Pregnant nurse fired for refusing flu shot

Editorial Team / Admin · Dec 29, 2013

Much more informative article from Lancaster's local newspaper: Elizabethtown nurse fired for refusing flu shot says she had to protect unborn child - News

allnurses Guide · Dec 29, 2013

I agree with the decision to fire her, but I am adamantly pro-vaccine.

I personally would require everyone, without a legitimate medical reason (verifiable allergy, rare immune problems etc.), to be vaccinated just as everyone in the military is required to do.

besaangel, ASN, BSN, MSN, CNA, RN, APRN, NP · Dec 29, 2013

"It's ironic. I have the right to terminate the pregnancy, but I don't have the right not to put a pharmaceutical in my body that has not been tested on a fetus or on a pregnant woman?"

Wow. Just WOW! I'd probably do the same thing, especially with her history or miscarriages. But why couldn't they allow her to wear the mask?

I hope she finds something better soon

allnurses Guide · Dec 29, 2013

"It's ironic. I have the right to terminate the pregnancy, but I don't have the right not to put a pharmaceutical in my body that has not been tested on a fetus or on a pregnant woman?"
Wow. Just WOW! I'd probably do the same thing, especially with her history or miscarriages. But why couldn't they allow her to wear the mask?
I hope she finds something better soon

Everyone has the right not to not get the flu shot, but you do not have the right to employment. Every job has requirements and she knew this requirement for several years.

By the way it has not gone through randomized control trials, but the safety has been determined through retrospective studies.

Am J Obstet Gynecol. 2011 Feb;204(2):146.e1-7. doi: 10.1016/j.ajog.2010.08.050. Epub 2010 Oct 20.

[h=1]Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990-2009.[/h]Moro PL, Broder K, Zheteyeva Y, Walton K, Rohan P, Sutherland A, Guh A, Haber P, Destefano F, Vellozzi C.

[h=3]Author information[/h]

[h=3]Abstract[/h][h=4]OBJECTIVE:[/h]The objective of the study was to characterize reports to the Vaccine Adverse Event Reporting System (VAERS) in pregnant women who received seasonal influenza vaccines to assess for potential vaccine safety concerns.

[h=4]STUDY DESIGN:[/h]We searched VAERS for reports of adverse events (AEs) in pregnant women who received trivalent inactivated influenza vaccine(TIV) from July 1, 1990 through June 30, 2009, or live attenuated influenza vaccine (LAIV) from July 1, 2003, through June 30, 2009.

[h=4]RESULTS:[/h]A total of 148 reports after TIV and 27 reports after LAIV were identified. Twenty TIV (13.5%) and 1 LAIV (4%) reports were classified as serious. No specific AEs were reported in 30 TIV (20.3%) and 16 LAIV (59%) reports. The most common pregnancy-specific AE was spontaneous abortion: 17 after TIV (11.5%) and 3 after LAIV (11%). The reporting rate of spontaneous abortion was 1.9 per million pregnant women vaccinated.

[h=4]CONCLUSION:[/h]No unusual patterns of pregnancy complications or fetal outcomes were observed in the VAERS reports of pregnant women after the administration of TIV or LAIV.

http://www.ncbi.nlm.nih.gov/pubmed/20965490

besaangel, ASN, BSN, MSN, CNA, RN, APRN, NP · Dec 29, 2013

Really nice study, but that may or may not apply to her. And I agree with your statement in regards to prior knowledge about job requirements (she should have understood the risk and made preparations accordingly). However, we do not know her medical history or if she has had a bad reaction to the vaccine in the past.

besaangel, ASN, BSN, MSN, CNA, RN, APRN, NP · Dec 29, 2013

Apply to her as in she might have reacted negatively prior

allnurses Guide · Dec 29, 2013

Really nice study, but that may or may not apply to her. And I agree with your statement in regards to prior knowledge about job requirements (she should have understood the risk and made preparations accordingly). However, we do not know her medical history or if she has had a bad reaction to the vaccine in the past.

She got two notes from different medical providers a CNM and a physician trying to get medical release from getting the flu shot and neither one stated any reason to not get the flu shot.

That study contains a review of over 19 years of reported adverse events in pregnancies after the flu vaccine. The report of incidence was 1 in 1.9 million of spontaneous abortion after the flu vaccine (not caused by but reported after the flu vaccine). The overall rate of spontaneous abortion is reported at 31%. With millions of pregnant women having been given the flu vaccine it would be safe to conclude at this point that the flu vaccine is safe during pregnancy.

Miscarriage

She had apparently gotten the flu shot without objections all her other years of employment and presumably without reaction, so again there wasn't any reason for her not to get the flu shot other than her personal objection.

Editorial Team / Admin · Dec 29, 2013

"It's ironic. I have the right to terminate the pregnancy, but I don't have the right not to put a pharmaceutical in my body that has not been tested on a fetus or on a pregnant woman?"
Wow. Just WOW! I'd probably do the same thing, especially with her history or miscarriages. But why couldn't they allow her to wear the mask?
I hope she finds something better soon

Not all facilities allow a mask as an option, unless there is an approved reason someone can't get the vaccine. I'm guessing since she was terminated, pregnancy was not an approved reason not to get the vaccine, and many actually strongly recommend pregnant women get the flu vaccine (just not the nasal version with live vaccine) because the flu can have a much more detrimental effect than the vaccine.

mizfradd, CNA · Dec 29, 2013

How many Dr.'s and/or hospitals, clinics really use VAERS?! There are so many un-reported reactions and mistakes even in administration of shots that the general public, (as well as a lot of healthcare providers) don't realize happen and never get reported.

How many HCP's even read the package inserts I wonder?

The CDC won't tell you to delve into more info., but reading pacakage inserts

will tell the real deal.

There is a "pregnancy registry" available that should be used.

The 2013 Fluzone package insert states:

-------------------------USE IN SPECIFIC POPULATIONS------------------

Safety and effectiveness of Fluzone Intradermal have not been established in pregnant women. (8.1) Pregnancy registry available for Fluzone Intradermal. Contact Sanofi Pasteur Inc. at 1-800-822-2463.

allnurses Guide · Dec 30, 2013

How many Dr.'s and/or hospitals, clinics really use VAERS?! There are so many un-reported reactions and mistakes even in administration of shots that the general public, (as well as a lot of healthcare providers) don't realize happen and never get reported.
How many HCP's even read the package inserts I wonder?
The CDC won't tell you to delve into more info., but reading pacakage inserts
will tell the real deal.
There is a "pregnancy registry" available that should be used.
The 2013 Fluzone package insert states:
-------------------------USE IN SPECIFIC POPULATIONS------------------
Safety and effectiveness of Fluzone Intradermal have not been established in pregnant women. (8.1) Pregnancy registry available for Fluzone Intradermal. Contact Sanofi Pasteur Inc. at 1-800-822-2463.

And all that means is that an RCT has not been done. You are stating nothing more than conspiracy theory myth with absolutely no proof. At least provide some scientific evidence if you are going to refute something.

[h=1]"Influenza Vaccination During Pregnancy[/h][h=3][/h]ABSTRACT: Preventing influenza during pregnancy is an essential element of prenatal care, and the most effective strategy for preventing influenza is annual immunization. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practice recommends influenza vaccination for all women who will be pregnant through the influenza season (October through May in the United States). The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice supports this recommendation. No study to date has shown an adverse consequence of inactivated influenza vaccine in pregnant women or their offspring. Vaccination early in the season and regardless of gestational age is optimal, but unvaccinated pregnant women should be immunized at any time during influenza season as long as the vaccine supply lasts.

Influenza vaccination is an essential element of prenatal care because pregnant women are at an increased risk of serious illness due to influenza. Most reports of excess seasonal influenza-related morbidity have focused on excess hospital admissions for respiratory illness during influenza season. For example, a retrospective cohortstudy in Nova Scotia compared hospitalizations and respiratory illness among pregnant women during influenza season with hospital admissions during influenza season for the same women in the year before their pregnancies. Women were more likely to have increased medical visits or increased lengths of stay if hospitalized for respiratory illnesses during pregnancy than when not pregnant, especially during the third trimester; the association between pregnancy status and hospital admission was particularly striking for women with comorbidities (1). In addition to the risks from seasonal influenza, pregnant women experienced excess mortality during the influenza pandemics of 1918–1919, 1957–1958, and most recently, the 2009 pandemic (2–10).

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommends that all women who will be pregnant during influenza season (October through May in the United States) receive inactivated influenza vaccine at any point in gestation; live attenuated influenza vaccine is contraindicated for pregnant women (11). No study to date has shown an adverse consequence of inactivated influenza vaccine in pregnant women or their offspring (12). The vaccine is made the same way each year, with the only difference being the use of a new strain of influenza based on predictions of prevalent strains in the community. There have been no reports of any adverse outcomes in pregnant women or their infants. Thimerosal, a mercury-containing preservative used in multidose vials, has not been shown to cause any adverse effects except for occasional local skin reactions. There is no scientific evidence that thimerosal-containing vaccines cause adverse effects in children born to women who received vaccines with thimerosal. Hence, ACIP does not indicate a preference for thimerosal-containing or thimerosal-free vaccines for any group, including pregnant women (11). In addition to the benefits of immunization for pregnant women, a prospective, controlled, blinded randomized trial demonstrated fewer cases of laboratory-confirmed influenza among infants whose mothers had been immunized compared with women in the control group, as well as fewer cases of respiratory illness with fever. Maternal immunity is the only effective strategy in newborns because the vaccine is not approved for use in infants younger than 6 months (13).

The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice supports ACIP's recommendation that all women who are pregnantduring influenza season receive inactivated influenza vaccine. Despite the safety of the vaccine, many obstetrician–gynecologists have not participated in influenza vaccination programs. Survey data suggest vaccination rates in pregnancy for seasonal influenza in recent years of 15–25% (11) and for 2009, an H1N1 vaccination rate of 38% (14). However, small numbers of pregnant women were surveyed, and confidence intervals around the estimates are wide. Provider education with simple chart prompts has been shown to increase the frequency of discussion between physicians and pregnant women regarding influenza and vaccination (15). This is particularly important because it has been shown that lack of knowledge about the benefits of the vaccine is a barrier to vaccine acceptance (16, 17).

Pregnant women represent a vulnerable population with regard to influenza, and influenza vaccination is an integral element of prenatal care. It is imperative that health care providers, health care organizations, and public health officials continue efforts to improve the rate of influenza vaccination among pregnant women."

ACOG - Influenza Vaccination During Pregnancy

pookyp, LPN · Dec 30, 2013

The hospital was just being nasty. She's been compliant with getting flu shots year after year. They could have at least let her wear a mask.

There are people who are exempt fur religious reasons and they still get to work. I know they are protected by the law, but they are walking around working just fine without a flu shot wearing their masks.

I think it's because she was pregnant they gave her the boot. The flu shot was just an excuse.