American Academy of Pediatrics: Make the Flu Shot Mandatory

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REUTERS/Shannon Stapleton

The American Academy of Pediatrics (AAP) has called for mandatory annual flu shots for all health-care workers, a position similar to that of other organizations, including the Society for Healthcare Epidemiology of America and the American College of Physicians. Many hospitals and some health-care systems, including the clinical centers of the National Institutes of Health, have already adopted mandatory-immunization policies, according to the AAP.

“Employees of health care institutions have an ethical and professional obligation to act in the best interest of their patients’ health,” wrote Drs. Henry H. Bernstein and Joseph A. Bocchini Jr., authors of the new policy statement, which will be published in the October issue of the journal Pediatrics.

The paper comes on the heels of a study by the RAND Corporation showing that 40% of health-care workers weren’t inoculated during the 2008 flu season. More than 23,600 people die of the flu each year and about 200,000 are hospitalized, according to government data; the very young, the very old, pregnant women and people with chronic diseases are most vulnerable to flu. The pediatricians group says mandatory vaccines will help protect these patient populations. According to USA Today:

[The AAP statement] cites a study published in 2000 of a flu outbreak in a newborn intensive care unit in which 19 of 54 infants were infected with flu by “health-care-associated transmission.” Six infants got sick and one died. A survey found that only 15% of health workers who responded got their flu shots. An outbreak in a bone marrow transplant unit cost two patients their lives, the statement says. Only 12% of the staff were vaccinated.

The current season’s flu vaccine includes the pandemic 2009 H1N1 strain, along with seasonal flu strains. In a recent study in the Journal of the American Medical Association, researchers from the Centers for Disease Control and Prevention found that the regular seasonal flu was associated with higher rates of hospitalization and complications resulting in pneumonia than H1N1.

To sidestep ethical and legal concerns over mandatory vaccination, the AAP recommends allowing a loophole for medical workers with religious objections to immunization or medical conditions that would interfere with the vaccine. The policy statement, along with the AAP’s logistical recommendations for implementing mandatory flu shots, will be available online on Sept. 13. In the meantime, a summary appears on the AAP website.

It’s interesting to note that while flu vaccines are a standard part of the U.S. government’s public-health strategy, at least one scientist has made the case that their ability to reduce influenza infection or risk of death hasn’t really been proven. Tom Jefferson, an epidemiologist with the Cochrane Collaboration, which periodically conducts extensive reviews of existing scientific data, says: “I think with influenza there’s a feeling in governments that ‘we have to do something.’ Well, you can do something: you can better promote cheap public health measures such as hand-washing. They work.” Read the full interview with Jefferson here.

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