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

[LadysSolo]

This is somewhat off topic but supporting concerned lady - there is cancer research involving taking part of the tumor and processing it to a type of "vaccine" to cause the body to mobilize its own immune system to attack and destroy the tumor cells, thus avoiding chemo and radiation.

[concerned lady]

I've heard of this, LadysSolo, regarding treating the malignant melanoma form of cancer! It is said to work!

Concerned Lady

[concerned lady]

Oops. Didn't mean to post twice (My bad).

Concerned Lady

[trinitymaster]

Have you read this study? It's an independent meta-analysis of 31 studies, 17 of which were RCTs, looking at the efficacy influenza vaccine. It considered only virology-confirmed endpoints.

Osterholm, M. T., Kelley, N. S., Sommer, A., & Belongia, E. A. (2012). Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. The Lancet infectious diseases, 12(1), 36-44.

I cannot access the full article, even through my school. What I did gather from the abstract is that the vaccine is about as useful as taking a Tums every day. "New vaccines with improved clinical efficacy and effectiveness are needed to further reduce influenza-related morbidity and mortality."

This seems to be a favorite article of yours. It would be nice to have access to the full PDF version so that I could look at the qualified studies.

[morte, LPN, LVN]

You are missing the sarcasm, the point being made, these persons weren't being tested BECAUSE they were vaxed , and there for "couldn't" have the flu....

I don't think I follow you.

A study subject has a constellation of symptoms that meets the criteria for flu-like illness.

They are swabbed and a laboratory test confirms if it is influenza A or not.

If the test is positive that subject is diagnosed with influenza.

If the test is negative it is diagnosed as flu-like illness.

It has nothing to do with the vaccination status of the study subject.

[trinitymaster]

Words such as 'ignorant' and 'stupid' are also excellent descriptors, applied appropriately.

I use ignorant within the context of its legitimate meaning: lacking knowledge, lacking information. I give the benefit of the doubt when I read something that is nonsensical and offer that the person speaking nonsensically is simply ignorant of what they are speaking about.

I believe it is nicer to assume that someone is ignorant of facts rather than incapable of understanding them (which is where the definition of stupidity would enter into the picture). Every day, in the course of my work, I meet with people who are clearly ignorant of the facts surrounding their need for the visit that day, but who are clearly NOT stupid. Others may well be both, but I cannot determine that until after the facts are presented, have been repeated, yet the individual still cannot grasp the data. In those cases.....very few, thankfully!.....lower intelligence can be to blame for not understanding a diagnosis or course of treatment (or whatever), NOT ignorance.

After awhile, when facts have been presented repeatedly---and I say FACTS, not supposition, not anecdotes, not internet celebrity crap, but actual SCIENTIFIC DATA---but there are individuals who still continue on in the same manner (as though they had not SEEN any facts, it wasn't THERE).....one has to eliminate "ignorant" as the most likely option, and go with stupidity.

Speaking plainly (and yes, sometimes harshly) isn't always popular. But the truth is what it is.

I have NO problem whatsoever with a difference of opinion. Happens on AN all the time, it's the very foundation of the site. But this thread isn't about opinion. It's about facts. Cold data. Evidence. Science. And when someone's response to all uncontroverted evidence is "yeah...well, says YOU...someone's just making all that up".....well then yes I guess I have a problem with it, and I call it as I see it.

I disagree. Words such as "Ignorant" and "Stupid" serve no other purpose than to show that the purveyor of such words is closed off to the notion of ideas that conflict with their internal beliefs, values, and attitudes.

Some people refer to those who choose holistic medicine as ignorant/stupid. Let me propose this scenario: If you lived in Jefferson's time and someone came up to you and said "You know what I'm thinking, Tom? I think we should pollute our air and water, inject our livestock with poisons, change our food into something other than the good Lord made, and let all of that stuff work into our systems until our bodies become diseased and dying. Then, instead of going back to the way we know things should be, we'll just put more poisons into our bodies and come up with new-fangled treatments that will extend our already expiring bodies by a few, short, agonizingly pain-filled months in which our quality of life will be 'nil. Sounds good, doesn't it?"

Surgery and radiation are powerful tools against cancer. Prayer and Holistic therapy are powerful adjuncts.

BTW: Did I mention that science does not always correlate with the realities of life?

BTW(2): "Facts" can and are refuted all the time. I suggest you use the word "Evidence". Your supposed "facts" are based on observations. When you were a child, you probably thought it was a "fact" that the Sun rose in the east and set in the west.

Example: The "fact" is 3+2=5

The "evidence" suggests that flu vaccines are moderately effective.

[rusti1]

I've heard many cases where conventional treatments were tried and failed, so the patients looked in other directions, and many found help. One found it in baking soda and molasses mixed in water, the molasses supposedly acts like a "trojan horse", carries the alkalining baking soda to the cancer cells, and kills them. This man was helped from stage 4 metastisized prostate cancer that he was told to go home being nothing more to do. Others have written to him with their own experience and how it helped different cancers, so it's not exclusively for one. I think it's a good thing to consider all kinds of possibilities if one wishes. I certainly would.

[trinitymaster]

From the CDC website:

These updated estimates were derived from data collected from the U.S. Flu VE Network from November 10, 2014, through January 30, 2015, and include an additional four weeks of data in comparison to CDC's early VE estimates released in mid-January.

When VE against all influenza viruses was combined, the overall VE estimate was 19% (95% CI: 7%– 29%). In practical terms, this means the flu vaccine reduced a person's risk of having to seek medical care at a doctor's office for flu illness by 19%.

Sure keep telling yourself it's EBP. SO sad bandwagon misinformation is spread in our profession….and others claiming people with data are the ones spreading misinformation.

"It's 19% effective, so you should just take it"….simple minds, simple minds.

Okay, first of all, it was only ineffective because of a unpredictable, yet somewhat predictable antigenic shift/drift that no one could predict because how do we prepare for the unexpected?

Oh yeah, that's right, by predicting which virus will be circulating months ahead of the flu season, because that has been shown to be 19-56% effective 100% of the time. So, if antigenic shift/drift is a confounding variable that cannot be controlled for, how do you propose that we control for it besides playing the guessing game?

Through advertising the flu vaccine as the best method of protecting yourself. Flu bugs get scared to death when they see us being injected with the flu vaccine- that's a fact.

Besides, not being vaccinated is a threat to the elderly and to the babies. And we all know what happens when you threaten the babies

[OCNRN63, RN]

Moderators and fellow AN members :), I apologize for veering a bit off course but some statements are so dangerous that I feel that they need to be challenged.

Concerned lady, I would never "poo poo" a cancer survivor but I will call the claim that holistic methods alone has ever cured cancer, rubbish.

If you or anyone else manages to convince even one cancer patient to reject/decline traditional treatment and choose alternative methods instead, that may well cost that patient his or her life. That's why I say it's dangerous to advocate for non-proven methods. The efficacy of these methods is not supported by evidence.

I find your use of words cutting, burning and poisoning to describe successful medical treatment methods, deeply distasteful. I hope that I'm wrong, but it almost seems that the intent is to scare people away from treatments that we know work.

I have to wonder, do you call an emergency c-section when the life of the mother or fetus is at risk, cutting? Are you against all forms of surgical interventions? Or is that term reserved for surgically removing cancerous tumours?

I don't think that you understand the mechanism of action of radiation therapy. It's either that or you're intentionally making it sound like something it isn't. It's not burning.

Radiation therapy can either be external beam, brachy therapy (radiation source temporarily placed inside the tumour or in a body cavity) or (permanent) implantation of seeds (often I-125).

External beam therapy uses ionizing radiation. This means that the energy used is sufficiently high to either excite an atom (displacing an electron further from the atom nucleus) or ionize it (the electron isn't just displaced, but removed from the atom thus forming an ion pair).

In Europe (and I assume in the US too) the most commonly used external beam method is photon radiation (ie electromagnetic radiation, zero mass, zero charge) but also partlicle radiation like electrons and protons are used. Electrons are good for tumours and sometimes lymph nodes near the surface of the body as electrons don't penetrate as deeply as photons.

Anyhow.. what ionizing radiation does is that starts a process that causes damage to the cell's DNA (it does other things too, but I don't want to bore you to tears on the off-chance that you're still reading this ). If we're lucky we get double strand breaks. Why do we want double strand breaks? Because we don't want the cancerous cells to keep on replicating. We actually want apoptosis or atrophy and the replication to cease. Cancerous cells usually replicate more rapidly than normal cells. And fortunately for us they are also usually less successful at repairing themselves after damage to their DNA than normal/healthy cells.

Do you know the cell cycle?

G0 --> G1 --> S --> G2 --> M --> G0 and on and on and on...

G2 and M (mitosis) phases are normally radiosensitive and very radiosensitive, G1 and S moderately resistant and G0 (resting state) pretty much resistant. So we aim to "attack" the cancer cells just as are they are structurally preparing to divide or when they actually are dividing. Cancer cells typically cycle through this rather quickly and we "attack" with radiation.

So as you see, there's no burning involved.

To help increase your understanding of radiations therapy, here's a text that describes the biologic basis for RT.

Biologic Basis of Radiation Therapy - Holland-Frei Cancer Medicine - NCBI Bookshelf

If you want to learn more about ionizing radiation interacts (lose energy) with cells in the body you can look up photoelectric effect, Compton scattering and pair production. Again, no burning!

Forgive me people, I've always been a physics nerd

Concerned lady, could you please describe the mechanism of action of holistic methods on cancer cells and how they manage to cure cancer and link some relevant research.

As an oncology certified nurse, and as someone with cancer, I can't love this post enough. Not that it will reach its intended target, but at least you fought the good fight macawake.

If only I had known that all I needed for my cancer was an eye of newt, wing of bat, tongue of snake. Oh, and a little valerian root. Boil them in a tea, forever cancer free.

/sarc

ETA: I see from another post I wouldn't have even needed all of that. Just some heapin' spoons of blackstrap molassas and Arm & Hammer!

[trinitymaster]

I've heard many cases where conventional treatments were tried and failed, so the patients looked in other directions, and many found help. One found it in baking soda and molasses mixed in water, the molasses supposedly acts like a "trojan horse", carries the alkalining baking soda to the cancer cells, and kills them. This man was helped from stage 4 metastisized prostate cancer that he was told to go home being nothing more to do. Others have written to him with their own experience and how it helped different cancers, so it's not exclusively for one. I think it's a good thing to consider all kinds of possibilities if one wishes. I certainly would.

Seriously, there is no way that works! That is like using old nun's urine to make medicine, or boiling the bark of a tree. You might as well suggest limes for scurvy, or snake venom derivatives for blood pressure and pain relief. Next thing you you know, you'll be talking about engines that run off of vegetable oil and alternative energy sources like solar energy.

[BostonFNP, APRN]

I cannot access the full article, even through my school. What I did gather from the abstract is that the vaccine is about as useful as taking a Tums every day. "New vaccines with improved clinical efficacy and effectiveness are needed to further reduce influenza-related morbidity and mortality."

This seems to be a favorite article of yours. It would be nice to have access to the full PDF version so that I could look at the qualified studies.

It is available for free: http://www.nogracias.eu/wp-content/uploads/2011/10/Lancet-Infect-Dis-MA-AC-Vacuna.pdf

The article presents both sides of the issue, as I said, it's independent.

Your quote from the abstract is absolutely true, we do need improved influenza vaccines to FURTHER reduce M&M. Did you read the rest of the abstract? Take a look at the whole study and the inclusion/exclusion criteria. It presents the closest approximation to the "real truth" available at this time.

[OCNRN63, RN]

Talk to some of the generous Cancer Control Society cancer SURVIVORS, and they will gladly share what helped them to conquer their cancers.

Some people will survive their cancer dx. without any treatment. I would love to know how many of the Cancer Control "survivors," had diseases that were stage lll or lV.