Shawn Kennedy, MA, RN, AJN editor-in-chief
The news has been full of reports about the influenza outbreak, deaths from complications, and shortages of vaccine and antivirals. Is the flu season as bad as purported, or are we experiencing media hype? Nurses are frequently asked for information by family, friends, and neighbors (and strangers—I was in a restaurant once and a diner at a nearby table, having overheard my conversation with a colleague, leaned over and asked if he could ask me a health question!), so here’s the latest information.
Week ending 1/5/2013; brown indicates states w/ widespread flu activity. CDC
According to the latest Centers for Disease Control and Prevention (CDC) report for the week ending January 5, epidemiologists from all states except three reported (see map) widespread “influenza-like illness” (ILI, meaning fever and cough or sore throat). California and Mississippi reported regional activity and Hawaii reported sporadic activity. The District of Columbia reported local spread. And while officials in some cities and states declared public health emergencies, the CDC notes that “influenza activity remained elevated in the U.S., but may be decreasing in some areas.”
One of the indicators is the proportion of people seeking treatment for ILI. Thus far, that number has risen as high as 6.0%, but has since fallen to 4.3%, as of January 5. In prior years deemed as moderately severe flu seasons, that indicator rose as high as 7.6%.
So in terms of history, we’re having a moderately severe flu season, but not the worst one we’ve had—at least not yet, as we’re still just in the middle of our season. Flu season typically begins in October, peaks in January or February, and usually ends in April, though timing can vary.
Some hospitals are getting tough on employees who refuse to receive the flu vaccine or take other actions to protect patients. ABC News reports that an Indiana hospital fired eight employees—including three nurses—who failed to get vaccinated against the flu; and USA Today ran the story of a Missouri nurse who was fired after she refused the flu vaccine and also refused to wear a surgical mask.
Many feel that those who work in clinical areas should be required to get vaccinated so they won’t transmit influenza to patients, but each year the issue of mandated flu vaccines for health care workers is again debated. In 2010, following the 2009 H1N1 pandemic, AJN explored this issue, presenting a “point–counterpoint” as well as a commentary from an ethicist. (These three AJN articles will be free until February 15.)
Me? I think health care workers—and not just nurses, but all who come in contact with patients and people who have compromised immune systems—are ethically bound to act in the best interests of their patients. That means either getting the flu vaccine, or wearing a mask to reduce the chance of transmission. And we should consider masks for hospital visitors, too.
So how do you stand?
People with cancer usually have a suppressed immune system . Moreover, many cancer patients undergo radiation therapy and potent immunosuppressive medications, which further suppresses the body’s ability to fight off infections. Everyone with cancer is highly susceptible and is at risk for complications from flu. People with cancer or a history of cancer should receive the seasonal flu shot. People with cancer should NOT receive the nasal spray vaccine. The flu shot is made up of inactivated (killed) viruses, and the nasal spray vaccines are made up of live viruses. The flu shot is safer for those with a weakened immune system. Those who have received cancer treatment such as chemotherapy and/or radiation therapy within the last month, or have a blood or lymphatic form of cancer should call their doctor immediately if they suspect they may have flu.
The influenza vaccine has a spot in health care.although It’s not as effective as some may think. My problem with the flu shot is that it will work to protect agaisnt 3 different virus’s ( out of approx 200) only and even then some peoples immune system will react inappropriately to the exposure.
End result–even though the flu shot was received you still don’t know if you are immunized or not. So you still may be exposing others to the very infection that you think you are immune too.
I strongly believe that it sshould not be mandated to all health care workers. The very idea that experienced/tenured/well respected Nurses are loosing their long term jobs because they object to the mandatory flu vaccination is beyond crazy. Health care facility’s should be ashamed of themselves.
The flu shot has 60% effectiveness. It does not prevent the flu but will diminish symptoms if you still get the flu. There is a segment of the population who will have adverse reactions to the flu shot (which you won’t find out until you get them) with these facts, I don’t feel I should be forced to have the flu shot. When the very producers of the vaccine won’t accept any liability for adverse reactions, I will not be a guinea pig. Natural immunity is best for me.
I did not take the vaccine until I started to give the vaccine at work, I then felt obigated to take it. I have been taking it every year for six years and have not had a problem. Having read the opinions of the ethicists I now feel that it is our obligation to take the vaccine unless there is a medical reason not to.
We are already obigated to have certain vaccines to work as a nurse so saying that you do not want to put something in your body does not agree with what you have already done. If heathcare workers are not vaccinated who will be there to care for the sick when we are sick. This may be an old fashion notion but I feel an obligation to my patients to prevent them from getting something from me and to prevent me from getting ill from the flu.
As nurses we will be the first line people to get a vaccine if a disaster occurs will you then say no I will not take the vaccine? This could mean life or death. If you would not take the vaccine or allow your family to take it in this instance then it may be fine for you to decline it now with this yearly disease. I have recently taken the DT to protect my grandchildren will you not take that vaccine? I think we need to carefully look at what we choose and the consequences of our actions.
Mandate it for all employees who have patient contact in all health care facilities AND child daycare where infants less than 6 months of age are admitted.
I think that the flu shot is helpful but so is washing hands. Why don’t we establish mandatory hand-washing for all hospital visitors, instead of focusing on requiring all staff to get the shot?
My experience with the flu shot was that it made me sick – not a serious reaction syndrome but just feeling lousy. So I don’t want to be forced to take it. I don’t have a religious objection or a medical disqualification. It’s an ethical disagreement that we should not mandate introducing foreign materials into our immune systems – whether that be via a shot or an inhaled burst.
For companies that require this, including health systems, it’s a slippery slope to other justifiable health-related mandates like “take an aspirin daily for heart health” and then “take a shot of caffeine daily for improved productivity.”
It’s one thing to require abstention as a condition of employment (“no smoking”, etc.). It’s entirely something else to require you to take something into your body.
My two cents!
Chris Flanders
http://www.axsiumgroup.com