The Controversy: Mandatory Flu Vaccines

[Julie Reyes]

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
• Headache
• Chills
• Myalgia
• Dry cough
• Sore throat
• Stuffy nose
• Loss of appetite
• Limb or joint pain
• Difficulty sleeping
• 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:

1. 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)?
2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?
3. What concerns do you have about the flu vaccine?
4. Do you know if anyone who has been released from their job because they did not get the flu vaccine?

References

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

[RNsRWe, ASN, RN]

RN...

Well, actually, I wasn't talking about vitamins to cure autism, but to "protect" your child, strengthening his/her immune system naturally,

No, you did not say anything about a cure, *I* did...once again, you are NOT READING thoroughly, for complete comprehension of what is written. I think we found the source of the problem, pretty clearly. When students are graded on their reading comprehension, it is to make certain that they CAN understand the context and point of a written paragraph. I do not believe this has been fully demonstrated here, and may well be the reason progress toward understanding has been impeded.

The point I was making regarding using vitamin therapy is that there most certainly ARE those who hawk this magical combination of vitamins AS the answer to autism (symptoms and physiology). It's crap, of course, but to the uninformed, the desperate....it is worth a try, right? Except it's just a sham fleecing people, having them pay for vitamins that will have ZERO EFFECT on the reasons the vitamins were being promoted: as a "fight against autism". Seriously, how can anyone condone that?

But, now you say he/she WAS vaccinated...so, then, according to your own health, your child is not in "danger" of the unvaccinated, but you want others to vaccinate anyway against THEIR will to protect your child from what then? He/she's vaccinated.

I am not "now" saying anything....I have been saying it all along, and you have been failing to completely read and understand any of it.

You are also NOT understanding how vaccinations work within herd immunity (or, maybe you "don't believe in it"?). ALL are at risk when the total population of vaccinated individuals falls below a certain threshold. It's really a very easy statistic to understand, if you look at it. There's even YouTube videos on the topic! This happens to be one that most everyone can follow, good visuals for those who need them, and it's entertaining as well:https://www.youtube.com/watch?v=f-cKzzPkz2o

This one I just find entertaining, but it does provide the data the anti-vax camp likes to work its way around

So YES, my vaccinated child....who has a normal immune system....IS at a greater risk by being surrounded by your kids, who can and probably will harbor the diseases in question. The fact that you don't understand herd immunity is another concern those of us who DO understand it have about those who don't. When the ones who don't understand it are allowed to make dangerous choices because of that ignorance, it affects US ALL.

And, anyone sick should stay home, vaccinated or not. Those that vulnerable not to be around any sickness perhaps shouldn't be anywhere in public. Colds might be a threat. I'd quarantine myself. I'd have everyone quarantined who gets a cold too, as, they're a danger to me with my asthma.

Maybe you're right. People will have to home school their unvaccinated children. But, somehow, I suspect the unvaccinated will be blamed anyway. It's a strange world we're coming to.

Oh, but those who refuse to vaccinate are not so quick to home school. Some, yes of course. But others? Nope, they want the convenience of sending their kids to schools where the requirements are that they BE vaccinated, so they sue. So far...are losing...but doesn't stop them from trying to afflict others. Will the unvaccinated be blamed for spreading disease that vaccines prevent? You betcha. Nothing strange about that. Oh, and those people who responsibly stay home when they are sick, so as to not infect others? Some do...some do NOT....and then there are those with INFLUENZA who do not feel sick yet, but are very much contagious, so they are irrepsonsibly spreading the sickness while feeling very self-righteous that they aren't harming anyone. And they most certainly ARE.

[RNsRWe, ASN, RN]

Y'know, this video is so well-done, such a good explanation about how herd immunity works (and why the argument that "vaccines don't work" is nonsense) that I'm posting it in it's very own little box :)

Enjoy the education.

[Spidey's mom, ADN, BSN, RN]

It's clear to me that leftflank pain and rusti1 (who don't seem to even be RNs) are avid anti-Vaxers here just to push their misinformed, conspiracy-driven, fear-mongering message that all vaccines are evil, and anyone in any way associated with them is just a "big pharma shill".

Sadly most anti-Vaxers of this type are so entrenched in their erroneous and quite frankly dangerous anti-science beliefs that it is almost useless to attempt to debate them with facts and science. If you attempt to do so, they will reject all contrary, science-backed info presented simply because in their extremely backward and frightening version of the world, expertise and education mean nothing (and in fact are highly suspect) when weighed against specious anecdotal "evidence" and Google University. They provide perfect real life examples of things like the Dunning-Kruger effect and confirmation bias.

I applaud everyone on this forum who has attempted to educate them - but I definitely don't anticipate anyone here being successful. Knowing that this small yet vocal population is present and growing really scares me as an RN - on both a personal and professional level, given the real threat they and they misguided beliefs pose to me, my loved ones, and public health in general.

Thanks. It is scary. Especially since all the "Big Pharma Shill" stuff has been debunked along with the other arguments.

I asked for some "scientific resources" not "blogs". There were no scientific resources there just pseudoscience blogs and op-ed articles. Do you have any scientific evidence? Or are you just believing what people tell you and then assuming its about all vaccines?

The sources anti-vaxx folks are linking are spreading false information and have for years so it is frustrating as others have mentioned to continue the same arguments with people who won't look at the evidence. NVIC, Mercola, Dr. Sears, Robert Kennedy, are all not trustworthy yet we still keep seeing them linked.

There's evidence that it starts BEFORE infancy, during gestation. It's been awhile since I read on that particular aspect, but it was pretty well-published several years back. While neurological pathways continue to develop in infancy, the foundation on which the autism disorder is laid appears to occur PRIOR to birth....throwing much of the anti-vax propaganda into the trash (where it belongs).

Yep - sorry, I should have been more clear. It starts most likely at the time the sperm and egg meet up. At conception when all the genetic material combines.

The 6 week History of Vaccines class I took was from Dr. Paul Offit, Director of the Vaccine Education Center at the Children's Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

He's a great teacher and pretty funny considering he's considered the epitome of evil by the anti-vaxxers. I love one of the stories he tells about his wife, who is also a physician. Obviously anecdotal but still . . . . makes a good point. Just a few seconds sooner and the story would have changed.

Why your convictions probably aren't as strong as you think they are | Genetic Literacy Project

Paul Offit likes to tell a story about how his wife, pediatrician Bonnie Offit, was about to give a child a vaccination when the kid was struck by a seizure. Had she given the injection a minute sooner, Paul Offit says, it would surely have appeared as though the vaccine had caused the seizure and probably no study in the world would have convinced the parent otherwise. (The Offits have such studies at the ready — Paul is the director of the Vaccine Education Center at the Children's Hospital of Philadelphia and author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.”) Indeed, famous anti-vaxxer Jenny McCarthy has said her son's autism and seizures are linked to so many shots” because vaccinations preceded his symptoms.

But, as Offit's story suggests, the fact that a child became sick after a vaccine is not strong evidence that the immunization was to blame. Psychologists have a name for the cognitive bias that makes us prone to assigning a causal relationship to two events simply because they happened one after the other: the illusion of causality.” A study recently published in the British Journal of Psychology investigates how this illusion influences the way we process new information. Its finding: Causal illusions don't just cement erroneous ideas in the mind; they can also prevent new information from correcting them.

An Epidemic of Fear: How Panicked Parents Skipping Shots Endanger Us All | WIRED

Paul Offit | Paul Offit is the Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

[Spidey's mom, ADN, BSN, RN]

Y'know, this video is so well-done, such a good explanation about how herd immunity works (and why the argument that "vaccines don't work" is nonsense) that I'm posting it in it's very own little box :)

Enjoy the education.

That was great! Thanks!

[rusti1]

I get the concept of "herd immunity", I just don't accept it as an excuse to force vaccines on anyone, especially for mild childhood diseases now propagandized as the plague with an instant death sentence, which they're not. More evidence is showing how vaccines destroy natural immune systems, causing more sickness:

The Canadian press recently broke the story that new research confirms initial findings that the flu vaccine appeared to actually increase people's risk of getting sick with H1N1, and cause more serious bouts of illness to boot.

According to the Vancouver Sun:¹

"Researchers, led by Vancouver's Dr. Danuta Skowronski, an influenza expert at the B.C. Centre for Disease Control, noticed in the early weeks of the [2009 H1N1] pandemic that people who got a flu shot for the 2008-09 winter seemed to be more likely to get infected with the pandemic virus than people who hadn't received a flu shot. Five studies done in several provinces showed the same unsettling results.

[BostonFNP, APRN]

Let's all get back to the topic of the INFLUENZA VACCINE.

[RNsRWe, ASN, RN]

The 6 week History of Vaccines class I took was from Dr. Paul Offit, Director of the Vaccine Education Center at the Children's Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

He's a great teacher and pretty funny considering he's considered the epitome of evil by the anti-vaxxers. I love one of the stories he tells about his wife, who is also a physician. Obviously anecdotal but still . . . . makes a good point. Just a few seconds sooner and the story would have changed.

Ooh, I'm jealous! Would have found that lecture fascinating. On a light note, I wonder if the parents who witnessed their child having a seizure prior to injection drew the conclusion that the mere PRESENCE of a vaccination in the vicinity of an innocent child is so toxic as to create a seizure-prone environment? MAN those vaccines are powerful stuff.....

Disclaimer: That was a joke.

[RNsRWe, ASN, RN]

I get the concept of "herd immunity", I just don't accept it as an excuse to force vaccines on anyone,

Your desire to not be forced to do anything despite all evidence that it's the responsible thing to do trumps my desire to have me and my family survive an epidemic. Got it.

especially for mild childhood diseases now propagandized as the plague with an instant death sentence, which they're not. More evidence is showing how vaccines destroy natural immune systems, causing more sickness:

The Canadian press recently broke the story that new research confirms initial findings that the flu vaccine appeared to actually increase people's risk of getting sick with H1N1, and cause more serious bouts of illness to boot.

According to the Vancouver Sun:¹

"Researchers, led by Vancouver's Dr. Danuta Skowronski, an influenza expert at the B.C. Centre for Disease Control, noticed in the early weeks of the [2009 H1N1] pandemic that people who got a flu shot for the 2008-09 winterseemed to be more likely to get infected with the pandemic virus than people who hadn't received a flu shot. Five studies done in several provinces showed the same unsettling results.

And with this final bit of nonsense.....I'm done.

[Spidey's mom, ADN, BSN, RN]

Let's all get back to the topic of the INFLUENZA VACCINE.

Ok. Getting immunized against this season's influenza shortly as well as my son, Spidey, and his father. Unplugging and taking a breather as well.

[LEFTFLANKPAIN]

Always baffles me when those who are pro-influenza vaccination imply that because they vaccinate their children, they are more compassionate than the rest of the world. Then in the next sentence will have such a hostile and indifferent stance when they cite or refer to children who truly have suffered vaccine injuries...or if a parent says that their child suffered permanent vaccine related injury or death they make personal attacks upon the parent and the child. The insecurity is mind blowing.

[alt_one]

Consequences? Are we going to have mandatory treatment for disease now. What if we find you have a STD or Hep C, can we force you to be treated? If not can we isolate you from society so you will not pass it on to someone else? Maybe we should build something like a leper colony for those who won't vaccinate. Who decides these issues?

I am not against vaccines. I believe in informed consent. Know what pharmacological product you are taking, why you are taking it, and the risks associated with that product. And having the right to decline the risks.

I have traveled all over the world. To travel I have to have proof of vaccines. I got the shots. I made the decision and accepted the risks. I had the mumps and measles as a child. I did not need the MMR vaccine but took the shots. My choice.

Education is the key to a proper vaccine program. The government needs to make safer vaccines. There is no metabolic need for mercury or aluminum in your body. The average person will have over 100 man made chemicals in their body and our government has no idea of the consequences when they interact together. Glyphosate is an endocrine disruptor and research indicates it may impact fetal development. There are limits to your exposure set by the government but our government doesn't even test for it in the food supply. Over a billion tons are sprayed on food crops annually.

One more point then I will get down off my soapbox. We are exposed to 100's of chemicals that were not around one hundred years ago. We have seen an explosion in autism and Alzheimer's and we don't know why. It is prudent to consider what chemicals are going into your body. I personally believe most vaccines are safe and that they should be seriously considered as part of your health plan. However I also think that the adjuvants could be the trigger to disease for people who have been exposed to toxins. Babies, children, and the elderly with immature/compromised immune systems could be most susceptible.

Can we develop vaccines without adjuvants? Do we really need all the vaccines the CDC says we need? We should double or triple the money spent on Planned Parenthood for prenatal care and focus on providing proper nutrition to children. And let's listen to others concerns about vaccines with some respect. It is a very emotional subject for many. Informed consent is a great way to start

[rusti1]

Reports (not research) in Vermont...

As of Aug. 10, there were 178 confirmed cases of pertussis in Vermont children between the ages of six months and 18 years. Of that number, 90 percent — or 160 kids — had received at least one dose of the child vaccination, while the majority had received five or six doses. According to the DOH, one child had received one or two doses, eight had received three doses, nine had received four doses, 74 had received five doses and 68 had received six doses.

90 percent of whooping cough cases in Vermont among vaccinated children

In San Diego...

Most of the people who got whooping cough in San Diego County so far this year were up to date with their immunizations, according to county data.

Of the 621 people who contracted the illness, 85 percent had all their preventative shots — calling into question the efficacy of the vaccine.

Pertussis vaccines offer high levels of protection within the first year of completing vaccinations,” said Dr. Wilma Wooten, a San Diego county public health officer.

But then the protection decreases over time,” Wooten said.

KPBS and inewsource first raised questions about how well the vaccine worked in 2010, after its statewide analysis of the data showed the majority of people who got the disease were already vaccinated.

Immunized People Getting Whooping Cough | KPBS

In Utah...

This is first time in many years that the area has experienced even one case of pertussis.

Could it be that the pertussis vaccine is actually causing pertussis?

Global Research reports: The most alarming aspect of the matter is that so far, all of the children diagnosed with whooping cough had been vaccinated against it. Of course, medical authorities have no good answer or understanding about how this could happen – fueling the debate about vaccine dangers. Unfortunately, some in the pro-vaccine community are attempting to twist things around as a plus” for vaccines.

Dozens of children have been tested so far, making it a busy week for pediatricians in Park City. Many more kids are expected to be tested. Pertussis is highly contagious, and it is perplexing to Park City officials that all of the infected kids are up to date with vaccinations; however, it is not as surprising to those who are already aware of vaccine dangers.

Whooping Cough Outbreak In Utah Only In Vaccinated Children | Your News Wire

Which I assume you won't accept.