Mandatory Influenza Vaccination Advised for Healthcare Personnel in VA, Non-VA Hospitals

A national survey was conducted to assess influenza prevention practices in Veterans Affairs and non-Veterans Affairs hospitals in the United States.

Responses from 1062 experts in the prevention of the spread of infectious disease to a survey published in JAMA Open Network indicated that many non-Veterans Affairs (VA) hospitals and nearly all VA hospitals are not mandating influenza vaccinations for all healthcare personnel (HCP).

The survey consisted of a questionnaire administered via mail between 2013 and 2017 to a nationally representative sample of all VA and non-VA hospitals in the United States. Overall response rates to the survey in 2013 were 69.3% (non-VA, 70.6%; VA, 63.5%), and in 2017 this dropped to 59.1% (non-VA, 59.1%; VA, 58.9%). Mandatory vaccination requirements increased from 37.1% to 61.4% from 2013 to 2017 (difference, 24.3%; 95% CI, 18.4%-30.2%; P < .001). This change appeared to be driven by non-VA hospitals for which requirements went from 44.3% to 69.4% during the study years (difference, 25.1%; 95%CI, 18.8%-31.4%; P < .001). There was no significant change in the proportion of VA hospitals requiring vaccination during this period (1.3% in 2013 to 4.1% in 2017 [difference, 2.8%; 95% CI, −2.4% to 8.0%; P = .29]).

The hospitals surveyed in 2017 were largely obtained from a different sample than those involved in the previous surveys and included a significantly higher proportion of rural, nonteaching hospitals with smaller total bed numbers. The investigators did not, however, detect differences in the presence of vaccination mandates based on these characteristics. It is also possible that differences in wording in the 2013 vs 2017 survey biased results because “the 2013 survey question explicitly focused on HCP providing patient care, potentially leading to an underestimation of the vaccination requirement among all HCP.” The investigators were also not able to show whether mandating vaccinations influenced influenza rates as flu rates were not collected in this study.

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The results do show that a significant increase in mandatory vaccination requirements occurred in non-VA hospitals.  Although these requirements are “strongly encouraged” in VA hospitals, <5% of those surveyed reported having them in place. The investigators recommend that “in addition to implementing other well-described strategies to increase vaccination rates, health care organizations should consider mandating influenza vaccinations while appropriately weighing and managing the moral, ethical, and legal implications.”


Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in influenza vaccination requirements for health care personnel in US hospitals. JAMA Network Open. 2018;1:e180143.