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

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

You know what is a really good one? Citing mercola.com.

All medical research is not being done by "BigPharma", less than half of it is. Of course there are lobbies, there are lobbies for everything, including nursing, CAM, etc. Unfortuantely it's how government works, at least here.

That IS a good one.

Mercola.com is not a credible site. And that's been shown numerous times already on this thread. But here are a few more (there are many more):

https://www.sciencebasedmedicine.org/9-reasons-to-completely-ignore-joseph-mercola-and-natural-news/

Mercola.com is a horrible chimera of tabloid journalism, late-night infomercials, and amateur pre-scientific medicine, and is the primary web presence of Joseph Mercola. Unfortunately, it is also one of the more popular alternative medicine sites on the web and as such is uncommonly efficient at spreading misinformation. I am not a fan, and have addressed his dross in the past.

FDA Orders Dr. Joseph Mercola to Stop Illegal Claims

Whole bunch of links at the bottom of the page on link above.

https://badscidebunked.wordpress.com/tag/dr-mercola/

Mercola claims:

Raw milk dairy products from organically raised pasture-fed cows rank among some of the healthiest foods you can consume. It's far superior in terms of health benefits compared to pasteurized milk, and if statistics are any indication, it's safer, too”

This is an outright lie. According to the Centers for Disease Control, unpasteurized dairy products are 13 times more likely to cause hospitalization and 150 times more likely to result in foodborne illness.2 Unpasteurized milk is a common source for the bacteria that causes diseases such as diphtheria, tuberculosis, and, typhoid fever.3 It's irresponsible for anyone labeling themselves as doctor” to spread deceit like this. Some of the dangers include:

Salmonellosis, usually transmitted to humans by consuming animal products contaminated by animal feces:4 Put bluntly, those organic cows you see standing in the organic fields munching organic grass growing in piles of organic shit… yeah, that's what feces” means. Salmonella is at best an uncomfortable disease, featuring diarrhea, fever, and abdominal cramps. In extreme cases it can lead to hospitalization. Untreated, in can result in death.

Brucellosis, most commonly acquired by consuming unpasteurized dairy products:5Common symptoms include fever, anorexia, muscle/joint pain, swelling of the heart/liver/spleen, and swelling of the testicles/scrotum in men. (If you're a female reporting swelling in the testicles, you're most likely an anti-vaccine proponent reporting a fake adverse reaction.)

[elkpark]

Similarly, it is not possible to say it did not. but if you going to deny that relationship, how do prove anything?

How about by using the scientific method to construct and conduct legitimate research to find out??

[Here.I.Stand, BSN, RN]

You don't think people die from the flu every year?

Let's count the people in America who died of Ebola last year compared to flu.

Come on.

I'm soooooo late to this party, but learned an interesting factoid from my patient's perfusionist the other day. Guess what was the indication for most of the area's VV ECMO cases last year? (Dozens of cases -- not three.)

Influenza. Yup.

[toomuchbaloney]

It fascinates me that a virus knows to come out of hiding every Autumn and hang about for a few months. A virus different from last year's virus.

I would recommend that you do a bit of research and reading about influenza viruses.

I suspect that if you do you will be able to answer your own question (perhaps a bit sheepishly).

[ixchel]

Oh elkpark, you are soooo naive. Surely you understand that a secret list of all the food products containing GMO'S has been distributed to all people in power, so that they know what foods to avoid. It's all part of the nefarious secret plan to kill off all the "sheeple". After that they'll live happily ever after in a world inhabited only by the "power elite". Eeerr... It's such a brilliant plan

My understanding is that list is the bylaws of the Illuminati.

[ixchel]

but what you are describing has nothing to do with her posts.

She asked why we are angry. I responded with an answer, albeit a little snidely. Maybe you missed that point. Honestly, morte, I'm trying to figure out what your point is. You're picking apart posts and questioning everyone without actually putting any of your own thoughts, research or experiences into the conversation.

Do you have a dog in this fight or are you just trolling?

[cayenne06, MSN, CNM]

But, aren't OTHER drugs/medications (other than vaccines) double blind tested, using actual placebos, in order to verify those OTHER drugs' effectiveness? And such double blind studies using placebo, are considered ethical, aren't they?

Clinical equipoise.

[MunoRN, RN]

Science? Pharma? Oh that's a good one. Let's try this again. Did you know that all medical research is now being done by Big Pharma and they are dictating medical practice? They have successfully invaded medical schools and are in control of what the students are taught. Have you ever noticed that conventional medicine only offers two things and that everyone else is a quack? Pharma has no interest in wellness. That's why there are only treatments but no cure.

More Proof Flu Shots Don't Work

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Here is a very interesting line from the article. They lobbied on behalf of, who was that?: Despite their ineffectiveness, public health and hospital officials have also lobbied hard on behalf of pharmaceutical companies to increase the percentage of health-care workers who get vaccinated, with a handful of Canadian facilities making the practice mandatory for their staff.

I think there's general agreement that we should all be wary of information provided by any company that offers carefully crafted, often misleading or outright false information to sell a product.

Yet it's hard you really practice what you preach when you post a link to a site that wants you to believe everything nothing than supplements will help you and then offers multivitamins at $130 a bottle.

[emtb2rn, BSN, RN, EMT-B]

My understanding is that list is the bylaws of the Illuminati.

Actually it's the stonecutters. D'oh!

[trinitymaster]

An actual study looking at the same issue; a pair-matched CRT study rather than a review, or an editorial as above.

CONCLUSION: These results support influenza vaccination of staff caring for institutionalized elderly people.

Lemaitre, M., Meret, T., Rothan‐Tondeur, M., Belmin, J., Lejonc, J. L., Luquel, L., ... & Carrat, F. (2009). Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster‐randomized trial. Journal of the American Geriatrics Society, 57(9), 1580-1586.

All studies support vaccinating those who care for the elderly since 95% of all influenza deaths are suffered by those 65 or older. Very few children die from influenza each year and it could be rationally argued that fewer than 50 children die of the flu each year, but that is not the point.

Wearing a mask when caring for the elderly would likely be more efficacious than the flu shot, but we are focused on something that has a low effectiveness. Perhaps we don't need different answers, maybe we need different questions.

[BostonFNP, APRN]

All studies support vaccinating those who care for the elderly since 95% of all influenza deaths are suffered by those 65 or older. Very few children die from influenza each year and it could be rationally argued that fewer than 50 children die of the flu each year, but that is not the point.

Actually, the reverse is true. There are numerous studies showing benefit in children but few showing effectiveness in adults over 65.

Wearing a mask when caring for the elderly would likely be more efficacious than the flu shot, but we are focused on something that has a low effectiveness. Perhaps we don't need different answers, maybe we need different questions.

We need a study showing that masks are more effective than the vaccine, the limited data on the topic has not been overtly positive.

"None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection. Some evidence suggests that mask use is best undertaken as part of a package of personal protection especially hand hygiene. The effectiveness of masks and respirators is likely linked to early, consistent and correct usage."

bin‐Reza, F., Lopez Chavarrias, V., Nicoll, A., & Chamberland, M. E. (2012). The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza and other respiratory viruses, 6(4), 257-267.

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

Very few children die from influenza each year and it could be rationally argued that fewer than 50 children die of the flu each year, but that is not the point.

Maybe you should go shadow a pediatric resident in a big city ER during flu season and try to care for all the kids who come in with the flu.

I say that because coincidentally, I was re-reading a book last night by Michelle Au, MD called This Won't Hurt A Bit (and other white lies) and came across this section:

"I admit that part of it was flu season. As sort of an annual tradition, like some sort of electronic harbinger of doom, the children's hospital would send out an e-mail to all staff around late October or early November, heralding the first diagnosed case of influenza in the hospital. Cut through all the administrative admonitions for staff to get their flu shots and the usual epidemiological details about viral strains, and this e-mail in effect amounted to an alarm to BATTEN DOWN THE HATCHES, FLU SEASON IS HERE. And so for the next five months, the Pediatrics staff was essentially under siege, the ER overflowing with vomiting, coughing, crying children; clinic waiting rooms filled to capacity with walk-in patients; with most of the residents, our puny immune systems rendered insensible with fatigue, no match for the virulent and often projectile nature of these bugs. War is hell, but flu season in a Pediatrics hospital should at least count as one of the outer circles of Dante's inferno."

As to deaths; link to latest report about influenza cases/deaths:

Weekly U.S. Influenza Surveillance Report | Seasonal Influenza (Flu) | CDC

A total of 145 influenza-associated pediatric deaths have been reported during the 2014-2015 season.