Friday Flu Shot: Recommendations For Health Care Workers
Feb 10, 2012

Three times a year the National Vaccine Advisory Committee (NVAC), which is an advisory group to the U.S. Department of Health and Human Services (HHS), meets to discuss vaccine related topics.  This week the Committee met and discussed a number of issues, including the Healthy People 2020 goal to reach 90% influenza vaccination rates among health care personnel.   Since flu vaccination rates among health care workers is currently around  63%, the Assistant Secretary of Health requested that the Committee propose recommendations for hospitals and other health facilities to help achieve the goal outlined by the Health People 2020 document.   After a year of deliberation among NVAC subcommittee members, representing a wide variety of views on this issue, the full committee voted on the following five recommendations:

  1. Establish comprehensive influenza infection control programs in hospitals that include education on how to prevent flu transmission with tools such as hand hygiene, cough etiquette, free access to flu vaccines, and information on the benefits and misconceptions of flu vaccines.
  2. Health care employees and facilities should integrate flu vaccination programs into existing flu prevention and occupational health programs.
  3. Continue efforts to standardize methods on how to measure health care worker vaccination rates.
  4. Facilities that can’t reach and  maintain 90% vaccination level without the first three steps should strongly consider mandatory flu vaccination policies and may consider exemptions.
  5. Develop new and improved flu vaccines and vaccine technologies.

Prior to adopting these recommendations, the Committee received extensive written public comments.  Additionally, during the meeting several health care workers  presented verbal testimony in opposition of the fourth recommendation that suggests facilities consider mandatory flu vaccine policies if they can’t raise vaccination levels after completing the first three steps.  With each comment, those opposing these recommendations focused on the rights of the individual nurse and health care worker.  However, no mention was made of those who may suffer from the actions of health care workers who may unwittingly spread deadly influenza virus to at-risk patients.

Executive Director Laura Scott is pictured here along with Families Fighting Flu Board Members

Fortunately, after about 30 minutes of comments made in opposition to this specific recommendation, Laura Scott, Executive Director of Families Fighting Flu, stood and addressed the Committee.  She strongly supported all the recommendations on behalf of the members of Families Fighting Flu.  She spoke of how concerned they were about unvaccinated health care workers and she reminded the Committee that these workers are not only a threat to themselves, but to the most vulnerable in our society, including our children.  Her public comment went as follows:
Our organization is dedicated to protecting the lives of children. Our members primarily include families whose children have suffered serious medical complications or died from influenza.  Member families like the Booths from CO, who, just one year ago, were watching their son, Austin, at his high school basketball game, when only one week later were planning his funeral; families like the Steins from VA, who suffered the tragic loss of their 5-year-old daughter, Jessica; members like the Duvalls from AK, whose 15-year-old old son, Luke, survived influenza after weeks in a coma; or members like Brooke Meredith who at 31-years-old and pregnant was hospitalized for nearly a month and on a ventilator due to influenza.
No one can talk about the real consequences of skipping the flu vaccine better than our members. 
This is why we believe so strongly that it’s completely unacceptable for health care personnel, including providers – the very people we go to for medical treatment – to not protect themselves and their patients by getting vaccinated. We know first-hand that the flu is serious and does kill. Patients expect health care personnel to take reasonable steps to help protect them from preventable-diseases, like influenza. Unvaccinated health care personnel are not only a threat to themselves but to the most vulnerable, including our children.
We all know that annual vaccination is our best defense against influenza. The risk of disease is far too great; it is incomprehensible why health care personnel would chance it by not getting vaccinated.
I recently read a letter in a medical journal that sums it up well. It said:

“Doctors and other health-care providers have an ethical obligation to make decisions and take actions that protect patients from preventable harm. Many patients are highly vulnerable to flu, so choosing not to be vaccinated is choosing to do harm—a choice that has no place in health care.”

Families Fighting Flu couldn’t agree more. Our organization strongly supports all five of the recommendations and strategies presented in this report. We look forward to continuing to help educate health care personnel about this serious disease and working together with all of you to achieve this goal.
In addition to Ms. Scott’s comments, the National Foundation for Infectious Diseases (NFID) also spoke in favor of the recommendations, praising them as a “measured and tiered approach to the issue.”  NFID stated that the fourth recommendation is an important accountability feature that addresses a critical patient protection issue.
After receiving these comments, the Committee spent the evening rewording the initial recommendations based on feedback from all participants and ensuring that proper protocol had been followed by the subcommittee.  In the end, all  five recommendations were approved.

Laura, like many moms, is committed to protecting all children from the dangers of influenza.

I am grateful that organizations such as Families Fighting Flu are willing to stand up and emphasize the seriousness of influenza and the importance of annual flu vaccination. If I, or my loved ones, are ever under the care of a health care worker, I certainly hope that they would care enough about my health and their own to be fully vaccinated.  Unfortunately, this is one thing I can never be sure of.  Since their privacy is protected by HIPAA laws, my right to know if they pose a medical risk is circumvented.  Instead, I must rely on these individuals to adhere to their oath to “First, do no harm.”
While I believe these recommendations will initiate some action among medical facilities that offer patient care, I also wish they weren’t necessary.  I simply wish health care workers everywhere would take these steps without the need for their employers to require it.
But I’m curious to hear what you have to say.  Do you feel it is reasonable to expect health care workers to be vaccinated for influenza?  And what are your thoughts on these new recommendations?

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9 responses to “Friday Flu Shot: Recommendations For Health Care Workers”

  1. L.J Tan says:

    Thanks to Ms. Scott and Mr. Novick for bringing the conversation back to the most important matter, protecting our patients and those most vulnerable to influenza complications – those in hospitals and other similar healthcare facilities. I think that most patients expect that the person taking care of them, or their children, is protected against transmitting influenza. They would be horrified to find out that s/he was not, and even more horrified to find out that s/he refused to be immunized.

  2. C. Duvall says:

    I am so proud of the work being done by FFF to protect the public from influenza through vaccinations-even ones for healthcare workers! When my son, Luke, was in ICU in a coma fighting H1N, we listened to a lady next door weep all night as her infant was dying from H1N1. Want to know where the baby got it? In the hospital! Most likely from a healthcare worker. Because of issues at birth it had never left the hospital. It is a memory that is searred in my mind. God bless this valiant effort to prevent this tragedy from ever happening again!

  3. Brian Schroer says:

    As a physician it is a privilege not a right to treat patients. All health care workers who can’t do what is right by being fully vaccinated should excercise their right to work in another field.

  4. Richids says:

    One thing that is disturbing, despite new studies showing that D3 is over 800% more effective at fighting influenza than the vaccine, no government regulatory agency is recommending increasing the RDA from its current paltry 400IU/day.
    Results: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006).
    70% of the market for flu vaccines is still MDV, and they all contain thimerosal. I’ve read how it is removed from the body super fast and how methyl mercury (fish) is much more dangerous. Well I beg to differ with that opinion:
    Mercury also activates microglia and does so in concentrations below 0.5 microgram (3 to 5 nanograms) per gram of wet tissue [113]. This is well below the concentration found in Thimerosal-containing vaccines administered to children. Ethylmercury hydroxide, like its cousin methylmercury hydroxide, enters the brain very easily, but once within the brain it is rapidly de-ethylated, forming tissue-retained inorganic mercury (Hg2+) species [114]. There is evidence that this “inorganic” mercury is significantly more neurotoxic than the organic mercury compounds from which it forms and more difficult to remove. Studies using monkeys demonstrated that ionic mercury is redistributed in the brain [115]. These same series of studies also demonstrated that there was extensive microglial activation in the monkey’s brain that persisted over 6 months after the mercury dosing was stopped. Thus, when the plasma mercury disappears, the brain mercury remains [116].
    The preceding facts are important to remember when vaccine safety promoters tout findings of new studies showing that ethylmercury (in Thimerosal) disappears from the blood within several days. Actually, the mercury leaves the plasma and enters the brain, where it is de-ethylated and, based on human post-mortem research [174], remains with a half-life of about two decades. What is also conveniently hidden are the results of recent studies demonstrating that, within a short time, on average only about 7% of the methylmercury hydroxide administered orally was converted into brain-retained “inorganic” mercury; whereas 34% of the Thimerosal (ethylmercury compound) injected was similarly converted [117]. [Note: The value for “organic” mercury is calculated as the difference between the “total” mercury value and the “inorganic” mercury value based on sub-sample assays from a given homogenized sample. The two mercury assay procedures, “total” and “inorganic” only differ by the severity of the oxidation step used to liberate the mercury species – where the work-up for a “total” mercury determination is done under more severe conditions.] This means that a greater quantity of a more destructive form of mercury is retained in the brain following administration of a Thimerosal-containing vaccine than from the methylmercury compounds present in fish.
    [113] Brookes N. Specificity and reliability of the inhibition by HgCl2 of glutamate transport in astrocytes cultures. J Neurochem 1988;50:1117–22.
    [114] Vahter ME et al. Demethylation of methylmercury in different brain sites of Macaca fascicularis monkeys during long-term subclinical methylmercury exposure. Toxicol Appl Pharmacol 1995;134:273–84.
    [115] Charleston JS et al. Changes in the number of astrocytes and microglia in the thalamus of the monkey Macaca fascicularis following long-term subclinical methylmercury exposure. Neurotoxicology 1996;17:127–38.
    [116] Charleston JS et al. Increase in the number of reactive glia in the visual cortex of Macaca fascicularis following subclinical long-term methylmercury exposure. Toxicol Appl Pharmacol 1994;129:196–206.
    [117] Burbacher TM et al. Comparison of blood and brain mercury levels in infant monkeys exposed to methylmercury or vaccines containing thimerosal. Environ Health Perspect 2005;113:1015–21.
    [174] Sugita M. The biological half-time of heavy metals. The existence of a third, “slowest” component. Int Arch Occup Environ Health 1978;41(1):25–40.

  5. toni bark says:

    Considering that all non-industry funded large scale meta-analysis looking at flu vaccine effectiveness is not too impressive. In addition, the studies looking specifically at health care workers and influenza in elderly in-patients did not show the vaccine to make any statistical difference. In addition, the true rates of influenza are about 7% of what is diagnosed or reported. The reality and science just do not add up with the recommended policies.
    And, as one writer added above, the studies on vitamin D seem to reduce hospitalization and severe complications from any upper respiratory infection, why isn’t that a recommendation for patients and workers?

  6. lilady says:

    @ Toni Bark: Inquiring minds want to know what homeopathic seasonal flu prevention medicine you prescribe and…what homeopathic seasonal flu remedies you would prescribe for the elderly at home and in long-term care facilities:

  7. Snore says:

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  8. lilady says:

    Spammer alert above for an anti-snore pillow.

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