Influenza vaccination uptake in an Australian hospital: time to make it mandatory for health care workers?

To the Editor: Poor influenza vaccination uptake among Australian health care workers has recently come under scrutiny in the media.1 The Australian immunisation handbook recommends influenza vaccination for all health care workers to prevent influenza transmission to patients and other staff.2 Despite this recommendation, the proportion of health care workers vaccinated has remained low across Victoria.3 Nevertheless, the Peter MacCallum Cancer Centre (PMCC) — a tertiary facility in Melbourne, Vic, responsible for the care of immunocompromised cancer patients — has recorded increasing vaccination uptake across four consecutive influenza seasons (Box). During our 2012 staff influenza vaccination program, overall vaccination uptake was 78% (1666/2138 employed staff); 76% and 88% among medical and nursing staff, respectively.

The vaccination program at the PMCC was delivered using a multistrategy approach. Executive endorsement, liaison with union representatives and targeted education ensured the support of managers, heads of department and other hospital staff. Intensive campaigning involved displaying posters, distributing the program timetable with employee payslips and emailing news articles. A vaccination clinic was held for 3 weeks, after which vaccination was provided by the infection control unit for 3 months. Weekend clinics and mobile vaccination services were available throughout the program.

A staff vaccination database was used to track vaccination and refusal rates. Since 2009, it has been mandatory for staff who do not wish to be vaccinated to complete a declination form. Although supervisors are provided with a weekly list of unvaccinated personnel, no punitive action is taken against staff who decline. Of all refusals at our centre, 14% were for medical reasons.

Despite having recorded our highest vaccination uptake to date, with rates in excess of Victorian trends, we consider there is room for improvement. This is particularly important, given the immuno-suppressed patient population managed at our centre. Some facilities in the United States have enforced a mandatory influenza vaccination policy with punitive action for non-compliance, resulting in sustained vaccination rates of above 97%.4 While barriers to implementation of mandatory vaccination have been previously identified,5 such policies have increased vaccination uptake among staff who decline because of personal preference.6 To our knowledge, no Victorian centre has employed such a strategy. We believe that mandating vaccination would improve and sustain its uptake among health care workers. National policy consensus is needed to assist this process.

Staff influenza vaccination rates 2009–2012, Peter MacCallum Cancer Centre (PMCC) compared with Victorian aggregate