Should the H1N1 Vaccine be mandatory for Healthcare Professionals?

CuriousMe · Nov 10, 2009

As a nursing student, I was told to get the shot or drop out. I am not happy with that of course but what can I do? I have worked very hard and put a lot of time and money into my schooling. The CDC says "it is not mandatory", but they are not regulating this statement. Also they are not testing for the H1N1 anymore, does that mean they are also not keeping track of adverse effects? This may be just like the flu shots. The CDC list possible reactions, yet who really reports them if you say you have had a reaction? I had mentioned to a few nurses that I had developed flu symptoms from the vaccine,and all I got was "you can't get the flu from a shot." I am sure they did not report my adverse reactions.

Well, that's probably because you can't get the flu from a flu shot. You could have had the flu already and not shown symptoms until your flu shot.....but you can't get the flu from the flu shot.

According to the Vaccine Information Sheet (that should be given to everybody who gets a flu shot (seasonal or H1N1). Unless you had a high fever, wheezing, or signs of anaphylactis as "flu like symptoms." Then you didn't have an "adverse reaction" you had a predictable reaction. See below for the predicted signs & symptoms from the flu shot. Additionally, the bottom of the VIS gives directions on what to do if you think you are having a serious adverse effect (gives the information and an 800 # for you to contact Vaccine Adverse Event Reporting System (VAERS)).

So, as an adult, the ball is in your court. If you didn't feel the nurse responded appropriately to you, you should have taken the next appropriate step.

Mild problems:

* soreness, redness, tenderness, or swelling where

the shot was given * fainting (mainly adolescents)

* headache, muscle aches * fever * nausea

If these problems occur, they usually begin soon after

the shot and last 1-2 days.

lamazeteacher · Nov 10, 2009

This was in an article in the NY Times, under "Health"

"The mixed reaction from parents about flu vaccine for children is the topic of today’s 18 and Under column by pediatrician Dr. Perri Klass. She writes:

There is a peculiar duality in the collective cultural mind just now, a kind of pandemic doublethink. Other doctors I know are all eagerly having their own children immunized. Many are answering frantic calls from people desperate for the vaccine. But at the same time, we are all coming up against parents who are determined to refuse that same vaccine."

It seems there is much confusion about the flu vaccine for the public. I'm certainly not suggesting that parents be mandated to have their children vaccinated against H1N1, but pointing to the possible inability to make decisions wisely.

It could be that there's too much information, or that people skim informative materials and have a cognition wipe out. When they want a health professional to take care of them by reporting to the CDC a side effect that they reported later, it harks of wanting more from health care professionals, in general, or simply to complain about something that the HCW did to them.

The flu vaccine clinics are crowded, angry people (for many reasons) abound in them, the quickened pace is disconcerting, and confronting a contagious illness that can kill, is never pleasant.

You should have heard (no, you didn't need to) the anger expressed by my 36 year old son who had to wait in very hot weather in his car for 8 hours, with his 6 week old baby and anxious post partum wife with a full bladder, before they had their shots! I had impressed upon him the need to have them, so I was somehow at fault (aren't moms at fault for everything?).

Also the HCWs in clinics held in commercial places are paid 1/4 of the salary usually earned by other professionals at their level. It could be "bottom of the barrel" staffing. They'd been yelled at by frustrated attendees, co-workers and store employees about things they couldn't control, hurried along, and had no time to educate anyone effectivly. The handouts need to have a procedure for reporting side effects to the CDC directly, but the company holding the clinic is afraid of legal repercussions, so they don't provide that.

Everyone is worried today, about the economy, their politicians, personal power ( or lack thereof), that they'll get the flu before the immunity they came for kicks in (if they're informed consumers and know it takes 2-4 weeks for that).

My 42 year old daughter who has MS went for her vaccination yesterday, worried that she'd be fired for taking too much time from work, didn't get it, and is going back today (I insisted). So of course if she suffers in any way, it will be my fault.

Unfortunately "transference" psychologically takes place in many nurse-patient (and government-public) relationships, and lack of getting everything they wanted (who could have?) from parents as children, spills over onto us. We are mother/father figures, like it or not. When people fear pandemic, lethal illness or are sick, they regress...... It's another challenge in being a nurse, and to be warm and caring, but not accept total responsibility for all the world's ills takes time, experience, and conditioning.

sharpeimom · Nov 10, 2009

i had a routine appointment with my internist today. we just switched to him back in the spring when our old internist retired. our new one is fresh out of residency and is

quite different from our old one. we actually have choices about our care now!!

i have been very ambivalent about getting either the "regular" flu shot or the h1n1

shot because back in august, when i received my 4th series of synvisc injections and had a weird reaction, no one (including the manufacturer of synvisc) could figure out why. until we could pinpoint what happened, i decided i absolutely would not get either a seasonal flu shot or a h1n1 shot. i had g-b symptoms, but they only lasted 10 days, my internist, neurologist, and orthopedist all said it wasn't that. on allergy tests, i have always reacted to eggs on the tests, didn't eat then until i was about 12,

nothing adverse happened, so now use a few in foods (like as a binder in meatloaf) but don't really eat them as a separate food. i have always taken the flu shots every year with no effects and have had a pneumonia shot with no problem. i'm going into this much detail, not to solicit medical advice, but to maybe help someone else. i will be protected by herd immunity and because my husband received a seasonal flu shot. our internist is not recommending that his patients get the h1n1 vaccine -- either mist or injection -- because he simply has too many reservations about it. he said if someone specifically asks for it, he has it and will give it, but will recommend seasonal flu shots instead.

end of novel!

kathy

sharpeimom:paw::paw:

Laidback Al · Nov 11, 2009

Our internist is not recommending that his patients get the H1N1 vaccine -- either mist or injection -- because he simply has too many reservations about it. He said if someone specifically asks for it, he has it and will give it, but will recommend seasonal flu shots instead.

Recommending seasonal flu shots for what? The H1N1 component in the seasonal flu vaccine does not protect against the pandemic H1N1 strain. Virtually 100% of flu cases now are infected with the novel strain of H1N1 not the past seasonal strain. I question your internist's advice.

indigo girl · Nov 11, 2009

I will be protected by herd immunity and because my husband received a seasonal flu shot. Our internist is not recommending that his patients get the H1N1 vaccine -- either mist or injection -- because he simply has too many reservations about it. He said if someone specifically asks for it, he has it and will give it, but will recommend seasonal flu shots instead.

I do understand why you would not get vaccinated but it is difficult to understand why your internist is not recommending influenza vaccine for patients, and to recommend only seasonal flu shots when there is so little seasonal flu makes no sense.

I am sure that we will start seeing at least some seasonal flu though so both vaccines are a good idea for the rest of us so that we can protect you with herd immunity.

lamazeteacher · Nov 11, 2009

:sniff:

I do understand why you would not get vaccinated but it is difficult to understand why your internist is not recommending influenza vaccine for patients, and to recommend only seasonal flu shots when there is so little seasonal flu makes no sense.
I am sure that we will start seeing at least some seasonal flu though so both vaccines are a good idea for the rest of us so that we can protect you with herd immunity.

If I had it to do again, I wouldn't have the seasonal vaccine first, as I believe the Canadian study that found 2,000 people in 4 different poulations more susceptible to H1N1 flu following administration of seasonal flu vaccine to them. Sometimes statistics reveal results that are hard to understand, but important to use.

Since seasonal flu isn't expected until late Decemeber, Jan., Feb., and March, getting that vaccine now isn't as essential as having the H1N1 vaccine NOW and avoid a higher morbidity and mortality rate. To the family and victims of H1N1 flu, the fact that people not at high risk were able to obtain vaccination before those in high risk groups, is abominable.

For some reason I haven't read that having H1N1 flu confers immunity. I may have gotten it twice, first in mid August, when I had early treatment with Tamiflu within 48 hours, before a test for H1N1 would turn positive (one that was taken was neg.), and again in October, when the same thing happened, but no test was done. Both times, s/s were identical with eacxh episode and others who had it, and my age (70) and asthma probably prolonged my recovery to 3-4 weeks following onset of s/s.

indigo girl · Nov 11, 2009

:
For some reason I haven't read that having H1N1 flu confers immunity. I may have gotten it twice, first in mid August, when I had early treatment with Tamiflu within 48 hours, before a test for H1N1 would turn positive (one that was taken was neg.), and again in October, when the same thing happened, but no test was done. Both times, s/s were identical with eacxh episode and others who had it, and my age (70) and asthma probably prolonged my recovery to 3-4 weeks following onset of s/s.

You can get it more than once. Too bad you were not tested for confirmation. Here is a case of positive confirmation of novel swine orgin both times:

http://dailymail.com/News/200911041062

Dr. Debra Parsons, a pediatrician at Kid Care West in Cross Lanes, said both she and her son came down with identical flu-like symptoms in August.
Figuring they had the same disease, Parsons swabbed herself and sent the specimen off to a lab. She tested positive for Influenza A, which includes several strains of the flu.
...a more specific follow-up "sub-typing" test at the state lab confirmed she had H1N1.
Parsons and her son recovered from the symptoms but in October they struck again and were much worse, she said. Both had body aches, fever, chills, wheezing, and shortness of breath.
This time Parsons swabbed both herself and her son, and both tests came back positive for Influenza A. She said she pushed for further testing to determine the strain, and the lab ran an immunofluorescence test on the specimens. They again tested positive for H1N1, she said.

lamazeteacher · Nov 11, 2009

this is a post from the nih, that may help those resistant to having vaccine for h1n1, and/or seasonal flu, in the future.

"influenza viruses evade the immune system by constantly changing the shape of their hemagglutinin protein, the protein that lets them attach to cells in the respiratory tract. this shape shifting, called antigenic drift, is why flu vaccines need to be reformulated every year. new findings about the evolutionary forces that drive antigenic drift suggest that it might be slowed by increasing the number of vaccinated children.

influenza virions seen by transmission electron microscopy. image by f. a. murphy, cdc.

seasonal flu shots are designed to prompt the immune system to produce antibodies matched to each year's circulating virus strains. a better understanding of antigenic drift will help improve flu vaccine strategies. drs. scott hensley, jonathan w. yewdell and jack r. bennink of nih's national institute of allergy and infectious diseases (niaid) led a research team exploring the mechanism of antigenic drift. dr. ram sasisekharan headed a collaborating group at the massachusetts institute of technology (mit) supported by nih's national institute of general medical sciences (nigms) and the singapore–mit technology alliance for research and technology.

the researchers used a strain of seasonal influenza virus that had circulated in puerto rico in 1934. they vaccinated some mice against this virus strain, while leaving others unvaccinated. all the mice were then infected with the 1934 influenza strain. the scientists isolated virus from the lungs of both sets of mice and passed on these viruses to new mice. after repeating the process 9 times, the researchers sequenced the virus hemagglutinin genes. the results appeared in the october 30, 2009, issue of science.

sequencing revealed that the unvaccinated mice, which lacked vaccine-induced antibodies, had no mutated influenza viruses in their lungs. in contrast, vaccinated mice harbored hemagglutinin genes that had mutated to allow the viruses to bind more strongly to the receptors used to enter lung cells. essentially, the viruses evolved to shield their hemagglutinin from antibody attack by binding more tightly to virus receptors.

the researchers next infected a new set of unvaccinated mice with the high-affinity mutant virus strains. in the absence of antibody pressure, the scientists found, the viruses reverted to a low-affinity form, enabling them to better propagate in lungs.

the researchers propose a model for antigenic drift in which high- and low-affinity influenza virus mutants alternate. in adults, who've been exposed to many influenza strains in their lifetime, the virus is pressured to increase its receptor affinity to escape antibodies. when these viruses are passed to people, such as children, who haven't been exposed to many influenza strains or haven't been vaccinated, receptor affinity decreases.

"the virus must strike the right balance," yewdell says. "excessively sticky viruses may end up binding to cells lining the nose or throat or to blood cells and may not make it into lung cells. also, newly formed viruses must detach from infected cells before they can spread to the next uninfected cell. viruses that have mutated to be highly adherent to the lung cell receptors may have difficulty completing this critical step in the infection cycle."

if this model is correct, yewdell says, vaccinating more children against influenza could slow the rate of antigenic drift and extend how long seasonal flu vaccines remain effective."

related links:

flu (influenza):
http://www3.niaid.nih.gov/topics/flu/

this week's nih research matters

catching flu’s drift

(we do, all of us pay for their work at nih. it would behoove us to know how they're earning our money..........)

lamazeteacher · Feb 25, 2010

i understand your thinking but it's not the fact that the WHO or CDC would intentionally harm the public with a vaccination, but it has happened as a side effect. example, the public use to be given the oral vaccination for polio until it was discovered, after a period of time, that it was giving a number (VERY FEW*, and it wasn't as severe as those cases who had it without the vaccine) of people polio as a side effect (that wasn't a side effect, it was an aberrant effect). It was then changed to an im injection which is still used today...

(The oral (Sabin)vaccine came after The injected Salk vaccine which was used for a decade or so, before that oral form became available, in the '70s *)

in point proven, sometimes what seems safe and beneficial at first can be deemed quite the contrary after a period of time. (I'd say that it was the exception that proves the rule)*

Actually, the Salk vaccine hadn't caused any s/s of polio, when it was solely used in the '60s; and when the Sabin vaccine resulted in rare mild cases of it, the reports about that resulted in the oral vaccine's withdrawal. It would have been quite interesting to know if those cases occurred in immunocompromised patients, or not. However those days there weren't T4 tests.............*

also... this was the first year I opted for the flu vaccination, and just as some people, it gave me the flu... who's to say that the same can't occur with the h1n1 vaccination... and even if it's one in a hundred... that one peron has to count for something... the numbers are people, not just statistics...

* denotes comments as a reply to the earlier post

There have been very few, if any documented cases of persons who were given H1N1 vaccine, getting H1N1 flu, after the 3 weeks for immunity to develop, passed. As with any vaccination, there is a time period within which antibodies in sufficient quantity to confer immunity, form. When/if a person has been exposed or becomes susceptible to the H1N1 virus before or within the 3 week period following their vaccine, they can become ill with it, although cases in which enough time passed after vaccination, for antibody formation, resulted in milder s/s (certainly not approaching death) as those who hadn't had it.

I'm curious to know if you were tested for H1N1 when you got it after receiving the vaccine, how long after you got it that you first had s/s of flu; and how ill you were.

indigo girl · Feb 26, 2010

* denotes comments as a reply to the earlier post
There have been very few, if any documented cases of persons who were given H1N1 vaccine, getting H1N1 flu, after the 3 weeks for immunity to develop, passed. As with any vaccination, there is a time period within which antibodies in sufficient quantity to confer immunity, form. When/if a person has been exposed or becomes susceptible to the H1N1 virus before or within the 3 week period following their vaccine, they can become ill with it, although cases in which enough time passed after vaccination, for antibody formation, resulted in milder s/s (certainly not approaching death) as those who hadn't had it.
I'm curious to know if you were tested for H1N1 when you got it after receiving the vaccine, how long after you got it that you first had s/s of flu; and how ill you were.

Certainly, the poster did not get the flu from the vaccine as that is not possible.

That said, some will still get the flu even if vaxed, and that is a sad fact with any disease. We know that an influenza vaccine is always chasing a moving target as the viruses will always mutate. And, it is still safer to get vaccinated rather than not, as most will garner some protection from the vaccine. We have no info on when the victim in the link I am referencing below was vaxed, or her date of infection. We do know that she was a paramedic. The premise that Dr. Niman is making is that the vaccine was not effective enough, and that is possible however, we still think that some protection is better than none for most of us providing that the mutation he is talking about is not truly important. That is what we don't know enough about yet. I have been following his posts as well as another researcher on this subject as well about this mutation for some time now, but the data is still not clear on whether or not this is a cause for concern as he would say.

I would still continue to advise vaccinating with H1N1 vaccine as the best protection we have thus far. Most of us, even if we get sick will be fine, but some will not be so lucky. Getting the vax is better than just randomly hoping to be safe.

http://www.recombinomics.com/News/02171001/H1N1_WY_Failure.html

...Benefiel had been vaccinated, friends said. Despite the vaccination, Benefiel contracted severe pneumonia as a result of H1N1 and had to be transported from St. John’s Medical Center in Jackson to Utah.
The Mill Hill low reactor designation for H1N1 with D225G raises concerns that a vaccine lacking D225G, as well as natural immunity to an infection by wild type H1N,1 will generate a response with reduced activity against D225G variants, which are linked to severe and fatal H1N1 infections.
This week the WHO is selecting the vaccine target for the 2010/2011 season, and WHO reports have significantly downplayed the role of D225G in fatal case, raising concerns that this week’s recommendation will be to use the same California/7 target as used for the current season in the northern hemisphere and the upcoming season in the southern hemisphere, which would lead to use of current stocks and further scale up of the current target, which lack D225G.

Laidback Al · Jun 16, 2011

Vaccination of health-care workers against influenza: our obligation to protect patient

The issue of mandatory vaccination for health-care workers won't go away just because it is isn't a current topic of discussion. The abstract posted below again raises the issue of mandatory vaccinations. It is clear from the poll associated with this thread that an overwhelming number of voters believe that influenza vaccination should not be mandatory. Yet, the authors of the article point out that influenza vaccination uptake is low among health-care workers. Why is that? Nosocomial infection is an established fact with influenza and other infectious diseases. What is the justification for refusing a vaccination when it might help protect frail and debilitated patients in a hospital or other health care setting?

Vaccination of health-care workers against influenza: our obligation to protect patients
Influenza Other Respi Viruses. 2011 Mar 21. doi: 10.1111/j.1750-2659.2011.00240.x. [Epub ahead of print]
Vaccination of health-care workers against influenza: our obligation to protect patients.
Maltezou HC, Tsakris A.
Source
Department for Interventions in Health-Care Facilities, Hellenic Centre for Diseases Control and Prevention, Athens, Greece. Department of Microbiology, Medical School, University of Athens, Athens, Greece.
Abstract
Please cite this paper as: Maltezou and Tsakris. (2011) Vaccination of health-care workers against influenza: our obligation to protect patients. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2011.00240.x. Nosocomial influenza poses a threat for specific groups of patients and is associated not only with the disruption of health-care services but also excess costs. Although vaccination of health-care workers (HCWs) has been recommended for almost three decades and constitutes the most convenient and effective means to prevent nosocomial transmission, vaccine uptake within this group remains unacceptably low worldwide. In regard to the pandemic influenza A H1N1, HCWs constitute a priority group for immunization. Nevertheless, low vaccination rates have been documented regarding the influenza pandemic and associated with the onset of nosocomial cases and outbreaks. HCWs, health-care institutions, and public health bodies have the moral obligation to protect vulnerable patients and therefore weigh the benefits of mandatory vaccination. Key effective interventions, such as the education of HCWs concerning the benefits and safety of influenza vaccination, the reinforcement of on-site, free of charge vaccinations, and the use of mobile vaccination teams in conjunction with incentives, should be widely implemented.
© 2011 Blackwell Publishing Ltd.
PMID:
21668685
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21668685

hat tip tetano