1. Healthcare worker influenza immunization-San Diego • 2006-2007 national HCW influenza vaccine coverage rate 44% • Significant effort by Occupational Health and Infection Control groups in recent years to maximize influenza vaccination • SB 739 and declination statements • SDHIIP project • H1N1!

2. Percent of hospital-based respondents vaccinated 06-08 by job category. The sample size for each category is too small to detect significant difference. Source: 2006, 2007 & 2008 RDD HCW Telephone Survey n = 509 (2006) n = 533 (2007) n= 192 (2008) Job categories recoded from self-reported job description, coding varied slightly between 3 years S:\PHS\Immun\Evaluation\RDD2008\HCW_ADULT 2008\Presentations\2008 RDD Highlights for Eval.ppt

3. Influenza Coverage Rates RDD Telephone Surveys 2005, 2008, and 2009 (n for each category on next slide) HCW shows 2007 coverage rate instead of 2005 HCWs not excluded from other categories S:\PHS\Immun\Evaluation\Results\Adults and Seniors\Highlights in PowerPoint Presentations\2009\Adult Influenza RDD Survey Results 2009.ppt

4. National HCW flu coverage rates MMWR 2010;59(12):357-62

5. San Diego HCW Influenza VaccineRDD Survey 2006-2008 – All HCWs Received Influenza vaccine last year 70% Have never received flu vaccine 19.8% Reasons why not Not in priority group 41.7% Vaccine side effects 16.7% Vaccine doesn’t work 13.2% I never get sick

6. Rationale for Mandatory Infuenza Immunization for Healthcare Workers There is precedent for requiring immunizations for employment in healthcare settings (measles, varicella, hepatitis B) Multiple studies implicate healthcare workers in the transmission of influenza to patients Maximum efforts over many years to reach the goal that >90% of HCW be immunized for influenza have failed People are infectious before they have symptoms so steps to avoid transmission come too late

7. BJC Healthcare/Washington University experience • Large system with 11 acute care hospitals • Mandated influenza vaccination and made it a condition of employment in 2008 • Medical and religious exemptions allowed • In 2009 25,561/25,980 (98.4%) employees vaccinated • 321 medical exemptions • 90 religious exemptions Babcock et al, Clin Infect Dis 2010; 50:459-64

8. BJC Healthcare/Washington University experience Babcock et al, Clin Infect Dis 2010; 50:459-64

9. Hospitals with Mandatory Influenza Policies Virginia Mason Health System, 2004 UC Davis Medical Center, 2009 University of Iowa Medical Center, 2009 BJC Healthcare/Washington University, St. Louis 2008 U Penn/CHOP 2009 All New York State Hospitals and long-term care facilities, 2009 Naval Medical Center San Diego (Civilians) 2009 UCSD Medical Center, Rady Children’s Hospital San Diego 2009