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ACOEM: Mandatory Flu Shot Not Justified for Health Care Workers

Mandatory influenza vaccination for health care workers is not justified, the American College of Occupational and Environmental Medicine (ACOEM) asserts in a new position statement.

ACOEM also says it opposes the use of declination statements, noting that there is "no evidence to suggest that such programs will increase compliance."

The statement, titled "Influenza Control Programs for Health Care Workers," applies to seasonal influenza and is not necessarily appropriate during a major antigenic shift in the virus resulting in a pandemic situation, according to ACOEM.

Influenza continues to be a major cause of death and disease, readily spread by respiratory droplets both in the community and in the hospital environment. While ample reasons exist for employers to sponsor influenza vaccination programs for their employees and to pursue strategies to maximize participation, ACOEM noted that mandatory flu shots are not justified for several reasons:

  • The vaccine itself is variably effective.
  • Vaccination does not preclude the need for other controls.
  • A coercive program has the potential to harm the employer-employee relationship.

In addition, the organization points out that "given the ubiquitous nature of influenza in the community, patients will continue to be exposed to influenza through family members and friends regardless of the vaccination status of their health care workers, with whom they have much less intimate contact."

"Vaccination is only one prong in a multifaceted approach to infection control," said William Buchta, M.D., MPH, FACOEM, chair of the association's Medical Center Occupational Health Section and author of the paper. "Health care workers must also appropriately use hand washing and personal protective equipment and they should consider self-removal from work when experiencing symptoms of a communicable illness."

Buchta also noted that reliance on employee vaccinations alone for prevention and control of influenza in the health care environment offers a false sense of security and ignores some of the more practical, but also effective, means of minimizing nosocomial transmission.

While ACOEM endorses a multifaceted influenza control program in all health care facilities and strongly encourages health care organizations to facilitate participation by providing influenza vaccine and/or prophylactic medication at no expense to the employee, the group discourages generalized policies requiring mandatory compliance with employee vaccination or prophylactic medication, noting that such policies already have been successfully challenged in Canada.

"Making people sign a statement that they have declined to receive a flu shot not only impacts the employer-employee relationship in a negative way, but diverts resources from activities known to increase compliance and devotes them to enforcement of a policy with no proven benefit," Buchta said. "Influenza control can be successful with creative programs that employ the 'carrot' rather than the 'stick' while still respecting the rights of both patients and employees."

"Influenza Control Programs for Health Care Workers" was approved by the ACOEM Board of Directors on July 30. It is available on line at In addition, the paper was published in the July/August issue of ACOEM Report, the organization's official newsletter.

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