9% in institutions that did not promote or offer the vaccine, compared with rates of more than 90% in institutions with mandatory vaccination policies. Policies that mandate influenza vaccination for healthcare personnel have legal and ethical justifications. Implementing such policies require multipronged approaches that include education efforts, easy access to vaccines, vaccine promotion, leadership support and consistent communication emphasizing patient safety.
Mandatory influenza vaccination for healthcare personnel is a necessary step in protecting patients. Patients who interact with healthcare personnel are often at an elevated risk of complications from influenza. Vaccination is the best available strategy for protecting against influenza and evidence shows that institutional policies and state laws can effectively increase healthcare personnel vaccination rates, decreasing the risk of transmission in healthcare settings. There are legal and ethical precedents for institutional mandatory influenza policies and state laws, although successful implementation requires addressing both administrative and attitudinal barriers.
鉴于医疗保健相关的流感是一个严重的公共卫生问题,本综述探讨了支持针对医护人员实施强制性流感疫苗接种政策的法律和伦理依据、实施问题以及有效性证据。
流感从医护人员传播给患者可能导致严重伤害或死亡。尽管大多数医护人员认为他们应该接种季节性流感疫苗,但美国疾病控制与预防中心(CDC)报告称,在2015 - 2016年度流感季,只有79%的医护人员接种了疫苗。在没有推广或提供疫苗的机构中,疫苗接种率低至44.9%,而在实施强制性疫苗接种政策的机构中,这一比例超过90%。针对医护人员强制接种流感疫苗的政策具有法律和伦理依据。实施此类政策需要多方面的方法,包括开展教育工作、方便获取疫苗、推广疫苗、领导层支持以及持续强调患者安全的沟通。
医护人员强制接种流感疫苗是保护患者的必要措施。与医护人员接触的患者感染流感并发症的风险通常较高。接种疫苗是预防流感的最佳可用策略,并且有证据表明,机构政策和州法律能够有效提高医护人员的疫苗接种率,降低医疗机构内的传播风险。虽然成功实施需要克服行政和态度方面的障碍,但机构强制性流感政策和州法律存在法律和伦理先例。