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Infect Control Hosp Epidemiol. 2018 Apr;39(4):452-461. doi: 10.1017/ice.2018.9. Epub 2018 Mar 8.

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

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1Veterans Affairs (VA) New York Harbor Healthcare System (NYHHS),New York,New York.
2Department of Biostatistics and Epidemiology,School of Public Health and Health Sciences,University of Massachusetts,Amherst,Massachusetts.
3Department of Biology and Emerging Pathogens Institute,University of Florida,Gainesville,Florida.
4Division of Infectious Diseases,Department of Medicine,Johns Hopkins University,Baltimore,Maryland.
5Infectious Diseases Section,Medical Service,Washington DC VA Medical Center.
7VA St Louis Health Care System,St Louis,Missouri.
9Children's Hospital Colorado,Aurora,Colorado.
11Division of Infectious Diseases,Department of Medicine,University of Texas Southwestern,Dallas,Texas.
12Denver Health and Hospital Authority,Denver,Colorado.
14Centers for Disease Control and Protection,National Institute for Occupational Safety and Health,National Personal Protective Technology Laboratory,Pittsburgh,Pennsylvania.
15Michael E. DeBakey VA Medical Center,Houston,Texas.
17VA Eastern Colorado Health Care System,Denver,Colorado.


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.


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