American Journal of Preventive Medicine
Volume 47, Issue 3, p233-374 September 2014
http://www.ajpmonline.org/current

A Systematic Review of Mandatory Influenza Vaccination in Healthcare Personnel
Samantha I. Pitts, MD, MPH, Nisa M. Maruthur, MD, MHS, Kathryn R. Millar, MPH, RN, Trish M. Perl, MD, MSc, Jodi Segal, MD, MPH
DOI: http://dx.doi.org/10.1016/j.amepre.2014.05.035
Abstract
Context
Influenza is a major cause of patient morbidity. Mandatory influenza vaccination of healthcare personnel (HCP) is increasingly common yet has uncertain clinical impact. This study systematically examines published evidence of the benefits and harm of influenza vaccine mandates.
Evidence acquisition
MEDLINE, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, and Conference Proceedings Citations Index were searched and analyzed in 2013. Studies must have assessed the effect of a requirement of influenza vaccination among HCP for continued employment or clinical practice. Studies were not limited by comparison group, outcome, language, or study design. Two reviewers independently abstracted data and assessed bias risk.
Evidence synthesis
Twelve observational studies were included in the study from 778 citations. Following implementation of a vaccine mandate, vaccination rates increased in all eight studies reporting this outcome, exceeding 94%. Three studies documented increased vaccination rates in hospitals with mandates compared to those without (p Conclusions
Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.