Measuring the impact of influenza vaccination on healthcare worker absenteeism in the context of a province-wide mandatory vaccinate-or-mask policy.

• In 2012, British Columbia introduced a vaccinate-or-mask policy for healthcare workers. • We assessed self-reported vaccination status impacts on individual HCW all-cause sick rates. • HCWs reporting 'early' vaccination had the lowest year-round sick rates. • Further study is needed to assess behavioral factors influencing HCW absenteeism. In 2012, British Columbia (BC) implemented a province-wide vaccinate-or-mask influenza prevention policy for healthcare workers (HCWs) with the aim of improving HCW coverage, and reducing illness in patients and staff. We assess post-policy impacts of HCW vaccination status on their absenteeism. We matched individual HCW payroll data from December 1, 2012 to March 31, 2017 with annually self-reported vaccination status for BC health authority employees to assess sick rates (sick time as a proportion of sick time and productive time). We modelled adjusted odds ratios (OR) of taking any sick time, relative rates (RR) of sick time taken, and predicted mean sick rates by vaccination status in influenza (December 1–March 31) and non-influenza seasons (April 1 to November 30). We used two methods to assess changes in influenza season sick rates for HCWs who had a change in their vaccination status over the five years. HCWs who reported 'early' vaccination (before December 1 when the policy is in effect) were less likely to take sick time (OR 0.874, 95%CI: 0.866–0.881) and took less sick time (RR 0.907, 95%CI: 0.901–0.912) in influenza season compared to HCWs who did not report vaccination; whereas HCWs who reported 'late' (between December 1 and March 31, and subject to masking until vaccinated) had similar sick rates to HCWs who did not report vaccination. These trends were also observed in non-influenza season. Influenza season sick rates were similar for HCWs that had at least one year of 'early' vaccination and one year where vaccination was not reported over the five year period. Overall absenteeism is lower among HCWs who report vaccination versus those who do not report. However, absenteeism behaviours appear to be influenced by individual level factors other than vaccination status. [ABSTRACT FROM AUTHOR]