Assessing state immunization requirements for healthcare workers and patients

Background: Laws requiring vaccination for school entry have resulted in high coverage and reduced disease incidence; however, few data exist on the use of similar laws in other settings. This study reviews laws regulating vaccination of healthcare workers (HCWs) and patients in selected healthcare delivery settings. Methods: From September 2004 to June 2005, Lexis-Nexis and other web-based databases were searched for laws pertaining to HCW and patient vaccination in 50 states and Washington DC. Laws were grouped by population, setting, vaccine type, and voluntary versus mandatory vaccination. Data were analyzed in 2006. Results: Over half of states (n = 32) have laws for HCW vaccination in traditional healthcare settings (hospitals, ambulatory care), while only seven states have laws for patients in these settings. Most laws regulating vaccine administration for HCWs were voluntary; requirements for mandatory immunization were most common for institutionalized populations. Conclusions: Significant state-to-state variation exists in laws for vaccination of HCWs and patients. Additional data are needed on how such vaccination requirements affect coverage in these populations. Model legislation may be helpful to states wishing to implement immunization requirements.