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Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

  • John Frederick (a1), Alexandria C. Brown (a2), Derek A. Cummings (a3), Charlotte A. Gaydos (a4), Cynthia L. Gibert (a5) (a6), Geoffrey J. Gorse (a7) (a8), Jenna G. Los (a4), Ann-Christine Nyquist (a9) (a10), Trish M. Perl (a11), Connie S. Price (a12) (a13), Lewis J. Radonovich (a14), Nicholas G. Reich (a2), Maria C. Rodriguez-Barradas (a15) (a16), Mary T. Bessesen (a17) (a18) and Michael S. Simberkoff (a1) (a19)...
Abstract
OBJECTIVE

To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).

DESIGN

Retrospective observational cohort study.

SETTING

This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.

PARTICIPANTS

The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.

METHODS

To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.

RESULTS

The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).

CONCLUSIONS

These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.

Infect Control Hosp Epidemiol 2018;39:452–461

Copyright
Corresponding author
Address correspondence to Michael S. Simberkoff, MD, VA New York Harbor Healthcare System, 423 East 23rd Street #111, New York, NY 10010 (Mike.simberkoffmd@va.gov) or Trish M. Perl, MD, MSc, University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd; Dallas, TX 75390 (Trish.Perl@UTSouthwestern.edu).
Footnotes
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a

ResPECT Team members: Trish Perl, MD, MSc, Johns Hopkins University, Baltimore, MD; Justin Getka, BA, Johns Hopkins University, Baltimore, MD; Tina Hoang, MS, Johns Hopkins University, Baltimore, MD; Rose Kajih, PharmD, Johns Hopkins University, Baltimore, MD; Amanda Krosche, BS, Johns Hopkins University, Baltimore, MD; Meghan Kubala, MS, MD, Johns Hopkins University, Baltimore, MD; Jenna Los, MLA, Johns Hopkins University, Baltimore, MD; Liandra Presser, MD, Johns Hopkins University, Baltimore, MD; Kathleen Pulice, MS, Johns Hopkins University, Baltimore, MD; Margaret Spach, DDS, Johns Hopkins University, Baltimore, MD; Michael S. Simberkoff, MD, VA New York Harbor Healthcare System, New York, NY; Cynthia Akagbosu, BA, MA, VA New York Harbor Healthcare System, New York, NY; Madeline Dansky, BA, VA New York Harbor Healthcare System, New York, NY; Benedict J. Frederick, BA, VA New York Harbor Healthcare System, New York, NY; Marilyn Last, RN, VA New York Harbor Healthcare System, New York, NY; Scott Laverie, RN, VA New York Harbor Healthcare System, New York, NY; Courtney Pike, BA, VA New York Harbor Healthcare System, New York, NY; Shefali Rikhi, BS, VA New York Harbor Healthcare System, New York, NY; Nicole Spector, RN, VA New York Harbor Healthcare System, New York, NY; Christine A. Reel-Brander, RN, VA New York Harbor Healthcare System, New York, NY; Connie Price, MD, Denver Health and Hospital Authority, Denver, CO; Katie Gorman, BS, Denver Health and Hospital Authority, Denver, CO; Amy Irwin, DNP, RN, Denver Health and Hospital Authority, Denver, CO; Sean O’Malley, Denver Health and Hospital Authority, Denver, CO; Kevin Silva, BS, Denver Health and Hospital Authority, Denver, CO; Trish M. Perl, MD, MSc, University of Texas Southwestern Medical Center, Dallas, TX; Deepa Raj, MPH, University of Texas Southwestern Medical Center, Dallas, TX; Mary Bessesen, MD, VA Eastern Colorado Healthcare System, Denver, CO; Jill C. Adams BSN, BA, VA Eastern Colorado Healthcare System, Denver, CO; Shannon Kingery, BS, VA Eastern Colorado Healthcare System, Denver, CO; Stefanie Tuder, BS, VA Eastern Colorado Healthcare System, Denver, CO; Erron Fruchter-Palmer, MPH, VA Eastern Colorado Healthcare System, Denver, CO; Ann-Christine Nyquist, MD, MSPH, Children’s Hospital Colorado, Denver, CO; Megan Brocato, BA, Children’s Hospital Colorado, Denver, CO; Cynthia Gibert, MD, MSc; Laura Chopko, BA, Washington DC VA Medical Center, Washington, DC; Kathy Haines, MSW, MPH, Washington DC VA Medical Center, Washington, DC; Caitlin Langhorne, MPH, Washington DC VA Medical Center, Washington, DC; Dana Silver, BA, Washington DC VA Medical Center, Washington, DC; Courtney Southard, MPH, Washington DC VA Medical Center, Washington, DC; Maria C. Rodriguez-Barradas, MD; Barbara Kertz, MS; Mahwish Mushtaq, MD, MPH, VA Michael C. DeBakey Medical Center, Houston, TX; Blanca Vargas, MD, VA Michael C. DeBakey Medical Center, Houston, TX; Edward Fisher, MS, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, PA; Ronald Shaffer, PhD, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, PA; Lewis J. Radonovich, MD, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, PA; Aaron Eagan, MPH, RN, Veterans Health Administration Office of Public Health, Gainesville, FL; Melanie Lipka, BS, HandyMetrics, Toronto, Ontario, Canada; Michael Tsang, PhD, HandyMetrics, Toronto, Ontario, Canada; Charlotte Gaydos, DrPH, Laboratory Core at Johns Hopkins University, Baltimore, MD; Jeffrey Holden, MA, Laboratory Core at Johns Hopkins University, Baltimore, MD; Alexandra Valsamakis, MD, PhD, Laboratory Core at Johns Hopkins University, Baltimore, MD; Geoffrey J. Gorse, MD, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Michelle Mitchell, BS, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Gira B. Patel, MS, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Yinyi Yu, BS, Laboratory Core at VA St Louis Healthcare System and St Louis University School of Medicine, St Louis, MO; Andre Hackman, BA, REDCap Core at Johns Hopkins University, Baltimore, MD; Michael Sherman, BS, REDCap Core at Johns Hopkins University, Baltimore, MD; Derek Cummings, PhD, MPH, MSc, Statistical and Epidemiologic Core, University of Florida, Gainesville, FL; Alexandria C. Brown, PhD, University of Massachusetts, Amherst, MA; Nicholas G. Reich, PhD, Statistical and Epidemiologic Core, University of Florida, Gainesville, FL; Justin Lesser, PhD, MHS, MS, Johns Hopkins University, Baltimore, MD.

PREVIOUS PRESENTATION. Parts of this manuscript were presented as a poster at ID Week 2017 on October 6, 2017, in San Diego, California.

Footnotes
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Infection Control & Hospital Epidemiology
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