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

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.

FIGURE 1.

(Panel A) Adjusted odds ratio for influenza vaccination in ResPECT HCP. Adjusted for study year (2012–2013; 2013–2014; 2014–2015), sex of participants, number of children <5years of age at home, age, reported exposure to patients with symptomatic respiratory illness in workplace, and work at mandatory or nonmandatory vaccination policy at workplace. (Panel B) Adjusted odds ratio for 1 or more SILI days absent during observation period. Adjusted for study year (2012–2013; 2013–2014; 2014–2015), sex of participants, number of children <5 years of age at home, age, reported exposure to patients with symptomatic respiratory illness in workplace, and work at mandatory or nonmandatory vaccination policy at workplace. (Panel C) Adjusted odds ratio for 1 or more symptomatic influenza-like illness (SILI) days absent during observation period in study participants at the sites without a mandatory vaccination policy. Adjusted for study year (2012–2013; 2013–2014; 2014–2015), sex of participants, number of children <5 years of age at home, age, and reported exposure to patients with symptomatic respiratory illness in workplace. (Panel D) Adjusted relative rate of SILI-associated days of absenteeism during observation period. Adjusted for study year (2012–2013; 2013–2014; 2014–2015), sex of participants, number of children <5 years of age at home, age, reported exposure to patients with symptomatic respiratory illness in workplace, and work at mandatory or mandatory vaccination policy at workplace. (Panel E) Adjusted relative rate of SILI-associated days of absenteeism during observation period in study participants at the sites without a mandatory vaccination policy. Adjusted for study year (2012–2013; 2013–2014; 2014–2015), sex of participants, number of children <5 years of age at home, age, and reported exposure to patients with symptomatic respiratory illness in the workplace. In all panels, dot represents the point estimate, whiskers the 95% confidence intervals.