Counterpoint: in favor of mandatory influenza vaccine for all health care workers.

Health care workers (HCWs) who have contact with patients have an increased risk of exposure to vaccinepreventable diseases and of spreading those diseases to vulnerable patients. Maintenance of immunity against vaccine-preventable diseases is an essential part of disease-prevention and infection-control programs [1]. Influenza is the most common vaccine-preventable disease, and nosocomial transmission is frequently identified in health care facilities; yet, voluntary vaccination policies permit HCWs to put patients at risk of influenza, despite the availability of a safe and effective vaccine. Together, influenza and pneumonia are the seventh leading cause of death overall in the United States. Deaths due to influenza and pneumonia greatly exceed the death toll from AIDS, and these illnesses rank in the top 10 causes of death for every decade of life. Annual epidemics of influenza result in ∼40,000 deaths and 1200,000 hospitalizations in the United States [2, 3], accounting for the winter increase in US mortality rates [4]. The greatest toll is on persons 65 years of age and those with underlying chronic illnesses—precisely the population in our hospitals, intermediate care facilities, and long-term care facilities. Vaccination is the primary means of preventing influenza. Inactivated influenza vaccine is safe and effec-