Should the H1N1 Vaccine be mandatory for Healthcare Professionals?

[Brian]

This is a hot topic, so I thought I'd ask all your opinion of allnurses.com community. According a survey linked below, 87% of the public think we should? What do you as a healthcare provider think? Please take a second and answer the poll, and make a comment if you wish. Thanks

Here are some related Discussions and Links:

• "Mandatory Flu Shots Hit Resistance" (currently over 105 comments)
  
• Survey: 87% favor mandatory health worker H1N1 shots ) (public opinion)
  
  
• Pandemic Flu Forum
  

[Polly Dipcya]

No, no and no...It should be the individuals decision. We don't even know if the H1N1 vax is effective, the side effects etc. The vax was rushed in the making and the media is scaring the heck out of people. No way will I ever take a "mandatory" injection or medication from my employer. I do get an annual flu shot but its MY choice. To each his own.

[indigo girl]

Perhaps instituting precautions like more sanitizing agents at establishments catering to the public or masks seeing as it is airborne, might help prevent the spread of not just the H1N1 virus, but the seasonal flu as well.

I practice excellent hand hygiene and I would think that the CDC would more highly value my near-ritualistic hand washing over my acceptance of a vaccination under forced pretenses...you know, seeing as they taut the frequency and quality of hand washing as being the MOST effective way to prevent the spread of infectious disease.

The most effective way to prevent flu? No. Good for C-diff though.

Although hand washing is certainly recommended, it is just one of many stragegies. But, is it really helpful?

Think about it. Do you really believe that washing your hands will protect you if someone with flu is coughing in your vicinity? That is why the CDC recommends the N95 mask for HCW caring for suspected swine flu patients. They don't tell us to just go

wash our hands...

http://scienceblogs.com/effectmeasure/2009/09/flu_handwashing_and_disinfecti.php

Posted with permission from Effect Measure:

Obviously if your hands are laden with virus because you cough or sneeze into them, it's good to sanitize your hands. But the evidence that you can get flu from virus particles you pick up from a doorknob, desk top, keyboard or even someone else's uncoughed-on hands is pretty meager. In fact, it's almost non-existent. So why do all the public health authorities, including CDC, keep telling people that the best defense is to wash your hands? That's the question that Dr. Arthur Reingold, head of epidemiology at the University of California, Berkeley, and codirector of the CDC-funded California Emerging Infections Program wanted to know. So he sent a letter to CDC asking it:

Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, says the CDC's emphasis on hand-washing is guided by the "science that supports hand-washing against respiratory infections in general." In particular, she cites a study conducted in Pakistan that showed that hand hygiene measures cut the rate of pneumonia in half. One of the unique features of swine flu—the fact that it causes diarrhea—also suggests to some that it could be transmitted on the hands like other diarrhea-causing diseases that do not belong to the influenza family. Schuchat stresses that the best way to protect yourself will be to get the vaccine once it becomes available in October, but adds that the CDC continues to believe that "contact precautions are useful with this flu." (Newsweek)

We will hazard two answers. The first is that many of the people at CDC and in health departments say it because they think it's true. They don't really know the scientific evidence for it. They think it's there, even though it isn't. Mistatements of facts by authorities isn't so uncommon. ..It also has the virtue of being what we think is actually the case.

Which brings us to the second reason CDC and state public health officials repeat the handwashing mantra. They not only believe it, but in fact without a vaccine they have nothing much else to offer. Giving people something to do affords a feeling of empowerment, which is also probably a good thing. The power they think they have (literally) in their hands might not be real, but it is comforting for most of us to think there is something we can do. And of course for public health officials, who are always being asked by the public what they should do, it's nice to have something to say, something that doesn't even require anything from the public health system. Like any placebo, it works best when both the patient and the doctor believe it works.

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

[Woodenpug, BSN]

I agree, indigo girl, vaccination, cough/sneeze etiquette, hand washing, PPE's represent a more complete orificenal against the h1n1 (hiney) flu. I would not think that were true from the quality of your source. However, I respect the CDC and your post is consistent with their recommendations. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm last accessed 10/27/09 at 02:30 EST.

I heard a patient call novel h1ni influenza the "hiney flu." I like that nick.

The CDC reports that I was wrong, your post about M95 shortages were after all accurate, I apologize, but probably will repeat the same mistake in the future. I do not trust non-peer reviewed sources. Thank you for your information indigo.

[indigo girl]

I agree, indigo girl, vaccination, cough/sneeze etiquette, hand washing, PPE's represent a more complete orificenal against the h1n1 (hiney) flu. I would not think that were true from the quality of your source. However, I respect the CDC and your post is consistent with their recommendations. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm last accessed 10/27/09 at 02:30 EST.

I heard a patient call novel h1ni influenza the "hiney flu." I like that nick.

The CDC reports that I was wrong, your post about M95 shortages were after all accurate, I apologize, but probably will repeat the same mistake in the future. I do not trust non-peer reviewed sources. Thank you for your information indigo.

You are very welcome, Woodenpug. We have not always agreed in the past, but I think we are mostly on the same page now.

Referring to the Effect Measure commentary, it is very true, that you cannot know for sure who the Reveres are either, can you? I, personally do know who one of the Reveres is (not sure if more than one), and that he is an epidemiologist in Boston. But, of course I would not expect readers here to accept his words as they would the CDC. The value though, of the Effect Measure commentary has been for me at least since 2006, the indepth explanations of infectious disease and public health issues which have always been very, very good. I have learned much from them over the years. They do usually give sources for what they are saying unless of course, it is just opinion. I think that Revere has made a very good case for handwashing not being much of a deterrant to the spread of influenza. In this case he is quoting from a query to the CDC from Dr. Arthur Reingold, head of epidemiology at the University of California, Berkeley and a Newsweek article:

http://www.newsweek.com/id/215435

In the same article is a quote from Dr. Osterholm of CIDRAP, who I had the pleasure of meeting in Minneapolis at the recent CIDRAP Conference 'Keeping the work working during the H1N1 Pandemic' last month. He said the same thing in person as he says here:

...the ferrets and guinea pigs tell a different story, says Dr. Michael Osterholm, of the National Institutes of Health-supported Minnesota Center of Excellence for Influenza Research and Surveillance, and head of the University of Minnesota's Center for Infectious Disease Research and Policy. Researchers in the Netherlands used ferrets to study the transmission of H1N1 and found that the disease was efficiently transmitted by small airborne particles. An earlier study examining a different flu strain in guinea pigs found that the animals did not pick up the virus from contaminated cages. That suggests that you're not really safer from the flu virus if you scrub your hands, paws, or cages because the virus travels through the air. While there's not enough evidence to conclusively say the flu works the same way for humans, the current research suggests that the H1N1 flu travels mostly by air, not via hand-to-hand contact—and therefore won't be prevented through hand-washing.

"We don't want to create a crisis in confidence," Osterholm says, "but we have to be honest: the evidence doesn't show that hand-washing prevents the spread of the influenza virus."

[kitty22]

it should be mandatory:coollook:

[lamazeteacher]

I do not believe that professional nurses should be made to take flu vaccines, as I believe we should be self informed through reading CDC publications, etc. to sufficiently to realize the importance of having them (Oh, if only.....)

I do want to communicate a concern of mine, brought about by keeping up with all the threads indigo girl has written about H1N1, one of which had a referral to a Canadian site that described a research study project there with 2,000 people who had been given the seasonal flu vaccination, and it was found that they were more susceptible to H1 N1 flu, due to that. So their recommended order of receiving the vaccines, is H1N1 first, then seasonal flu. (I took seasonal flu vaccine because it was available, 2 1/2 weeks before becoming ill with H1N1 flu).

Perhaps the study was just that, and didn't reach the criteria of having a "double blind" format, to give CDC the benefit of the doubt for not implementing the findings..... However, had I to do it over, I sure would have waited for the H1N1 vaccine to become available for lower risk people, and then taken the seasonal flu vaccine in the beginning of December, for the 3 viruses expected to be here in January, February, and March.......

[lamazeteacher]

Indigo's post # 111 contains a "quote from Dr. Osterholm of CIDRAP" as follows:

"We don't want to create a crisis in confidence," Osterholm says, "but we have to be honest: the evidence doesn't show that hand-washing prevents the spread of the influenza virus."

I think adequate proof of the value of handwashing in preventing transmission of disease causing organisms has been accomplished, and this quote belies thye importance of it, which could be disasterous if nurses believed it!

Dr. Semmelweiss was faced with this kind of irresponsible observation in the nineteenth century, until he could present his valid research to many health care professionals (who laughed at him, as we all know).

Dr. Osterholm may want another modern research study done, specifically for H1N1, which would be costly, and reiterate what we already know to be true. The alcohol based waterless sanitizer used responsibly and adequately verified, is a quicker way to achieve less spread of any disease vulnerable to it. The emolients added to it correct the dryness caused by soap and water, so they have a less deleterious effect on the skin, making them preferable antiinfective agents.

Since people who fall ill with any disease are more vulnerable to infection, I would hope that few professionals in the health care fields, would believe that coughed up phlegm on their hand(s) doesn't need to be washed off, preferably with soap and water, before they go on to care for patients. Such a concept is repugnant, and yet the quantity of the infective agent is a factor in its viability, infectivity, and mode of transmission; and possibly should be studied, if only to do away with bulky gowns for respiratory/droplet isolation technique.

I think animal research in regard to infection, is not accurately transposed to humans, since they don't even need sterile technique used in surgery, to prevent post operative infection.......

I'd vote for another worthy research program before reinventing that wheel.

[Kidagora]

Aren't aerosol droplets another mode of transmission for influenza? And don't you become a vector 1 day before exhibiting symptoms? So it seems handwashing would have little effectiveness in that instance if someone infected is coughing, sneezing in a general vicinity and you're in direct care of them. Wouldn't the vaccination be all the more effective if you can't tell who is in the early stages? Or you could just walk around with a mask all day and wait till someone is diagnosed a week after becoming ill? Just wondering.

[indigo girl]

Aren't aerosol droplets another mode of transmission for influenza?

Airborne as well as droplets hence the need for the N95 mask. If it was just droplets, CDC would only recommend the surgical mask. Fomites are supposed to be a third method of spread of what is primarily a respiratory disease. In the hospital, the CDC says that HCW exposed to patients suspected of having swine flu are to be protected with the N95 if possible. They don't just leave us with handwashing as our major defense against the flu.

It is the ultimate act of trust to send kids to school. Parents expect that everything possible is being done to protect them. Dr. Osterholm's comments at the conference that I attended regarding handwashing were made mostly in regard to this issue. Kids are the primary spreaders of swine flu yet what the CDC is recommending for the protection of school kids is completely different from what we are doing in hospitals. Does this make sense? The school authorities keep assuring parents that cleaning and handwashing will help keep their kids safe. They say they are doing everything possible.

Osterholm has pointed out that the animal studies do not support fomites as a major method of spread. I don't doubt that handwashing is still useful if they are coughing and sneezing into hands but as the primary method of protection? No. The kids are only being protected somewhat by dealing with fomites. This seems very inadequate to me especially as parents continue to send sick kids to school and they can be infective 24 hours before showing s/s. And that is why this thread is growing weekly: https://allnurses.com/pandemic-flu-forum/whats-happening-now-422611.html

[quetepye]

I say no. Why should it be?

Now, just for the record, I DID get the H1N1 vaccine because I'm immunocompromised to the point of where getting H1N1 would probably be worse than any vaccine effects. BUT - I did not do it because I was required, and I would never think anyone else should be required to do so either.

Of course there is the generic vaccine info that you hear on the news all the time of autism, parents not vaccinating their kids, etc. - no one knows what to do about that. Do we really think there is going to be a unanimous consensus on this??

Not to mention - like many of you have reminded us - they "assembled" this vaccine as fast as they could, tested it even faster, and really have no evidence of the long-term effects of the ingredients.

But back to the requirement issue...

So healthcare professionals DON'T get the vaccine and either a) do not get H1N1 at all, or b) get H1N1, take some time off (is that what the hospitals, etc. are trying to prevent?), or c) get H1N1 and "die" - worst case scenario. Unlikely.

That's pretty much it, so what's the big deal? As long as a healthcare professional is not at work while infected with H1N1, what does it matter?

It's our individual decisions to make. If they are going to require anything, I say require time off if a HCP gets H1N1 just so the patients are protected.

If they're making this vaccine required, then we ourselves are becoming the patients, and since when did patients lose their right to decline consent for anything?

[Me, SN]

The most effective way to prevent flu? No. Good for C-diff though.

Although hand washing is certainly recommended, it is just one of many stragegies. But, is it really helpful?

Think about it. Do you really believe that washing your hands will protect you if someone with flu is coughing in your vicinity? That is why the CDC recommends the N95 mask for HCW caring for suspected swine flu patients. They don't tell us to just go

wash our hands...

http://scienceblogs.com/effectmeasure/2009/09/flu_handwashing_and_disinfecti.php

Posted with permission from Effect Measure:

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

NOW THAT IS SPIN! BRAVO!

You only highlight what you want to pick apart in an effort to deem me ignorant. Did I not also say that we should be doling out masks?!

Anyway, vaccinating HCW isn't enough to prevent a dz that will most certainly spread in our petri dish EDs where WHO KNOWS what is all over the furniture and the whole environment. And where do most patients enter the hospital? The ED, of course. Hospitals are setting up tents in order to prevent flu patients from being in the ED and infecting the immunocompromised patients who come in with emergencies. But what about those who THINK they have the flu and don't?

Patients infecting other patients is always going to be a big concern too. If I'm vaccinated for the flu, and I pretend handwashing isn't a big deal, the patient is still likely going to get the flu if I've been around infected patients. And yes, the CDC tells the general public that handwashing IS the most effective way to prevent the spread of infectious disease.

IMO, I think we're fighting a futile battle. Like trying to rid a home with a bug infestation using a shoe.

[indigo girl]

NOW THAT IS SPIN! BRAVO! You only highlight what you want to pick apart in an effort to deem me ignorant. Did I not also say that we should be doling out masks?!

It is only because you mentioned handwashing, Me SN that I posted to you. I certainly do not think that you are ignorant at all.

You make some very valid points. And, yes, you did say something about masks, didn't you? You are helping me to think this through because the handwashing advice on the part of the CDC seems kind of lame particularly with regards to the schools. That is primarily where my concerns lie. I am finding the increase in pediatric deaths since schools went back in session to be of great concern. I think that more could have been done than just handwashing...

Anyway, vaccinating HCW isn't enough to prevent a dz that will most certainly spread in our petri dish EDs where WHO KNOWS what is all over the furniture and the whole environment. And where do most patients enter the hospital? The ED, of course. Hospitals are setting up tents in order to prevent flu patients from being in the ED and infecting the immunocompromised patients who come in with emergencies.

The vaccine will certainly help for those HCW that have not already been infected though the disease seems to be picking off my colleagues at work one by one via their kids, and another co-worker just started on Tamiflu this morning.

As for the patients coming into the ED or the tents, we give them masks. And, if I am anywhere within 6 feet of someone that I suspect has an ILI, I am going to be wearing an N95.

But what about those who THINK they have the flu and don't?

I don't get your point about them...What about them?

Patients infecting other patients is always going to be a big concern too.

Absolutely. This has already happened on my unit when we accepted patients from other units. They brought their infections with them...

If I'm vaccinated for the flu, and I pretend handwashing isn't a big deal, the patient is still likely going to get the flu if I've been around infected patients.

No one is saying that you should not wash your hands. Of course, you should. I am

not saying that handwashing is "not a big deal" either but, the question being asked

is does it really prevent the spread of influenza? The epidemiologists in my posts are questioning it. Personally, I think that you should do as we have been taught but suspect that fomites are not the primary means of spread of influenza.

The CDC website admits that the transmission of flu is not yet fully understood, and so they still say that fomites are thought to be a method of spread. Intuitively speaking as lamazeteacher has said, one would think that if the virus is on hands and other surfaces, and you touch your face, maybe you could be infected. However, the scientific evidence is not there to prove this. I think that this is pretty much what what these epidemiologists are saying.

So where is that scientific evidence specific to influenza? Does anyone have any? That's what is being asked. Can we come up with any studies on this? Should we question this? I am not saying, don't wash your hands. But, I am saying that if the schools

are telling parents that they are doing everything possible to prevent the kids from getting sick at school but all they are really doing is disinfecting, washing hands and sending kids identified as being sick home, than this is not not true.

http://www.newsweek.com/id/215435

...the ferrets and guinea pigs tell a different story, says Dr. Michael Osterholm, of the National Institutes of Health-supported Minnesota Center of Excellence for Influenza Research and Surveillance, and head of the University of Minnesota's Center for Infectious Disease Research and Policy. Researchers in the Netherlands used ferrets to study the transmission of H1N1 and found that the disease was efficiently transmitted by small airborne particles. An earlier study examining a different flu strain in guinea pigs found that the animals did not pick up the virus from contaminated cages. That suggests that you're not really safer from the flu virus if you scrub your hands, paws, or cages because the virus travels through the air. While there's not enough evidence to conclusively say the flu works the same way for humans, the current research suggests that the H1N1 flu travels mostly by air, not via hand-to-hand contact—and therefore won't be prevented through hand-washing.

http://scienceblogs.com/effectmeasur...disinfecti.php

Obviously if your hands are laden with virus because you cough or sneeze into them, it's good to sanitize your hands. But the evidence that you can get flu from virus particles you pick up from a doorknob, desk top, keyboard or even someone else's uncoughed-on hands is pretty meager. In fact, it's almost non-existent. So why do all the public health authorities, including CDC, keep telling people that the best defense is to wash your hands? That's the question that Dr. Arthur Reingold, head of epidemiology at the University of California, Berkeley, and codirector of the CDC-funded California Emerging Infections Program wanted to know. So he sent a letter to CDC asking it:

Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, says the CDC's emphasis on hand-washing is guided by the "science that supports hand-washing against respiratory infections in general." In particular, she cites a study conducted in Pakistan that showed that hand hygiene measures cut the rate of pneumonia in half. One of the unique features of swine flu—the fact that it causes diarrhea—also suggests to some that it could be transmitted on the hands like other diarrhea-causing diseases that do not belong to the influenza family. Schuchat stresses that the best way to protect yourself will be to get the vaccine once it becomes available in October, but adds that the CDC continues to believe that "contact precautions are useful with this flu." (Newsweek)

I really respect Dr. Schuchat. I really do like her but, the best she can say is that CDC continues to believe that "contact precautions are useful with this virus?" Useful?

And yes, the CDC tells the general public that handwashing IS the most effective way to prevent the spread of infectious disease.

It is useful. That's what she said. And, what else are they going to tell the public? Before everyone can be vaccinated, what else is there to offer them but that advice?

IMO, I think we're fighting a futile battle. Like trying to rid a home with a bug infestation using a shoe.

Could be that we could have done more if we had been more prepared. HHS warned the states that this was coming over three years ago. They kept down sizing public health departments. Lots more could have been done. More research is needed to look at exactly how influenza is spread because it is still not fully understood.

Peace, Me SN.