Assessment of state immunization requirements for healthcare workers and patients

A new study shows wide state-to-state variations in laws regulating vaccinations for health care workers and patients, setting the stage for future research to determine whether more laws could serve as effective tools to combat infectious diseases.

The Centers for Disease Control and Prevention study does not offer conclusions as to whether more state laws would mean lead to better protection for the population.

The authors write that school entry laws nationwide have succeeded in maintaining high vaccination levels among children, thus reducing the incidence of diseases that vaccines can prevent. State laws geared toward immunization of other population segments are inconsistent.

There are no federal immunization laws.

The next step would be to conduct research that “really will provide evidence that laws are an effective tool for ensuring coverage of vaccines for health care workers and others,” said Megan Lindley, lead author of the study.

The study, which appears in the June issue of the American Journal of Preventive Medicine , says it is the first to review laws mandating immunization of health care workers and patients in a variety of settings in all 50 states and Washington, D.C. The results of the survey were current as of June 30, 2005.

“There aren't very many laws, period,” said Lindley, who is affiliated with the Immunization Services Division of the National Center for Immunization and Respiratory Diseases.

Laws pertaining to vaccination of health care workers and patients “vary widely by state” in terms of specific vaccines required, where the health care workers are employed and the people covered, the study said. Mandatory vaccination laws most often pertained to patients or residents in institutional settings such as prisons or facilities for the developmentally disabled.

For example, only 32 states had some type of law about administering vaccines to health care workers. Of those, the laws in 21 states were for voluntary immunization of health care workers and the laws in 15 states were for mandatory vaccination. The majority of laws for voluntary immunization of healthcare workers, enacted in 20 states, concerned hepatitis B immunization; only three states had laws for voluntary flu vaccinations of health care workers.

“We are looking for tools so people can be vaccinated against diseases,” Lindley said. “State laws are one of the tools that could be used … It's premature to use our data to say there ought to be a law, even if we suspect that if we had better laws we would have better [immunization] coverage.”

The American Nurses Association opposes mandatory vaccination for nurses as a condition of employment because of possible problems with new vaccines, though the ANA does encourage nurses to be immunized, especially against hepatitis B

“We believe that it [vaccination] is a good thing. But I wouldn't want to be the one mandating it,” said Mary Jean Schumann, director of nursing practice and policy at the ANA. “I want to protect the public, but do we want to protect ourselves and our children? Absolutely.”

Model legislation could help states that want to implement vaccination requirements in various health care settings, the study concluded. Such requirements for health care workers and patients, properly enforced, it said, should be an effective tool in reducing infections associated with health care and should increase the overall quality of medical care.

Lindley MC, et al. Assessing state immunization requirements for healthcare workers and patients. Am J Prev Med 32(6), 2007.