The American Academy of Pediatrics issued a statement on September 13, 2010, supporting a policy of mandatory flu vaccination for all health care workers (allowing for medical exemptions, of course). They state that it is "ethically justified, necessary and long overdue to ensure patient safety." I agree that the flu vaccine is important. I agree that it is useful for health care workers to get a flu vaccine in order to lower their chance of catching the flu and passing the illness to patients. A doctor, such as myself, would be contagious for a day or two before even feeling sick. Then when I did get sick, I'd likely keep working if my symptoms were minor. I'd wash my hands and wear a mask, but I'd still be exposing some patients. Of course, with a fever or severe flu symptoms, I'd take a few days off (like last year, when I caught the H1N1flu, I took a Friday off and was back to feeling normal by Sunday). So I'm not arguing that the flu shot isn't important for health care workers. Those who choose to not be vaccinated should take some extra responsibility to take time off work if they do catch the flu.
What I take exception to is the thought that the government or medical boards would make it mandatory. Absolutely, without exception, lose-your-license-if-you-don't-comply, mandatory. That makes me shiver. I could understand such a policy if the flu vaccine was 100 percent harmless to every single person that got one. But it isn't. There are very rare but very severe, even fatal, reactions to the vaccine every year. There are a lot more fatalities from the actual flu then there are severe vaccine reactions, but nevertheless the vaccine does have some element of risk.
Here is just an example of what one vaccine product insert lists as reported (but not verified or proven) reactions to flu vaccine: bleeding from low platelet blood cell counts, severe anaphylactic allergic reactions, Guillain-Barre Syndrome (temporary paralysis), seizures, inflammation of the brain and spinal cord, dysfunction of the nerves in the eyes, face, or arm, inflammation of blood vessels, shortness of breath, Stevens-Johnson syndrome (severe allergic reaction involving the skin and some organs), and chest pain.
I find it interesting that less than half of health care workers get a flu vaccine each year. Why is that? Is it because they've all read the vaccine product insert and don't like that long list of possible, but unlikely, side effects? Or do they just not get around to it for no particular reason? I don't know.
In my opinion, no government has the right to force anything potentially dangerous on anyone. We should all have the freedom to choose between a flu vaccine and risking the disease. Patients who come into a doctor's office or hospital take a small risk every time, but not primarily from the doctor. There's far more risk of catching something from another patient. So, if this policy passes, what's next? Denying hospital admission or even health care to anyone who doesn't get a flu vaccine? After all, that patient would be putting others in the hospital or office at risk, and we can't have that. And why stop at the flu vaccine? Let's make all vaccines 100 percent mandatory for everyone! Hey, why don't we just burn the constitution?
Dr. Bob Sears
Pediatrician and author of "The Vaccine Book: Making the Right Decision for Your Child"
Mark Hyman, MD: Is There a Cure for Autoimmune Disease?
David Katz, M.D.: What to Do About Flu? Get Vaccinated
Dr. Bob Sears: Why You Shouldn't Mix Flu Shots With Other Vaccines
CDC - Seasonal Influenza (Flu) - Key Facts About Seasonal Flu Vaccine
Influenza vaccine - Wikipedia, the free encyclopedia
Learn About Flu Shot -- the Influenza Vaccine -- and Its Side Effects
Flu shot: Your best bet for avoiding influenza - MayoClinic.com
Your mom's in care. Chronic bronchitis. A simple flu-like illness could tip her into pneumonia and death. But hey, that's OK, lets make sure none of the staff have their seasonal flu vax, right? I mean we wouldn't want any of them to get a fever, would we, or to infringe upon any of their liberties, even if lives are at stake.
Your wife's due a major operation? Here's hoping the surgical staff are careful, huh? And hope like hell that one of them isn't a carrier of something like Hep B or Hep C, which she could easily catch. I mean, you wouldn't want her surgeons to undergo screening and mandatory vaccination against hepatitis now, would you? Of course not!
Your kid's sick with leukemia. Weak, vulnerable.
But hey! It's OK if all the staff in pediatrics haven't been checked to see if they are immune to things like measles and varicella (and OK if they haven't been immunised if they aren't immune). We can't have them risking a sore arm now can we, just to save your kid from a potentially fatal infection. Here's praying one of them doesn't come down with something and give it to your kid. God has to do it all on his own here, since we aren't going to help one little bit.
Lots of emoting. We all know what the arguments for vaccination are, it is question of whether the products are as safe and effective as the propaganda claims. Of course, if you are not allowed to have a civilised and open discourse about it, then it is highly prejudicial in all sorts of ways.
The point is that several vaccines are mandated in order to protect patients from infection. And people support this policy, and would be reticent to avail themselves of medical care if their care givers did not undergo this process.
Next thing there will be a complaint that the civil liberties of nurses are being infringed because hospital policy mandates they need to wash their hands. (Don't the foolish managers know some people can get allergies to handwash lotion?)
By the way, there are c.difficile vaccines under development.
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"HCP’s [Health Care Professionals] have an moral obligation to minimize the chance that will harm will occur to patients, many of whom are particularly vulnerable. This duty is summed up in the three laws of health care:
A HCP may not injure a human being or, through inaction, allow a human being to come to harm.
A HCP must obey any orders given to it by SBM [Science Based Medicine] , except where such orders would conflict with the First Law.
A HCP must protect its own existence as long as such protection does not conflict with the First or Second Law."
or from the SHEA report
"Those in support of mandatory programs argue that influenza vaccination is an ethical responsibility of HCP, because HCP have a duty to act in the best interests of their patients (beneficence), to not place their patients at undue risk of harm (nonmaleficence), and to protect the vulnerable and those at high risk of infection. The duty to put patient interests first is outlined in nearly every professional code of ethics in medicine, nursing, and other healthcare fields."
Dr. Mark Crislip has a great take on making flu vaccine mandatory for HCPs. Take a look
http://www.sciencebasedmedicine.org/?p=7714
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That's a quote from a great presentation by Dr. Carolyn Bridges of the CDC. More info below. It seems to me that if health care professionals had mandatory (with exemptions) vaccination, they would be more likely to recommend it to their patients.
The quotes from a great powerpoint presentation from the CDC dated August 30, 2010. It includes a discussion of the disease, the varying death rates (in years when H3N2 predominates there are 2.7 times more deaths than when H1N1 or Influenza B dominates). There's a discussion of the recent Hutterite colony study showing that vaccinating some protects others and even an explanation of blood levels. You don't need a scientific or medical background to understand it. A lot of great information.
www.bt.cdc .gov/coca/ ppt/HHSCDC Flu_083010 .pdf
If the CDC continues to employ poor scientific methods in sampling their data, and continues to purposefully propagate statistics they know to be incorrect, then they have no credibility.
Weekly August 27, 2010 / 59(33);1057-1062 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5933a1.htm
2009 H1N1 killed fewer people than seasonal flu because those most vulnerable, the elderly, had been exposed to flu prior to 1957. 2009 H1N1 killed many more people who weren't elderly. In terms of years of life lost, 2009 H1N1 was pretty dangerous.
Schwartzz the all-knowing, who sees into the hearts of mankind, declares that the CDC "purposefully propagate statistics they know to be incorrect." You know, behaving just like Wakefield who was deliberately dishonest. There's tons of evidence that Wakefield was dishonest --- I'm sure you've got lots of evidence that the doctors who wrote the August 2010 report were dishonest.
I assume you are filing a complaint with the medical discipline boards where these doctors are licensed. Please email me at copy at the address at my blog www.vaccineswork,blogspot.com
The typical injected placebo is saline (salt water). In some studies a vaccine against a different disease is used as a placebo. That is spelled out in the consent form that each participant has to agree to. When I took part in a full blown Phase 3 drug trial, I knew that I would either get the test drug or a saline placebo.
The recent study in Bangladesh which proved that vaccinating pregnant women against the flu not only protected the pregnant woman, but also protected the newborn for a few months against the flu used pneumococcal vaccine as the placebo. Using a vaccine against a different disease didn't make the results less accurate because "The primary outcome in infants was the first episode of laboratory-confirmed influenza before 24 weeks of age."
"Effectiveness of Maternal Influenza Immunization in Mothers and Infants" http://www.nejm.org/doi/full/10.1056/NEJMoa0708630#t=articleTop
So your claim that no one knows what is in a placebo is wrong.
Flu vaccine is effective in preventing the actual flu in healthy adults. If they don't get infected with the flu, they can't spread to those they serve, which includes those too young to be vaccinated, the elderly who don't react strongly to the flu vaccine and those with weakened immune systems.
That's dispassionate. Take zero practical risk and protect those you serve.
"Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited."
But what if the healthworkers are reluctant to take the vaccines themselves because they know from experience they will get unpleasant unresearched side effects, which the industry and the government aren't interested in?
I think you meant that's disillusional not dispassionate. There is no credible evidence quantifying risk or efficacy, so your statement is based on something other than science.
True. If the medical professionals believed in getting flu vaccines every year... guess what? They would be getting them every year. The fact that the majority refuse the flu shot tells you all you need to know.
Please explain how your 'immune diligence' will protect you and much more importantly, those patients you come into contact with, against the new H3N2 strains that will be doing some of the infecting.
The reason for moving towards mandatory influenza vaccination of health care professionals is largely to capture for vaccination those who don't have a strong opposition to influenza vaccination. Those who are strongly opposed to vaccination may not go along with the policy and may escape through a religious or philosophical exemption. Or they may have to find a different line of work or move to a state where they can continue to infect their patients.
I actually would think (although I certainly can't prove it) that the vast majority of American citizens would not approve of forced flu vaccines for their doctors. That's a gut a feel. I think that most people would trust their doctors enough to think that they would take precautions when known to be sick (ie staying home, wearing a mask, etc.). And of course, most importantly, getting a flu shot in no way, shape or form "protects" you from getting the flu as there are many different strains out there which aren't covered by the vaccine (even if the vaccine is somewhat effective). There are no guarantees in life. Instead of the health care professionals moving to another state, why wouldn't the Sheldon's, Josephius', etc. start up a new compound of some sort where they would control and manage those who work in that compound? That sounds more reasonable than your suggestion, Sheldon.
MD's all over are leaving the profession. There is a huge shortage of MD's already and with the new health care coming in the US this is an extremely troubling problem facing our nation. Many like my husband are positioning themselves to do virtual care and will never "see" patients again. The liability insurance is too high and the compensation doesn't cover the cost of overhead - staff/buildings/equipment.
Anyway most MD's don't get immunized for the flu. They know that they just are efficient or proven safe. See the latest study on this below. So far all the MD's that I know that have refused the influenza vaccine this season aren't being told to leave and their contracts are not being canceled. That's because there isn't anyone to replace them Sheldon.
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From the AAP Paper
◠In a NICU [Neonatal Intensive Care Unit], 19 of 54 (35%) infants were infected with influenza A as a
result of health care–associated transmission; 6 became ill, and 1died. Only 15% of staff survey respondents in this NICU had received influenza vaccine—67% of physicians and 9% of nurses. Fourteen
percent of the employees reported taking time off from work because of illness, which suggests that these
symptomatic personnel had a role in transmission."
◠During an outbreak of influenza in a bone marrow transplant unit, there were 7 cases of health care–
associated influenza; 6 patients developed pneumonia, and 2 patients died. Five staff members developed influenza-like illness during the outbreak. Surveys revealed a vaccination rate of 12% among unit staff. The hospital took measures the following influenza season to implement a multifaceted voluntary
education program aimed at improving immunization rates. However,even with these aggressive measures, 42% of the staff on the bone marrow transplant unit remained unimmunized the following year.
Do you have a reference for that claim or a citation?
The authors examined four randomized controlled trials and one cohort study. They found that vaccination of personnel had no effect on the incidence of laboratory-proven influenza, pneumonia, admissions to the hospital, and death from pneumonia. The authors concluded, “There is insufficient evidence to support the vaccination of health care workers as a measure to protect older patients from influenza.†(Am. Fam. Phy. Oct 1, 2010. Vol. 82, No. 7. Pg. 763-4).
Roy Mankovitz, Director
http://www.MontecitoWellness.com
A research organization
Does that tell us whether ensuring that health care professionals are vaccinated who come into contact with those they care for in their offices or hospitals is not a good idea or not effective? No.
Lack of evidence does not provide an argument supporting mandatory vaccination or vaccination at all.
Lack of evidence of efficacy most certainly provides ammunition against flu vaccination given that there are known risks.
Exactly, John. Thank you.
I am often asked why I continue to research/post on this topic. People will say, since you have made the decisions for your kids leave it at that. The problem is.... We are getting to the point where force and coercion are the norm on this topic. My "choice" may not be my "choice" for long (if the government and pharma companies have their way). A friend of mine and I were talking and I recalled a time (before children) that I did not understand her views on vaccines. She had told me that she was protesting against the Hep B vaccine being mandated for entry to school years ago. At the time, I brushed it off... Respecting her views - it was obvious that she had done her homework - but still, I just shrugged it off. Her work in blocking a state mandated requirement for Hep B failed..... Newborn babies receiving the Hep B vaccine? Are you kidding me? Now, here we are.... Looking for health care personnel being forced to have flu shots... slippery slope... schools will be next. This is why I can't give up.
And lately I've noticed a trend for parents to be informed that they have to have a signature from clergy to get a medical exemption. http://insidevaccines.com/wordpress/2010/08/30/vaccine-exemption-shenanigans/
While the US is unusual in recommending the first dose of Hep B vaccination for all children at birth, it isn't unusual in recommending the first dose of Hep B vaccination very early. For worldwide information, go here http://apps.who.int/immunization_monitoring/en/globalsummary/diseaseselect.cfm It is very common for Hep B to given as part of a vaccine combined with DTaP or DTP
So it isn't a civil rights issue, as there is no right for employees or health care professionals to work without being vaccinated.
Another part of me says that, on the other hand, we as physicians do take some personal risks when it will benefit patients. We handle infected instruments, interact with patients who have easily communicable diseases, and go into dangerous places to take care of the sick.
So I have a really hard time with this one. I, personally, have gotten the flu shot every year, because every year that I didn't I've gotten sick as a dog, and I hate calling out sick and asking colleagues to cover my shifts.
Actually, I've just made the transition into industry/research, so I'm not exposed to patients these days, but I'd still recommend it to anyone who asks me. Yes, there are risks. But they are pretty low.
Gregory Goldmacher, MD, PhD
Now they are threatening if I don't get a shot I will have to wear mask during the months of the flu season.
Maybe it is time to get a new job.!
I thought geting fngerprinted was bad , even though nurses are the most trusted profession but a mandatory vaccine is way beyond even that.
And just so you know, the likelihood of contracting GBS from a flu shot is around 1:1,000,000. The likelihood of dying from the flu is ~ 1:10,000, 100x greater risk.
Except for the fact that there is zero evidence that getting a flu shot will protect you 100% from the flu. In fact, I imagine that in either case, you have the same chance of contracting the flu whether or not you had the flu shot. As I stated somewhere else, there is no "flu shot shield" out there.... To suggest that their is... is hilarious.
Silly me for not wanting to be on an iron lung.
http://www.journals.uchicago.edu/doi/abs/10.1086/594124
If GBS scares you, get vaccinated - it will lessen he likelihood of getting GBS during a flu outbreak.
(It was 1 in 100,000 after 1976 swine flu vaccine, but since then has been at a rate of about 1 per million for seasonal vaccines, and for last year's swine flu vaccine was at a rate of 0.8 per million vaccines.)
I haven't had a flu shot in over 20 years. I haven't gotten the flu yet in that time.
The goal of vaccination is to provoke a strong immune response. That's why the influenza vaccination is most effective in raising the antibody level in the blood to the proper level in healthy adults. The flu vaccine is less effective in raising the antibody level in the elderly and those with weakened immune systems. The very young includes those under 6 months, too young to get vaccinated.
Where do you find a concentration of the very young, the elderly and those with weakened immune systems? In doctor's offices, in medical labs and hospitals. Vaccinating health care professionals protects the very young, the elderly and those with weakened immune systems from coming into contact with influenza.
I read the same AAP statement and wrote a very different synopsis/article about it. I am a practicing pediatrician, writer, blogger and mother of two. I have had influenza illness when I was in my mid-20's. I had no risk factors. I get the immunization myself every year, and I get it for my children. I feel others should read my take as well. We have the same amount of training and yet my take is very different from yours. I do also hold a degree in bioethics. Please read what I wrote and leave a comment if you wish.
You can find it here:
http://seattlemamadoc.seattlechildrens.org/mandatory-flu-shots-ethically-justified-necessary-long-overdue/
That's great. You do that. That's a much better idea than using coercion and force to make doctors take unnecessary flu vaccines.