Flu Shot or Mask?

[Nurse Beth]

Recently at the nurse's station at work, I was talking with Lisa. Lisa was wearing a surgical mask. To keep her job, she has to wear a mask until flu season is over because she declined to get a flu vaccination this year.

I asked how it felt to wear a mask for 12 hours. She said, "Well...it's kinda claustrophobic, but I'm getting used to it. What's really weird is people keep asking me to repeat myself.. It's like they can't hear me if they can't see my lips moving. And when I smile at patients, I have to try really hard to smile with my eyes."

Position Statements

The American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), a CDC panel of medical and public health experts that advises on vaccine use, all align in recommending flu vaccines for healthcare workers with allowable exceptions for religious and/or medical reasons.

National Nurses United (NNU) opposes mandatory flu shots as fostering an atmosphere of distrust. Likewise, they oppose masking on the basis of stigmatizing the individual.

Masking: the Science

The influenza virus is transmitted by direct contact, large droplet spray (like a sneeze or cough, distance of about 3 feet), and by aerosolization (smaller particle aerosols).

The rationale for masking is that unvaccinated asymptomatic persons can shed the influenza virus for 24 hours before symptoms appear and up to 5 days after the onset of illness. However, minimal data regarding aerosol shedding and infectiousness of aerosol particulates exist.

The effectiveness of N95 respirator masks in preventing transmission of airborne viruses has been shown but the results of studies on the efficacy of surgical masks are mixed.

Many surgical masks are not certified as protective against respiratory infections and are loose fitting. There are no clear guidelines on how frequently surgical masks should be changed.

According to the CDC, there are no definitive studies to show that surgical masks worn by health-care workers reduce influenza transmission.

Legislation

State law, state Departments of Health, and county health officers have the authority to mandate flu shots and/or masks. For example, California state law (Health & Safety Code §1288.7 / Cal OSHA §5199) requires either flu vaccination or the signing of a declination statement for all acute care hospital workers and most health-care personnel, including clinic and office-based staff.

Additionally, many county health officers in California mandate that health care workers either receive an annual flu vaccine or wear a mask during the flu season.

Employee Rights

Many acute care facilities have adopted coercive "flu shot or mask" policies. In some cases, healthcare workers have been fired for refusing to be vaccinated.

Legally, most employers can require flu shots as a condition of employment as most employees work under an "at-will" work agreement.

However, the research used by employers to justify mandating flu vaccines for healthcare workers may be flawed and insufficient. Four such studies cited by employers were conducted in long-term care facilities and have not been proven to be generalizable to acute care settings.

Ethics

The ANA maintains vaccination is a public health concern and nurses should role model illness prevention through immunization. Nurses have a responsibility to not place their patients at risk.

Vaccination is for the greater good, but individual rights must also be considered. Sometimes the ethical principle of preventing harm is in direct conflict with the ethical principle of autonomy.

Protective or Punitive?

When I see a co-worker wearing a surgical mask I cringe a little. My core values of justice and fairness are triggered. Is this really about protecting patients based on robust evidence or is this about shaming the nurse?

I believe in doing what is best for the greatest good but I also believe in autonomy. It comes down to personal rights versus social responsibility. I am pro-vaccination but stop short of supporting "flu shot or mask" policies.

For me, it would take irrefutable evidence of patient benefit to justify overriding personal rights and I don't believe we have that.

The rush to disregard individual freedom over scanty evidence concerns me more than the thought of Lisa not wearing a surgical mask.

Do you believe nurses should be required to get mandatory flu shots or mask? Why or why not? I'd love to hear your view.

More thought-provoking articles by Nurse Beth:

Ageism in Nursing is Real

Why Do Nurses Quit?

References

Booth, C. M., Clayton, M., Crook, B., & Gawn, J. M. (2013). Effectiveness of surgical masks against influenza bioaerosols. Journal of Hospital Infection, 84(1), 22-26.

CDC. Interim Guidance for the Use of Masks to Control Influenza Transmission.2009. Accessed January 2017 Interim Guidance for the Use of Masks to Control Influenza Transmission

| Health Professionals | Seasonal Influenza (Flu)

Serres, G., Skowronski, D., Gardam, M., Lemieux, C., Yassi, A., Patrick, D., Krajden, M., Loeb, M., Colignon, P., Carrat, F. 2017. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLOS.org. accessed January 2017 Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement

[ComeTogether, LPN]

Beth, I like where you're going with these latest articles! Health 3.0, baby!

[kimtimp]

I personally feel requiring the flu vaccine us an infringement on my rights. I went for years without receiving a flu shot and NEVER got the flu. Three years ago, I began working for a new employer and when I attempted to refuse the flu vaccine I was told I would be required to wear a mask from October through May. I was STRONGLY advised to get the vaccine, and I eventually caved to the coercion. I've researched the efficacy of flu vaccines for myself. First off the influenza virus mutates and every year the developers of the vaccine "guess" as to how the virus will mutate. In studies of adults in long term care facilities the vaccine was shown to only have a 1% efficacy rate. I think it is wrong to require healthcare workers to receive a vaccine that may not offer any significant protection against the virus. And I feel I should have the right to refuse.

[GM2RN]

Yes you don't have to get a shot, but you do have to wear a mask.

Not necessarily.

Nurses Union Wins Battle Over ‘Vaccinate Or Mask’ Policy, Here’s Why

[LadysSolo]

Interesting - if your employer provides your medical insurance, they would NOT be allowed to release the information to the public due to privacy policies, so they would be in violation......Huh! I wonder if their counsel has been made aware of the risks of the "mask or vaccinate" policy....

[mrl3fnp]

Oh, I'm sorry, it seems YOU need to do a little research on the flu vaccine from credible sources. Here, I'll help you out.

From the CDC

What are the benefits of flu vaccination?

While how well the flu vaccine works can vary, there are a lot of reasons to get a flu vaccine each year.

Flu vaccination can keep you from getting sick with flu.

Flu vaccination can reduce the risk of flu-associated hospitalization, including among children and older adults.

A 2014 study* showed that flu vaccine reduced children's risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.

Another study published in the summer of 2016 showed that people 50 years and older who got a flu vaccine reduced their risk of getting hospitalized from flu by 57%.

Flu vaccination is an important preventive tool for people with chronic health conditions.

Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year.

Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79%) and chronic lung disease (52%).

Vaccination helps protect women during and after pregnancy. Getting vaccinated can also protect a baby after birth from flu. (Mom passes antibodies onto the developing baby during her pregnancy.)

A study that looked at flu vaccine effectiveness in pregnant women found that vaccination reduced the risk of flu-associated acute respiratory infection by about one half.

There are studies that show that flu vaccine in a pregnant woman can reduce the risk of flu illness in her baby by up to half. This protective benefit was observed for up to four months after birth.

Flu vaccination also may make your illness milder if you do get sick.

Getting vaccinated yourself also protects people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

As a nurse, if you aren't doing everything you can to protect yourself and your patients from VPDs and diseases in general, then you have no business being in this field. Period. Even a 5% efficacy rate gives you a better chance of not contracting it or a more mild case if you do than the 0% you'll have without it. And guess what, dihydrogen monoxide can kill you, but I don't see you telling people to consume it. In fact, DHMO kills more people daily than vaccines have ever. Look it up if you don't believe me. But as with everything, the dose makes the poison. If you took basic chemistry you would know that.

A 2014 study* showed that flu vaccine reduced children's risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.

Financial support. This work was supported by funding from the US Centers for Disease Control and Prevention to Abt Associates, Inc, Cambridge, MA (contract 200-2010-F33396).

Potential conflicts of interest. J. F. has received travel support from Sanofi for an unrelated project.

Another study published in the summer of 2016 showed that people 50 years and older who got a flu vaccine reduced their risk of getting hospitalized from flu by 57%.

Financial support. This work was supported by the CDC.

Potential conflicts of interest. W. S. reports receiving fees for serving on a data safety monitoring board from Merck and Pfizer and consulting fees from Novavax and Genentech.

Flu vaccination is an important preventive tool for people with chronic health conditions. Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had a cardiac event in the past year.

Collaborator. Solvay Pharmaceuticals, which was sold to Abbott Laboratories in 2009 and is a large manufacturer of the flu vaccine.

Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79%) and chronic lung disease (52%)

Date. Evidence-based practice should not rely on out-of-date data from 1997. Do you have any up-to-date studies???

Vaccination helps protect women during and after pregnancy. Getting vaccinated can also protect a baby after birth from flu. (Mom passes antibodies onto the developing baby during her pregnancy.) o A study that looked at flu vaccine effectiveness in pregnant women found that vaccination reduced the risk of flu associated acute respiratory infection by about one half

Financial support. This work was supported by the CDC (contract 200-2010-F-33132 to Abt Associates Inc).

Another study found that babies of women who got a flu vaccine during their pregnancy were about one-third less likely to get sick with flu than babies of unvaccinated women. This protective benefit was observed for up to four months after birth.

Financial support. Bill & Melinda Gates Foundation. (BMGF provides hundreds of millions of dollars each year to vaccines industries, GMO technologies, and sterilization technologies. BMGF is also a huge global depopulation advocate who is currently being sued by the Indian Government for vaccine-related fraud and the killing and injuring of 100s of girls between the ages of 9-15 during HPV trials).

[mrl3fnp]

As a nurse, if you aren't doing everything you can to protect yourself and your patients from VPDs and diseases in general, then you have no business being in this field. Period.

Nice talking points......But can we talk now about evidence-based practice? There is no evidence that the flu shots work. In contrast, there is a lot of evidence that mask-wearing dramatically lowers the risk of the transmission of viruses. If you really want to protect your patients you need to commit yourself to mask-wearing. Arguing that those who do not wish to inject themselves with potentially harmful substances are somehow not your moral equivalent has no value because it is not supported by evidence.

[mrl3fnp]

Oh, I'm sorry, it seems YOU need to do a little research on the flu vaccine from credible sources. Here, I'll help you out.

From the CDC

What are the benefits of flu vaccination?

As a nurse, if you aren't doing everything you can to protect yourself and your patients from VPDs and diseases in general, then you have no business being in this field. Period.

When my employer mandates a policy, especially one that mandates I inject potentially harmful substances, I want it to be supported by evidence-based practice...........No, I demand that it is supported by evidence-based practice. I think most of us can agree that mandating flu shots doesn't feel right inside......There is a reason for that feeling.......Because there is no evidence that flu shots work. In contrast, there is evidence that masks work. Follow the money if you want to explain why there are flu shot mandates because the efficacy of mask wearing is undeniable.

[PopcornRN36]

I cannot get a flu vaccine due to allergy to the preservatives used (same problem with annual TB test - in fact it was apparently the TB test that sensitized me.)

LadysSolo - has your allergic reactions been systemic or localized? There are some flu vaccines containing the preservative Thimerosal. There are single dose flu vaccinations available containing no preservatives. In fact, some states do not allow pregnant women to receive preservative-based flu vaccinations.

The PPD contains 0.25% phenol (not the same type of preservative).

If your employer requires you to have a flu vaccination, with an allergic reaction, you could probably have your provider sign a medical declination letter.

[BostonFNP, APRN]

I sit on a national committee for vaccination as well.

Which national committee?

Believe what you want, the majority of Americans have spoken and lived personally through the research and no longer believe in the good vaccines because of the sham of the influenza vaccines.

Cite your sources please, as we all know, the plural of anecdote in not data.

[BostonFNP, APRN]

And I feel I should have the right to refuse.

You do have the right to refuse, you stated so in the third sentence of your post...

[WestCoastSunRN, MSN, CNS]

Wow. Just wow. I opened this thread thinking maybe there could be some civil discussion about this topic. Some of the vitriol here is truly disturbing. And I don't even necessarily agree with the opposing views -- but I am astounded by how some of you are conducting yourself in this thread. I don't know you, so I hope this is a one off for you and you are just so passionate about this subject that you are forgetting to show respect to opposing viewpoints. I'm all for healthy, robust discussion and perhaps if the inflammatory theatrics in this thread were toned down a bit, posters could give each other some serious food for thought.

ADMIN EDITED TO ADD: Many of the posts WestCoastSunRN is referring to have been deleted.

[WestCoastSunRN, MSN, CNS]

A 2014 study* showed that flu vaccine reduced children's risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.

Financial support. This work was supported by funding from the US Centers for Disease Control and Prevention to Abt Associates, Inc, Cambridge, MA (contract 200-2010-F33396).

Potential conflicts of interest. J. F. has received travel support from Sanofi for an unrelated project.

Another study published in the summer of 2016 showed that people 50 years and older who got a flu vaccine reduced their risk of getting hospitalized from flu by 57%.

Financial support. This work was supported by the CDC.

Potential conflicts of interest. W. S. reports receiving fees for serving on a data safety monitoring board from Merck and Pfizer and consulting fees from Novavax and Genentech.

Flu vaccination is an important preventive tool for people with chronic health conditions. Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had a cardiac event in the past year.

Collaborator. Solvay Pharmaceuticals, which was sold to Abbott Laboratories in 2009 and is a large manufacturer of the flu vaccine.

Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79%) and chronic lung disease (52%)

Date. Evidence-based practice should not rely on out-of-date data from 1997. Do you have any up-to-date studies???

Vaccination helps protect women during and after pregnancy. Getting vaccinated can also protect a baby after birth from flu. (Mom passes antibodies onto the developing baby during her pregnancy.) o A study that looked at flu vaccine effectiveness in pregnant women found that vaccination reduced the risk of flu associated acute respiratory infection by about one half

Financial support. This work was supported by the CDC (contract 200-2010-F-33132 to Abt Associates Inc).

Another study found that babies of women who got a flu vaccine during their pregnancy were about one-third less likely to get sick with flu than babies of unvaccinated women. This protective benefit was observed for up to four months after birth.

Financial support. Bill & Melinda Gates Foundation. (BMGF provides hundreds of millions of dollars each year to vaccines industries, GMO technologies, and sterilization technologies. BMGF is also a huge global depopulation advocate who is currently being sued by the Indian Government for vaccine-related fraud and the killing and injuring of 100s of girls between the ages of 9-15 during HPV trials).

Yes, I always look for the hidden agendas. Sadly, it can be very difficult for modern science to produce unbiased testing results. Like anything, science is vulnerable to belief, philosophy and world-view. You often have to sift through a lot of garbage to find studies that were conducted well.