The following is part of a series of original guest columns by the American College of Physicians.
by Steven Weinberger, MD, FACP
In the Fall of 2009, we physicians should perhaps change the Biblical phrase, “Physician, heal thyself” to “Physician, immunize thyself” and then follow the phrase twice – once for seasonal influenza and once for H1N1. To date, physicians and other health care workers have too often been lax about following this advice, and the past data for immunization of health care personnel against seasonal flu leave much to be desired: only about 40-45 percent of health care personnel are immunized each year, according to the Centers for Disease Control.
Equally concerning is the fact that at least 70 percent of health care personnel continue to work despite being sick with flu. Is this surprising? Not really, because at least for physicians, there is a tradition of stoicism that probably dates back to residency training, when taking time off from work could be considered “a sign of weakness” that imposes additional work on fellow residents. However, continuing to work while one is sick with influenza exposes not only co-workers, but also patients who may have co-morbidities that put them at particular risk for developing complications.
What needs to be done?
The recommendations of the Advisory Committee on Immunization Practices (ACIP), which is an advisory committee to the Centers for Disease Control (CDC), are quite clear:
* Re seasonal influenza: All health care personnel and persons in training for health-care professions should be vaccinated annually against influenza. Persons working in health care settings who should be vaccinated include physicians, nurses, and other workers in both hospital and outpatient care settings, medical emergency response workers (e.g., paramedics and emergency medical technicians), employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.
* Re H1N1: Similarly, health care personnel are considered a high priority group for receiving the H1N1 vaccine. When vaccine is first available, ACIP recommends that programs and providers administer vaccine to health care and emergency medical services personnel.
The ACIP also recommends both that facilities employing health care personnel should provide vaccine to workers, and that the level of vaccination among health care personnel should be considered as a measure of a patient safety program.
What are the recommendations for health care personnel with flu-like symptoms staying at home?
Although the general CDC recommendation states that “people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]) or signs of a fever without the use of fever-reducing medications,” there is a different recommendation for health care personnel. Specifically, the CDC states that, for health care personnel, the “exclusion period should be continued for 7 days from symptom onset or until the resolution of symptoms, whichever is longer.”
What is the position of the American College of Physicians and other organizations?
The American College of Physicians (ACP) fully endorses the recommendations of the ACIP. The Joint Commission now stipulates that offering influenza vaccinations to their staff is a requirement for institutional accreditation. Going one step further, the Infectious Diseases Society of America has recommended mandatory vaccination for health care personnel, though individuals could decline vaccination based on religious or medical reasons. Please also be aware of state-specific immunization laws for health care workers.
As we gear up for a Fall season in which the impact of influenza, particularly H1N1, remains unknown, it is incumbent upon the medical profession to do its part with patients relating to education, prevention, and treatment. But that is not all, as we physicians are not just external observers of the influenza scene – we are also direct participants. Influenza immunization and education are equally important for us, not only for our own health, but our ability to impact the health and well-being of the patients we serve.
Dr. Weinberger is Deputy Executive Vice President and Senior Vice President, Medical Education and Publishing, of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.