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

[ixchel]

"You get enough in your food!", which is totally amazingly un-"scientific" since there's no way anyone would know how much they themselves get or need in their own foods, let alone someone else thinking they do, despite all their "education" in it.

Fun fact! Your mind will be blown with this one. Are you ready?

These guys, they like to science the **** out of these things, right? They do what's called "blood testing", and magically, POOF! They can see if you're getting enough vitamins!

It's AMAZEBALLS!!!!!!

And not only that!!!!!

They can test your electrolytes, too!!!!

Gosh, I imagine before that, they just used a magic 8-ball.

Thank you for revitalizing the scare quotes. I think I'm going to program my autocorrect to change science to "science".

[Ankh]

I want to point out that this post and survey are one-sided. No attempt is made to even scratch the surface of why some nurses are opposed to taking the flu vaccine and/or mandating it for healthcare professionals

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)?

No. I do not participate because I believe in holistic concepts which aim to prevent the flu without the use of vaccines. I also do not advocate adding additional components, many of them controversial to my body-system. (Why are those who decline the vaccine being asked to state their reasons? Why not those who participate in flu vaccination as well?)

2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

It is state-mandated but my hospital allows one to opt-out so long as we agree to wear a mask in all patient care areas during influenza season.

3. What concerns do you have about the flu vaccine?

I have similar concerns about the flu vaccine as I do with other vaccines. First, they contain unsafe components. Some will attest that the amounts are harmless and I will disagree with the understanding that something toxic and unfit to be in the human body does damage at both small and large levels. Further, it is absolutely my right whether or not to put these substances in my body as it is another persons. Secondly, I am ethically opposed the corporatization of medicine. When the profit motive can be fully divorced from CDC and other mainstream health recommendations, a new kind of conversation can take place.

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

Not personally though I have heard of incidents.

[elkpark]

I want to point out that this post and survey are one-sided. No attempt is made to even scratch the surface of why some nurses are opposed to taking the flu vaccine and/or mandating it for healthcare professionals

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)?

No. I do not participate because I believe in holistic concepts which aim to prevent the flu without the use of vaccines. I also do not advocate adding additional components, many of them controversial to my body-system. (Why are those who decline the vaccine being asked to state their reasons? Why not those who participate in flu vaccination as well?)

2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

It is state-mandated but my hospital allows one to opt-out so long as we agree to wear a mask in all patient care areas during influenza season.

3. What concerns do you have about the flu vaccine?

I have similar concerns about the flu vaccine as I do with other vaccines. First, they contain unsafe components. Some will attest that the amounts are harmless and I will disagree with the understanding that something toxic and unfit to be in the human body does damage at both small and large levels. Further, it is absolutely my right whether or not to put these substances in my body as it is another persons. Secondly, I am ethically opposed the corporatization of medicine. When the profit motive can be fully divorced from CDC and other mainstream health recommendations, a new kind of conversation can take place.

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

Not personally though I have heard of incidents.

What, are they tag-teaming us now? One antivaxxer steps out for a break and another comes in??

[ixchel]

What, are they tag-teaming us now? One antivaxxer steps out for a break and another comes in??

It would seem so. :\

[BostonFNP, APRN]

Are you mad about being asked or not being asked?

I want to point out that this post and survey are one-sided. No attempt is made to even scratch the surface of why some nurses are opposed to taking the flu vaccine and/or mandating it for healthcare professionals

(Why are those who decline the vaccine being asked to state their reasons? Why not those who participate in flu vaccination as well?)

[BostonFNP, APRN]

First, they contain unsafe components. Some will attest that the amounts are harmless and I will disagree with the understanding that something toxic and unfit to be in the human body does damage at both small and large levels.

Which unsafe compounds are you specifically concerned with?

Sola dosis facit venenum. I know, its sooooo 1490s, but it still holds true today.

[rusti1]

I want you to show actual proof from a RELIABLE resource that this is true.

In the last 50 years, we have seen advances in the control and treatment of communicable diseases. We have learned how to utilize proper nutrition and have further examined sanitation for better living conditions. Food deserts have been recognized and there has been active and ongoing effort to eliminate them. Social and economic policy has recognized the need for access to healthcare by increasing funding and availability to care (Medicare and Medicaid). We've increased our understanding of so many health conditions and for some, truly have perfected diagnosis and treatment. We sharpened our diagnostic tools and can detect and treat many conditions far sooner.

But wait - lets back up to that beginning part there. "We have seen advances in the control and treatment of communicable diseases". 50 years ago, in the 60s, we did something that I think most probably never thought possible. We ERADICATED a preventable disease - small pox. How did we do that? Vaccination.

To your indignant insistence that you feel like you have been bullied by being told the blood is on your hands, allow me to get in line behind all those other bullies and say that you, and others like you, are the reason why we can't get rid of these deadly diseases (you know, the ones that aren't the plague).

As for the conditions that are getting more frequent (non-communicable diseases - kidney failure, heart failure, hypertension, diabetes, etc.), these are not new conditions, but they are increasing. A lot of these issues are increasing mostly for two reasons: 1 - people are living so much longer and bodies can only get so old before deteriorating, and 2 - people are way too sedentary and they love horrible cholesterol and calorie-laden food that gives them no actual nutrition. So, basically, people are either living to death, or they're destroying their own bodies. THAT is the only part of health trends that are not doing that well. Vaccine-preventable illnesses should NOT be happening, if we're doing our part.

If you have a chronic condition that is treated by a med that gives you 10 frustrating side effects, change that med. It's absurd to load up on even more pills when better options may be available. A decent MD/NP/PA would recognize changing the problematic med is a reasonable solution.

And yes, people may very well be taking more medications than before. It's because of the chronic conditions I listed above, and any other chronic condition you could think of. Two examples:

56 year old, 300 lb male comes in to the ED complaining of cough x 3 week, leg swelling, intermittent chest pain and increasing shortness of breath. A chest x-ray and blood work show that this person has congestive heart failure. His vitals show he has hypertension. He gets admitted, and begins his life-long journey with a beta-blocker, diuretic, and probably an additional anti-hypertension med. He needs these medications to literally survive. Without them, he may fill his lungs with fluid, destroy his kidneys, and destroy his heart. So, ~3 meds to live a longer life? Or skip them, knowing you won't survive after a little while? He's only 56. THIS is a very typical presentation of an overweight, sedentary person who does very little to maintain their own health. It's not just the meds they need. They have to change their whole normal routine. Exercise, weight loss, daily weight monitoring, cutting cholesterol, cutting fat, definitely cutting salt. When it gets as bad as this guy has it, it's sad but often they don't make lifestyle changes. But, they do more often take their meds, and that's a better start than NOT taking them.

32 year old female with only known medical history of spinal fractures presents to ED with altered mental status. Medication history includes low doses of opiates, muscle relaxers, and NSAIDs. Patient relies on those medications to actually maintain the active lifestyle her kids need from her, to be able to get out of bed in the morning and take care of herself, to not suffer the pain she WOULD feel without. It is determined the medications involved probably don't directly cause altered mental status, but one does decrease seizure threshold. Working diagnosis - absence seizures, which is confirmed through EEG. Now, in addition to pain management, the patient requires a neuroleptic. Without the neuroleptic, this woman can't drive, can't be left safely to take care of herself or her kids. This is required. First neuroleptic, bad side effects. Tried a second one. Not only is this one effective, it is also used to treat nerve pain. Now she has a medication that can help her take less of her other medications.

Both of these scenarios are very real, very serious, and absolutely require medications. The first scenario, this is often the most common patient I get at work. The second scenario? That one is me. It is so easy to judge "over" medicating when you are generally healthy. The reason medication usage is on the rise is because it is needed. I am beyond thankful that they are available, and that new types come on the market all the time. Just because I have a neuroleptic that is perfect for me, doesn't mean that it will be perfect for someone else.

Is it "respiratory problems all your life", or is it since you were pregnant. For real, pick one story and stick with it.

Not getting the flu proves literally nothing. It only proves that IF you were even exposed in the first place, you didn't manage to get it in you. That is the ONLY thing that means. Most people don't get the flu every single year. Some people may even go decades like you have. Last year was my first time in decades. No exaggeration. I tested positive for it, and was thankful it was gentle. That's where if the vaccine doesn't work, it is still helpful. Even the government and those following the vaccine effectiveness rates still came out and said it was a crappy year for vaccines. This WILL still happen sometimes. It is a calculated risk well worth taking.

And by the way, your self identified respiratory issues puts you in the one of highest risk categories for respiratory complications from the flu. That means when this lucky streak you are on ends, you are significantly at risk for requiring an ICU admission with mechanical ventilation. You are at very high risk of death. When the bronchospasm/constriction does not respond to the vitamin C (it won't), you will be relying on EMS to get to you in time. This is a terrible, naive gamble.

Who is this magical 4 bad flu episodes person you keep talking about? And once again, I ask you - did this person get tested for the flu, or is it an assumption that that is what it was?

Having 4 difficult "flu episodes" in 5 years has literally nothing to do with the flu vaccine. NOTHING.

No nurse here will be finding out for him or herself any of what you have said because what you are saying is not based on any reality whatsoever. What they are finding out is how scary and stubborn anti-vaxxers are and how strongly they cling to complete conspiracy crap.

Ixchel, if someone doesn't tell your sister nurse there that getting yet another vaccine, after 4 of 5 years of flu episodes almost putting her out despite being vaccinated, she may not survive this one, I am not the one who is "dangerous". You along with most are brainwashed in the vaccine hoax as well that the flu vaccine itself doesn't cause the flu. I only gave her some advice in order to survive the vaccine.

[rusti1]

Re: Is it "respiratory problems all your life", or is it since you were pregnant. For real, pick one story and stick with it.

It's both! :) Since a child, having bronchitis. This wasn't bronchitis but, one time I woke up with my throat closing, unable to breathe if I tried to clear my throat, kind of choking on my own phlegm..? My aunt took me to her doctor, who took off my shoe and sock and simply pressed the sole of my foot, (my right foot I remember:), and the next minute my throat completely cleared. Actually, less than a minute. I'd be so happy to see ER's knowing that procedure!...The slightest cold, especially cold water, and I'd start sneezing. I kind of grew out of it, though still susceptible to cold. Then asthma began as I said. So, it's both. As a child and as an adult. Even now, I start coming down with cold symptoms many more times than a usual person would, but, I know how to catch them quickly with vitamins (esp C). That's how I know a little about it, and what that poor nurse needs.

[rusti1]

And, Re: "Who is this magical 4 bad flu episodes person you keep talking about? And once again, I ask you - did this person get tested for the flu, or is it an assumption that that is what it was?

Having 4 difficult "flu episodes" in 5 years has literally nothing to do with the flu vaccine. NOTHING."

It goes back to Page 79:

0 Nov 6 by rusti1

Quote from Oh'Ello

Yes, I get vaccinated annually. Yes it is mandatory at my workplace. My only concern is how my immune system would handle the flu without the vaccine. I've had the vaccine almost every year for 12 years. I've gotten the flu 4 of the last 5 years and was very very sick. One of those times with ARDS requiring intubation (H1N1). Now I'm afraid if I don't get vaccinated the flu will actually kill me. I have seen individuals released from their jobs for refusing vaccination, as I work in Hematology Oncology. They were able to secure employment elsewhere in the hospital system though.

This was my answer:

The vaccine itself is lowering your immune system. If you have to get the vaccine, please take Vitamin C before, during and after the shot. It will help you. In fact I would take it every day especially during cold weather. Vitamin C and Omega 3s. Maybe cod liver oil.

Really, nothing? How many ended up in the hospital with the flu, having been vaccinated, I'd be very curious to know. O, and I was called "dangerous" for that advice. Vitamin C advice. I don't know what to say? You all have gotten so convinced of the flu vaccine's success, that this one thinks her flu would be "worse"?? without one? and, I'm dangerous? Omg

[ixchel]

Ixchel, if someone doesn't tell your sister nurse there that getting yet another vaccine, after 4 of 5 years of flu episodes almost putting her out despite being vaccinated, she may not survive this one, I am not the one who is "dangerous". You along with most are brainwashed in the vaccine hoax as well that the flu vaccine itself doesn't cause the flu. I only gave her some advice in order to survive the vaccine.

As far as the woman with mental problems, I would suggest considering low-dose lithium (a natural mineral found in food and water). Not the prescribed synthetic kind. That might work far more safely and effectively. I've heard amazing things with it.

Did you just seriously call my epilepsy "mental problems" and then recommend a medication that treats BIPOLAR disorder? A medication that can easily have horrific side effects (including seizures) and be OVERDOSED when not taken with strict, routine lab work? One that is packaged by anyone without any oversight to make sure they give you what the manufacturers claim are in it?

I'm done with your absolutely ridiculous asinine flawed and completely uneducated "beliefs" about "science". One of these days you're going to kill someone with your medical advice. Remember us when it happens.

[JustMeRN]

Ixchel, if someone doesn't tell your sister nurse there that getting yet another vaccine, after 4 of 5 years of flu episodes almost putting her out despite being vaccinated, she may not survive this one, I am not the one who is "dangerous". You along with most are brainwashed in the vaccine hoax as well that the flu vaccine itself doesn't cause the flu. I only gave her some advice in order to survive the vaccine.

giving medical advice without any medical training?!?! To strangers over the Internet?!?! You are delusional and dangerous. You need to back yourself up and realize what you are doing is dangerous,unethical, and bordering on illegal. You are one of those keyboard warriors seen all too often urging others to forgo actual medical treatment for unproven, unsafe remedies. People suffer unnecessarily because of people like you and it makes me sick. You want to dole out medical advice? Go to medical school. Or at least get a real degree in some sort of medical field so that you might actually understand what you are talking about. You are allowed your "I think" and "I feel" 's, but those are not facts. You are allowed your own "reality" but you are not allowed to encourage others to follow your reality when it is dangerous.

[JustMeRN]

And, Re: "Who is this magical 4 bad flu episodes person you keep talking about? And once again, I ask you - did this person get tested for the flu, or is it an assumption that that is what it was?

Having 4 difficult "flu episodes" in 5 years has literally nothing to do with the flu vaccine. NOTHING."

It goes back to Page 79:

0 Nov 6 by rusti1

Quote from Oh'Ello

Yes, I get vaccinated annually. Yes it is mandatory at my workplace. My only concern is how my immune system would handle the flu without the vaccine. I've had the vaccine almost every year for 12 years. I've gotten the flu 4 of the last 5 years and was very very sick. One of those times with ARDS requiring intubation (H1N1). Now I'm afraid if I don't get vaccinated the flu will actually kill me. I have seen individuals released from their jobs for refusing vaccination, as I work in Hematology Oncology. They were able to secure employment elsewhere in the hospital system though.

This was my answer:

The vaccine itself is lowering your immune system. If you have to get the vaccine, please take Vitamin C before, during and after the shot. It will help you. In fact I would take it every day especially during cold weather. Vitamin C and Omega 3s. Maybe cod liver oil.

Really, nothing? How many ended up in the hospital with the flu, having been vaccinated, I'd be very curious to know. O, and I was called "dangerous" for that advice. Vitamin C advice. I don't know what to say? You all have gotten so convinced of the flu vaccine's success, that this one thinks her flu would be "worse"?? without one? and, I'm dangerous? Omg

How about you back up that medical advice with some reasons, studies, anything. Why vitamin c? What's the dose? What does vit c do in the body on a biochemical level? What physiologically does it do for the immune system? What is max threshold for vit c? Can it be toxic? At what levels? What are the side effects? Who is it contraindicated for? What studies have been and what were the outcomes? Does vit c interact with anything else? Is there anything that potentiates vit c? Increases absorption? Decreases absorption? What are different preparations and compounds? Which is best?

Your ridiculous advice belays the reality that you have no medical training, you have no understanding of the complexity of the human body on a cellular level. You repeat from rote memory the advice of natural practitioners whose sole purpose is to sell you that vitamin c. I could point you to dozens of studies showing homeopathy is a hoax, vitamin c does nothing for your immune system, and vaccines work. But it would be a waste of my time. You are so focused on the nonsense you "believe" that you can not even begin to understand what you don't know. You won't be able to answer my questions about vitamin c, but you still will not admit that you do not have the knowledge or the education to back up anything you say. You "feel" and you "think" but you do not have the education to understand those things you "feel". That's why people like you ARE dangerous.