First, let me just go over some of the symptoms of the flu, and then we will get down to business on the controversy surrounding the push to create mandatory flu vaccines for healthcare workers:
Sudden onset fever
Loss of appetite
Limb or joint pain
Diarrhea or upset stomach
I can't think of anyone who wants any of these symptoms, or to come down with the flu, can you?
Influenza vaccination research has clearly documented the benefits of receiving the flu vaccine (google it - you will find a plethora of information...however, I will list some links at the end of this article for your information). However, even though there is sufficient evidence to prove the benefits of receiving the flu vaccine, vaccination rates among healthcare workers are pitifully low. In 2013, only 55% of nurses in the frontlines were vaccinated.
Organizations such as The Joint Commission, the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, American College of Physicians, Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the Centers for Medicare & Medicaid Services, the Centers for Disease Control, Healthy People 2020, etc., etc., have stated their position on recommending the flu vaccine for healthcare workers in order to decrease the risk of exposure and reduce deaths. Due to this recommendation, many healthcare facilities are now creating mandatory flu vaccine policies as a condition of employment.
Employers who create mandatory policies will have exemptions, of course. Exemptions are made for medical and religious exceptions. For places that do not have a mandatory flu vaccine, they may "strongly recommend" the vaccination and may have a declination form for employees to submit if they refuse the vaccine. Additionally, some employers will enforce refusers to wear a mask during flu season while they are at work in order to protect the patients and the employee.
What is the purpose behind the push toward flu vaccines?
Evidence has shown that there are more than 36,000 deaths in the US each year related to influenza, and more than 200,000 hospitalizations. Influenza is the 6th leading cause of death. Healthcare workers are the leading cause of influenza outbreaks in the healthcare system. up to 50% of people who are infected by the flu virus do not fill ill for several days and can spread the virus to people at risk of complications and death from the flu. Additionally, evidence shows vaccination decreases mortality by 40%, decreases the spread of nosocomial infections by 43%, and decreases absenteeism by 20-30%.
Additionally, there is the ethics to consider. As healthcare workers, we have all taken an oath to "do no harm". As a nurse caring for patients who are not in their most physically healthy state, do we take the vaccination in order to prevent spreading the flu to our vulnerable patients, in order to "do no harm"? We must consider this when we make our decision to take or refuse the vaccination.
What hospitals have created a mandatory flu vaccine policy?
I have the names of a few hospitals, and this is by no means a comprehensive list. This is based on a ListServe survey of hospitals and these are the responses received:
Children's Hospital of Philadelphia (Philadelphia, PA) - since 2009
Children's Mercy Hospitals and Clinics (Kansas City, MO)
Children's Colorado (Aurora, CO)
Children's Hospital of the King's Daughters (Norfolk, VA)
Children's Medical Center Dallas (Dallas, TX) - since 2012
Riley Children's (Indianapolis, IN) - since 2012
East Tennessee Children's (Knoxville, TX) - since 2013
Boston Children's (Boston, MA)
Sharp Mary Birch Hospital for Women and Newborns (San Diego, CA) - since 2013
Roger Williams Medical Center (Providence, RI)
Brookwood Medical Center (Birmingham, AL)
Johns Hopkins (all hospitals/clinics) (Baltimore, MD)
Driscoll Children's Hospital (Corpus Christi, TX)
Spohn Health System (Corpus Christi / San Antonio, TX)
All Connecticut Hospitals
What are some reasons that people refuse the flu vaccine?
Refusal may be largely due to misconceptions related to the vaccine. Fears that the immune system will cause them to get the flu, beliefs that hygiene and better nutrition are more helpful than the vaccine, fear of needles, beliefs that the vaccine does not work, and fear of side effects. Others believe that they have a constitutional right to refuse the vaccine and that mandatory policies are violating these rights.
Common concerns and myths about the flu vaccination
(taken from the Los Angeles County Department of Public Health outline of flu vaccine talking points for managers)
The flu shot will give me the flu
The flu shot does not give people the flu. It uses inactivated ("dead") virus. People may still catch a cold or other virus that the vaccine is not designed match.
I don't believe the flu vaccine actually works
Studies have shown that flu vaccination prevents flu in 70% to 90% of healthy adults younger than 65 years old.
I had the vaccination last year
You need a new vaccine every year - the virus changes over time.
What about possible adverse reactions
Serious adverse reactions are very rare. They are explained on the CDC's Vaccine Information Statement, which is distributed when the vaccine is administered.
Local short-term reactions - such soreness at the vaccination site, slight fever, achy feeling - may occur but usually do not last long. Over the counter medicines are helpful. Even short-term reactions are much less bothersome than catching the flu and feeling very sick for days.
I'm not in a high-risk group
Your patients are at-risk, and possibly some friends and family members. You can be infected with the flu virus but not feel ill - and can still transmit flu to at-risk patients.
The flu vaccine made every year does not match the circulating flu strain
Inactivated influenza vaccine is effective in preventing transmission and reducing complications of the flu. In years when there is a close match between the vaccine and circulating virus strains, the vaccine prevents illness among approximately 70%--90% of healthy adults under 65 years of age. Vaccinating healthy adults also has been proven to lead to decreased work absenteeism and use of health-care resources, including use of antibiotics. Strong protection is also expected when the vaccine is not a close match with circulating strains, with 50%--77% effectiveness in these instances. In addition, effectiveness against influenza-related hospitalization for healthy adults from inactivated vaccine is estimated at 90%.
Knowledge is Power
All healthcare facilities will be facing the choice of creating a mandatory influenza vaccination in the near future, if they have not already. In order to make an informed decision on the topic, we must have information. Knowledge is power. Before you make a blanket statement on pros or cons, have the information you need, know the research, and make an educated decision.
Please respond to this article by answering the following questions:
Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?
Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?
What concerns do you have about the flu vaccine?
Do you know if anyone who has been released from their job because they did not get the flu vaccine?
American Association of Family Practitioners. (2011). AAFP supports mandatory flu vaccinations for healthcare personnel. Retrieved from: AAFP Supports Mandatory Flu Vaccinations for Health Care Personnel
ATrain. (2014). To accept or refuse the flu vaccine. Retrieved from: ZZZ_133_Influenza: Module 7
CDC. (2014). Vaccination: Who should do it, who should not and who should take precautions. Retrieved from: Vaccination: Who Should Do It, Who Should Not and Who Should Take Precautions | Seasonal Influenza (Flu) | CDC
Influenza Action Coalition. (2015). Influenza vaccination honor roll. Retrieved from: Honor Roll: Mandatory Influenza Vaccination Policies for Healthcare Personnel
Los Angeles County Department of Public Health. (2014). Talking points for managers. Retrieved from: http://tinyurl.com/p6nbg2u
National adult and influenza immunization summit. (2015). Vaccinating healthcare personnel. Retrieved from: Vaccinating Healthcare Personnel - National Adult and Influenza Immunization Summit
NursingTimes. (2014). Why do health workers decline flu vaccination? Retrieved from: http://www.nursingtimes.net/Journals/2014/11/28/y/k/x/031214-Why-do-health-workers-decline-flu-vaccination.pdf
TJC. (2012). R3 Report: Requirement, rationale, reference. Retrieved from: http://www.jointcommission.org/assets/1/18/R3_Report_Issue_3_5_18_12_final.pdf