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

[trinitymaster]

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

Okay, the influenza vaccine is simply a stop-gap measure that may or may not work. Anecdotally, it may be making the problem with the immunological-compromised patients even worse.

Here is how: Nurse A is vaccinated against the flu, but Nurse A was already exposed to H3N2 the day before at the farmer's market. Two days later, Nurse A develops a fever at work but dismisses it as "flu-like" symptoms. Fortunately, Nurse A worked a three day stretch and will have the next four days off.

At home, Nurse A develops a 103 degree fever. After visiting the doctor, who by chance does an RIDT and confirms nurse A's fear that the symptoms were caused by the actual flu, Nurse A goes home and debates whether to call work and alert them that all of the patients have exposed.

Well, Nurse A does not want to become known as Patient zero for the flu epidemic that is sweeping through the hospital like a Los Angeles wildfire. Instead, it is best to let the non-vaxxers be blamed. They are after-all, an appropriate scapegoat.

This could have been avoided if the nurse was allowed a four day period immediately after the shot to let any influenza strains they had been exposed to time to incubate. But that is not going to happen.

BTW: the initial symptoms for flu, Ebola, and MERS are essentially the same.

BTW(2): Attenuated virus is not dead. It is simply asleep and has suffered a lost of virulence. The CDC does not inform us that is indeed possible for that non-virulent strain to undergo a little-blue pill mutation that will make it virulent once more.

BTW(3): Toddlers do shed the flu virus after receiving some forms of the vaccine. So, yes, that cute little rugrat can make you sick as a dog.

[trinitymaster]

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.

Anecdotally, my first travel assignment had me taking care of children. Every single case of whooping cough was previously vaccinated. However, that is to be expected when there is a high rate of dTAP immunization. If 100% of children receive the immunization, then it is to be expected that 100% of whooping cough cases will be in previously immunized children.

Now, getting back to the influenza vaccine . . .

[trinitymaster]

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.

Has anyone mentioned the narcolepsy that people are suffering after having received the H1N1 vaccination in Europe?

Narcolepsy Following Pandemrix Influenza Vaccination in Europe History | Concerns | Vaccine Safety | CDC

[cayenne06, MSN, CNM]

One teeny problem: All of these can also be symptoms of many viral "flu-like illnesses" without being influenza at all. Unless they test everyone with these symptoms for the actual influenza virus, there is no way to make these assertions.

Another teeny problem: Excellent epidemiological evidence suggests that there is little, if any, excess mortality even in what are traditionally termed "vulnerable populations" from influenza in the US. Since this flies in the face of conventional wisdom, the authors of the study used meticulous research to come to their conclusions.

And another teeny problem: There's no way to predict the upcoming strain(s) with certainty, or to create a "flu" vaccine that covers the inevitable mutations during the season, so there's no certainty that a vaccine given in the fall will be worth anything in December. This is likely why people think getting the vaccine made them get the flu. They got the vaccine and they got a flu, but not because they got the vaccine.

There's more.

Does the Vaccine Matter? - The Atlantic

You WILL want to read the whole article describing in good detail how a team of epidemiologists investigated this over years.

Now, I am perfectly aware that when people are confronted with facts that are counter to their cherished beliefs, their beliefs become stronger. But I like to think that educated health professionals have a better ability to read studies and consider actual data. For the record, I am not an "anti-vaxxer" at all. I know (not "believe") that science has proven beyond doubt that vaccines for tetorifice, mumps, measles, chickenpox, diphtheria, polio, pertussis, smallpox, and others are vital to individual and public health, so no worries on that score.

I do, however, take pause at the epidemiological statistical and virological evidence that indicate that the "flu vaccine" is not as effective as people think it is, and therefore, requiring it for health care workers is a knee-jerk reaction to an unsupportable conclusion. This article is about the flu vaccine, not about vaccination in general, so please pause to read all of it. From the introduction:

"But what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government—with the support of leaders in the public-health and medical communities—has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina.

THE TERM INFLUENZA, which dates back to the Middle Ages, is taken from the Italian word for occult or astral influence. Then as now, flu seemed to appear out of nowhere each winter, debilitating or killing large numbers of people, only to vanish in the spring. Today, seasonal flu is estimated to kill about 36,000 people in the United States each year, and half a million worldwide.

I should just follow you around and 'like' all your posts. You always seem to say what I'm thinking better than I ever could!

[cayenne06, MSN, CNM]

Do I do nothing-No. I take homeopathic Influenzinum 1M -10 drops every month. If I feel a sore throat coming I take zinc. Precaution is wise, but I feel I should make the decision on what to put in my body.

I support an adult's right to use whatever pseudo-medicine they wish. But the fact remains that homeopathy flies in the face of basic laws of physics and is nothing more than an expensive (and profitable) placebo. And while the placebo effect is real and often clinically significant, it is disingenuous and unethical to market it as effective medicine.

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.

How about the research that shows that MMR vaccination significantly decreases the chance of contracting other illnesses in the future?

It is simply false that natural infection provides benefits above vaccination.

The case mentioned above was specific to the H1N1 vaccine- it is not applicable to the standard yearly flu vaccine. But yes, the flu virus is a tricky little bugger and we are a long way from figuring out how to more effectively protect vulnerable populations.

Flu masks are meant to "mark" the nonvaxxers. Its nothing more than a scarlet letter. There's absolutely no indication that they reduce the risk of inpatient flu cases and I think we should do away with them. That being said, I am not sure if mandation is/is not a good idea. My instinct is to say that if you don't accept the vaccine (barring medical reasons), you should not be allowed to work during the flu season. But I also know that the vaccine is far from perfect and I understand why some are leery. It's not quite the same as requiring MMR. So I don't know. But the mask thing just makes me roll my eyes, and I feel like it is potentially very offputting, or even scary, to patients, who might not always be aware of why the staff member is wearing one.

Vaccines are a victim of their own success. Now that many childhood illnesses have been drastically curtailed or esentially eliminated, we don't have the daily reminders of why vaccination is so important.

As a holistic CNM, I am deeply invested in public health and preventative medicine. Vaccines are one of the greatest success stories in human history.

[cayenne06, MSN, CNM]

Let us also not forget that many vaccines are made using fetal cell DNA. The residual DNA fragments are capable of incorporating themselves into our primal DNA chain, thus changing us completely once they are administered. Now, there's the rub. How do pro-life advoacates and fundamental Christians feel about vaccines, now? They should be marching in front of Big Pharma instead of SCOTUS.

Not quite... a couple vaccines are made using fetal cell lines as a medium (I believe there are two cultures being used nowadays, could be wrong). Could fragments of DNA wind up in the vaccine? Sure. Is that dangerous? Nope. Is there any evidence, ANY, that inert fragments of DNA injected IM will somehow find it's way into our genetic code and "change us for life?" No. There is not. It is, however, true that many viruses insert their genetic code into our DNA, where it then stays for life. Our DNA is chock full of mutations from other species. Mothers also carry their fetus's DNA in their body indefinitely, after being pregnant.

And just for the record, the fetal cell lines being used for vaccine development are from 2 abortions performed like 20-30 years ago (I'm just going from memory here, but it's something like that). Ongoing fetal tissue donation is enormously important in many areas of research, but not so much for vaccines.

[trinitymaster]

And let us not forget how wrong the CDC can be. I remember seeing their first recommendations and cursing at their complete and utter misinformation. I was on another site arguing with everyone about how the CDC got it all wrong and posting CDC pictures of how they handle the Ebola virus when they encounter it. Take a gander at this:

Ebola: Five ways the CDC got it wrong - CNN.com

How does this relate to the influenza virus? Well, here is the way it is. The CDC has become a political office rather than a protector of the people. After 9/11 they were taxed with the mission to prepare us for a terrorist strike and all that mumbo-jumbo in order to pacify the constituents.

The CDC has to project an air of confidence in order for the public to feel a higher sense of security. They absolutely will not admit that they are wrong until it becomes a news story. And that, ladies and gentlemen, is the rest of the story

[trinitymaster]

Awe SNAP, BOOM, and POW. It just dawned on me that some of you advocating for the flu shot are also on the record as stating that it is okay not to wear gloves with every patient contact.

The Irony.

How do you reconcile this in your mind?

[trinitymaster]

Okay, so I'm way too lazy to go back and try to find the vitamin posts in this thread. But here is a partial list of diseases cured with vitamins/minerals:

Scurvy

Rickets

anemia

Beriberi

Pellagra

etc....

Could flu one day be on this list?

To say that vitamin therapy will never work is to show that you are a true product of BigPharma sponsored education.

[Spiker, ASN, RN, EMT-P]

Yes, I always take the free flu vaccine @ work, with no concerns, other than my arm aching for a couple of days! Carolinas Healthcare System went mandatory last year, after being voluntary previously. Non-vaccinated clinical staff had to wear masks when doing direct patient care (which wasn't difficult in the OR). Vaccinated staff were given special stickers to wear on our badges, clearly noting we were "safe". Now CHS has stated if you refuse the vaccine, due to allergy/adverse reaction to vaccine components, you may be exempt by presenting a note from your PCP stating this. Otherwise, termination of employment is threatened. I know of no one who actually has been fired for this. Only Per Diem staff who were terminated (so far, a total 3 over about 2-3 years) after a long illness or surgery, for failing to work the weekly total hours needed to maintain the PRN position.

[Angie_75]

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)?

I've had the flu vaccine 3 times in the last 10 years- the 1st I got because of the policy being "new" with the current company I was working for. I got strep throat that year, twice. Missed two weeks of work from being so sick.

The other 2 times while in the nursing program mandated by the school. I got a really bad respiratory virus 2 times the first year, and a really bad flu virus the 2nd year - both times I was out of commission for a minimum of 5 days.

Maybe it's coincidence. But I've got a healthy immune system and I never get sick- prior to those 3 years, I hadn't been sick since grade school. Any other year I haven't gotten the flu shot, I don't a miss any days of work because I don't get sick. If I start feeling a "little under the weather," I get a really good night's sleep and I'm fine the next day. But, maybe it's just coincidence.

Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work? My employer has a "get vaccinated or wear a mask" policy. I've chosen the mask. I work under a hospital.

What concerns do you have about the flu vaccine?

It's a really good money maker for the pharmaceutical industry. I do think one should be able to choose. There's no way to vaccinate against everything. Even if one has had the flu vaccination, there are plenty of other bacterial and viral strains of infection that can be spread before any symptoms are present. I think the reasoning behind making an individual be vaccinated because they could be infected without knowing it implies an illusion that this is the one virus you are safe from? Or does it mean more yearly vaccines are going to roll out and become mandatory as well? Don't get me wrong - I believe in some, the ones that eradicate the infection altogether. But what kind of mutation is going to happen for the survival of these organisms? They will continue to mutate for survival, as they have since we first discovered them. I think now, we may just be playing with fire.

Do you know if anyone who has been released from their job because they did not get the flu vaccine?

no- but if you didn't get the shot while in the nursing program at my school, you weren't allowed to continue in school. The ONLY exception they made is IF you had a proven allergy, you would be granted the "mask" policy. So, I ended up getting the shot against my own wishes - I wanted to become a nurse.

[BostonFNP, APRN]

People, including infants and children, who are immune-compromised

(like, having cancer, being on chemo or radiation, being gluten-sensitive,

being on steroids, etc.) are MORE likely to catch the flu from those who

were vaccinated, due to "shedding" of portions of the vaccine onto the

immune-compromised folks.

Therefore, those who get vaccinated, should do the responsible thing, and voluntarily SELF QUARANTINE themselves, until after "shedding" stops being a possibility.

Sincerely, Carol Sidofsky, retired RN

(Concerned Lady)

To see my website, click on my name above, and then click on the small "house" icon.

That is actually incorrect. There is no live virus in the inactivated influenza vaccine thus there is no "shedding". The is a very small theoretical risk from the LAIV, the nasal influenza vaccination.