need for or usefulness of administrative leave as a way to support health care worker decision-making and perhaps to ensure patient safety. When ACIP met in October 2002, members discussed the issue of administrative leave for health care workers who would receive the vaccine in the pre-event vaccination program. In their recommendation, they stated, “With respect to administrative leave for health care workers, the ACIP does not believe that health care workers need to be placed on leave because they received a smallpox vaccination. Administrative leave is not required routinely for newly vaccinated healthcare workers unless they are physically unable to work due to systemic signs and symptoms of illness, extensive skin lesions which cannot be adequately covered, or if they do not adhere to the recommended infection control precautions. It is important to realize that the very close contact required for transmission of vaccinia to household contacts is unlikely to occur in the healthcare setting” (CDC, 2002e).
The issue of administrative leave is complicated. CDC has no authority to resolve the issue of costs for administrative leave; it can only provide guidance based on ACIP recommendations as stated above. Nevertheless, the committee is sympathetic to the concerns of workers who might not participate in the program without adequate accommodation, but also to the financial and staffing problems that hospitals or health departments would have in offering administrative or other paid leave. Ideally, any individual or institution that wished to use an administrative or other paid leave policy would be able to do so. However, this may not be feasible to resolve for phase I of the program, given the short period until vaccinations begin and the reportedly short duration of phase I. Therefore, the committee recommends that during phase I, CDC assess the effects of the current situation regarding administrative leave, disseminate the analysis widely, and before phase II begins, decide whether the ACIP recommendation needs to be reassessed. Any evidence of transmission of vaccinia virus to a patient from an immunized health care worker should lead to an active case investigation or to an immediate reassessment of policy. In order to provide an appropriate evidence base for such a reassessment, CDC might wish to:
Develop preliminary standards of care for the types and extent of contact recently vaccinated health care workers should have with patients, taking into account that hospitals care for different spectra of patients with respect to age, disease types, and disease severity;
Survey and analyze the effect of the vaccine on absenteeism; and
Analyze how the cost of offering administrative leave with pay compares with the cost of not offering administrative leave with pay (e.g., accidental inoculations in patients, medical errors due to health care workers not functioning at the proper level due to adverse reactions), using data from hospitals and health departments that decide on their own to offer administrative leave with pay.