Vaccinating all caregivers against the flu: an obvious obligation
Press release from the French National Academy of Medicine
September 19, 2020
In France, vaccination coverage of healthcare workers against influenza remains insufficient. During the 2018-2019 season, it was estimated at 35% in healthcare institutions (67% for doctors, 48% for midwives, 36% for nurses and 21% for nurses’ aides) and at 32% in nursing homes for dependent elderly people (EHPAD) (75% for doctors, 43% for nurses, 27% for nurses’ aides and 34% for other paramedical staff )[1].
Because of their occupational exposure, the risk of influenza infection is higher among caregivers than in the general population. They are often implicated as a likely source of contamination in nosocomial influenza epidemics, with 50-80% of them continuing to work when infected. Hospital-acquired influenza is common in hospitals and in EHPAD, where it leads to up to 60% mortality [2].
Influenza vaccination for healthcare professionals protects vulnerable individuals, reduces nosocomial transmission of influenza and decreases patient mortality. It is an ethical responsibility to protect patients in their care [3]. 3] Depending on the country, vaccination of healthcare workers is based on a recommendation or an obligation, sometimes with differences depending on the category of staff. In France, it was made mandatory in 2006 by article L3111-4 of the Public Health Code, but the decree n°2006-1260 of October 14, 2006 suspended this vaccination obligation [4].
The Covid-19 pandemic has made it necessary to reconsider this decision.
The recommendation to make the annual vaccination of healthcare workers against seasonal influenza mandatory has already been formulated in the report adopted by the National Academy of Medicine in January [5] and reiterated in its communiqué of May 13 [6].
Noting that a resurgence of the epidemic of Covid-19 is manifesting itself in a major part of the national territory at the approach of autumn, the National Academy of Medicine wishes to recall the following points:
– The current evolution of epidemiological indicators makes us fear the persistence of a circulation of SARS-CoV-2 in an epidemic mode until next spring;
– no one can predict the magnitude or severity of the seasonal influenza of 2020-2021;
– the risk of overloading hospital services by the addition of severe influenza cases to Covid-19 cases, aggravated by the incapacity of sick caregivers, cannot be assumed.
Consequently, the National Academy of Medicine considers that it is urgent to make flu vaccination mandatory for all healthcare personnel working in the public or liberal sector, in health establishments and in EHPADS, as well as for elderly care assistants.
References
[1] Santé Publique France. Couverture vaccinale antigrippale chez les professionnels de santé. Bulletin de santé publique, octobre 2019.
[2] HCSP. Rapport « Efficacité de la vaccination contre la grippe saisonnière chez les personnes âgées et les professionnels de santé », mars 2014.
[3] Perl TM, Talbot TR. Universal Influenza Vaccination Among Healthcare Personnel: Yes We Should. Open Forum Infect Dis. 2019 ; 6(4) :ofz096.
[4] Conseil supérieur d’hygiène publique de France. Avis relatif à la mise en œuvre de la protection individuelle contre la grippe des professionnels visés à l’article L 3111-4 du code de la santé publique par une obligation vaccinale, 19 mai 2006.
[5] Académie nationale de médecine. Rapport « La lutte contre l’antibiorésistance dans la politique nationale de santé », 14 janvier 2020.
[6] Académie nationale de médecine. Communiqué « Face à la Covid-19, vaccinons contre la grippe ! », 13 mai 2020.
