Healthcare workers and the flu vaccine: Masking and mandatory measures?

A literature review, conducted by the UK’s National Institute for Clinical Excellence (NICE) has found that of all the trial measures they examined, offering healthcare workers the choice between becoming immunised against influence or wearing a face mask was the most effective means of increasing uptake.

The review examined studies which assessed the outcomes of different trails, employing different measures to increase uptake of the flu vaccine amongst healthcare workers around the world. Measures included increasing access, increasing the availability of educational resources, incentivising healthcare workers, circulating reminders and issuing declination forms. Some studies also examined the effects of using multiple components to encourage vaccine uptake.

Of all of the peer-reviewed studies reviewed however, the greatest effect (RR 1.58, 95% CI) was produced through offering healthcare workers the choice between becoming immunised to protect themselves and their patients, or wearing a surgical face mask.

The 2013 US study, ‘Developing a program to increase seasonal influenza vaccination of healthcare workers: lessons from a system of community hospitals‘ examined the effects of such mandatory measures on an overall healthcare worker population of 515,115. It found that with 100% compliance with the policy, the vaccination rate increased from a mean of 58% to over 90% for three consecutive influenza seasons. However, study authors also note that ‘Essential components (of the programme) included steadfast leadership support, continuous education and communication efforts’.

Such educational supplements appear necessary, given that the review also summarised findings from qualitative studies, and found that education and awareness, particularly around the efficacy of the flu vaccination were important to overcoming barriers to immunisation (see figure 1, presented at NICE’s Final Public Health Advisory Committee for Increasing Flu Vaccination Uptake, 2017).

With front line healthcare worker uptake rates of the flu vaccine at only 50.6% in England, such findings may well prompt immunisation advocates to consider the merit of mandatory measures in different care settings.