Laws Promoting Flu Vaccines For Hospital Workers Tied To Lower Patient Mortality

U.S. state laws promoting hospital worker vaccination against influenza were associated with reductions in pneumonia and influenza mortality rates among patients when the vaccine matched circulating strains, researchers say.

"The elderly are extremely vulnerable to influenza and are also generally less responsive to the vaccine," Dr. Emily Lawler of the University of Georgia in Athens told Reuters Health by email. "Evidence suggests, however, that vaccinating hospital workers against influenza reduces influenza disease transmission and protects this vulnerable population."

"We believe that a federal mandate requiring hospital workers to annually receive the influenza vaccine would serve to further reduce influenza-related mortality," she said. "Related evidence has shown that stricter policies...result in higher vaccination rates. Similarly, our results are consistent with the idea that these stronger laws result in larger reductions in influenza-related mortality."

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"If the COVID-19 vaccine is effective at reducing an individual's ability to transmit the disease - which, to the best of my knowledge, still remains unknown - it would be reasonable to expect that vaccinating hospital workers against COVID-19 would also similarly serve to reduce disease transmission and mortality in the broader community," she added.

As reported in Annals of Internal Medicine, Dr. Lawler and colleagues analyzed pneumonia and influenza mortality per 100,000 persons by state and by month using restricted-access National Vital Statistics System files for 1995-2017. They collected information on the timing and content of state laws from the CDC Public Health Law Program's Menu of State Hospital Influenza Vaccination Laws and from a review of state statutes.

Using quasi-experimental, state-level, longitudinal designs, they estimated the association of state laws with mortality rates. To determine national trends in hospital workers' vaccination coverage and exposure to state laws over the sample period, they used annual influenza vaccination rates by occupation from the National Health Interview Survey and hospital sector population data from the Current Population Survey.

An influenza year spanned July to June to capture the full influenza season. The team's main analyses were limited to 17 influenza years in which the vaccine was well matched to circulating strains (five with match rates below 50% were excluded).

The proportion of hospital workers subject to an influenza vaccination law increased from less than 2% in 1995 to approximately 38% in 2017, as the number of states with a law increased from one (Alabama) to 15.

Implementation of state laws requiring hospitals to offer influenza vaccination to their employees was associated with a 2.5% reduction in the monthly pneumonia and influenza mortality rate (−0.16 deaths per 100,000 persons during the years when the vaccine was well matched to the circulating strains). The largest effects occurred among those ages 65 and older and during peak influenza months (December through March).

Dr. Daniel Kuritzkes, Chief, Division of Infectious Diseases at Brigham and Women's Hospital in Boston, commented in an email to Reuters Health regarding the potential implications of the study for COVID-19 vaccinations. "It's premature to be talking about making COVID-19 vaccines mandatory, as they still do not have full FDA approval. Right now, the emphasis is on voluntary acceptance of the vaccine."

"If, at some future point, COVID-19 vaccination does become mandatory," he said, "it is likely that hospitals and other healthcare institutions will handle compliance in the same way that influenza vaccination is currently handled."

—Marilynn Larkin

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