Requiring Influenza Vaccination for Selected Health Care Personnel in New York State

Background: The NYS Department of Health (DOH) spent several years working with health care facilities, provider organizations and other stakeholders to increase voluntary influenza vaccination rates. A regulation mandating influenza vaccination for certain health care personnel (HCP) was proposed because rates remained static. The routine regulatory process was already underway when the H1N1 pandemic occurred.  However, due to an immediate concern for patient safety, the regulations were implemented on an emergency basis on August 13, 2009, mandating both seasonal influenza vaccination and H1N1 vaccination.

Setting: The requirement applied to regulated hospitals, clinics, certain long-term home health care programs, home health care agencies, and hospices.

Population: The regulation applied to certain HCP in covered facilities who provided direct patient care or whose activities were such that if they were infected could potentially expose patients to influenza.

Project Description: The regulations were modeled after existing requirements for measles and rubella vaccination and only allowed for medical exemption.  Challenges included: difficulty with implementation due to shortages of both influenza vaccines; determining which personnel met the definition of those who must be vaccinated; determining the disposition of those who had a medical exemption or refused vaccination; dealing with opposition from a vocal minority of HCP, consuming considerable DOH staff time; and misconceptions about influenza vaccines.  Several lawsuits were filed.  Due to a lack of vaccine supply, the Commissioner suspended the requirement on October 23, 2009. 

Results/Lessons Learned: Despite supply issues and other challenges, many hospitals successfully implemented comprehensive vaccination programs. DOH will survey all hospitals to study this further.  DOH will continue with the routine regulatory process and plans to have a requirement effective for the 2010-2011 influenza season. Changes to the permanent regulation will attempt to clarify issues that arose and education will continue in order to correct misconceptions and counter opposition.