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Immunizations and Exemptions

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Immunizations and Exemptions IMMUNIZATIONS AND EXEMPTIONS Policy Position | 2020-2021 Policy Council In order to protect the health of the public effectively, Texas Nurses Association (TNA) supports policies that mandate “all individuals receive immunizations against-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP),” in line with the American Nurses Association (ANA) revised position statement on immunizations. Registered nurses (RNs) along with all health care workers should be vaccinated based on the guidance for health care workers put forth by the CDC and ACIP. TNA does not support exemptions from immunization, except for annually documented and recertified medical contradictions. Furthermore, TNA does not support philosophical or religious exemptions to immunizations. People with documented medical exemptions may be required to reduce the chance of infectious disease transmission through workplace protective measures or practices, and employers should support and offer these reasonable accommodations. Development of safe vaccinations readily available to everyone is essential to protecting public health. TNA supports ongoing research into prevention and control of novel infectious diseases, such as COVID-19. TNA further collaborates with the Texas Department of State Health Services Immunization Unit, the Immunization Partnership, and the Texas Public Health Coalition. BEST PRACTICES According to CDC, ACIP, and Association of Professionals in Infection Control and Epidemiology, all people, including RNs, must receive immunizations against vaccine-preventable diseases to effectively protect the public.1 Immunization protects nurses and indirectly prevents patients from acquiring significant morbidity and mortality from health care- associated vaccine-preventable diseases.2 Texas Administrative Code requires each health care facility to develop, implement, and enforce a policy and procedures to protect patients from vaccine-preventable diseases (TAC 25 §1.702). VACCINE SAFETY It is imperative that every health care worker recognize the available safety data and feel confident and empowered to give credible information backed by scientific evidence.3 After a vaccine receives approval and recommendation as a routine vaccine for administration, it continues to be monitored for safety by the Food and Drug Administration and CDC through several systems.4 Immunizations | 1 • The Vaccine Adverse Event Reporting System collects and analyzes reports on adverse events that occur after vaccination. • The Vaccine Safety Datalink and Post-Licensure Rapid Immunization Safety Monitoring are two network systems for health care organizations used by scientists across the U.S. to monitor vaccine safety. The Clinical Immunization Safety Assessment Project is a collaboration between the CDC and seven medical research centers with vaccine safety experts assisting providers to answer complex vaccine safety questions while also researching to better understand vaccine safety and identify strategies to prevent adverse events following immunization. There is no known benefit to delaying or skipping vaccinations. Children and adults can be exposed to vaccine- preventable diseases in the public environment and within their own home. If people do not vaccinate, they must know their responsibility to prevent disease outbreak if their child or they become infected with a vaccine-preventable disease.5 In 2000, the CDC declared measles eliminated in the United States. However, vaccine hesitancy led to 1,282 cases of measles in 2019, mostly in those who were not vaccinated against the disease.6 ETHICAL DUTY For registered nurses, the principles of beneficence and nonmaleficence guide nursing care. For example, seasonal influenza is highly contagious. Most health care organizations expect that all health care workers receive the flu vaccine. Without this mandatory requirement, the vaccine rate may be as low as 70% for HCW and can remain suboptimal.7 Evidence shows mandatory flu vaccination policies are justified in context of the nurse’s ethical duty or obligation and the conscious autonomous choice to work in the service and interest of the vulnerable patient. Furthermore, as stated in the Code of Ethics for Nurses, the nurses’ primary commitment is to the patient, whether an individual, family, group, community, or population.8 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient, and has the authority, accountability, and responsibility to make decisions and take actions consistent with the obligation to promote health. In addition, the nurse owes the same duty to self as to others including promotion of safety and should participate individually and in collective efforts to establish, maintain and improve health care environments and conditions of employment conducive to safe, quality health care. 1 Centers for Disease Control and Prevention. (2011). Immunizations of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 60(7). Morbidity and Mortality Weekly Report (MMWR) 2011;60. Accessed on October 16, 2020. https://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf 2 Maltezou, H. C., & Poland, G. A. (2016). Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare (Basel, Switzerland), 4(3), 47. https://doi.org/10.3390/healthcare4030047 3 Geoghegan, S., O'Callaghan, K. P., & Offit, P. A. (2020). Vaccine Safety: Myths and Misinformation. Frontiers in microbiology, 11, 372. https://doi.org/10.3389/fmicb.2020.00372 4 Centers for Disease Control and Prevention. (2018). The journey of your child’s vaccine. Accessed on October 16, 2020. https://www.cdc.gov/vaccines/parents/infographics/journey-of-child-vaccine.html 5 Centers for Disease Control and Prevention (CDC). (2019). Making the vaccine decisions: Addressing common concerns. Accessed on October 19, 2020. https://www.cdc.gov/vaccines/parents/why-vaccinate/vaccine-decision.html 6 Centers for Disease Control and Prevention (CDC). (2020). Measles (Rubeola): Measles cases and outbreaks. Accessed on October 18, 2020. https://www.cdc.gov/measles/cases-outbreaks.html 7 Van Hooste, W., Bekaert, M., (2019). To be or not to be vaccinated? The ethical aspects of influenza vaccination among healthcare workers. International Journal of Environmental Research and Public Health, 16(20), 3981. https://doi:10.3390/ijerph16203981 8 American Nurses Association. (2015). Code of Ethics for Nurses: with interpretive statements. Silver Spring, MD: Nursesbooks.org. Immunizations | 2 .
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