Just under half of health care workers do not get their annual flu vaccine. Some of these workers contract the flu and unknowingly transfer it to their sick hospitalized patients, and in some cases, because of them passing the flu along, those patients die. We know the most important reason for health care workers to get vaccinated against influenza is that it is the most effective way of preventing influenza among their patients. And yet, unfortunately, many health care workers are putting patients at unnecessary risk.
If medical professionals know this, then why aren’t they complying? As physicians, one of the most challenging things we do is to encourage our patients to comply with our treatments. Why, then, do we not comply with a preventive treatment we know we protect our patients and ourselves? I asked colleagues about this over the years and they have usually told me that they are either afraid of side effects or they don’t believe that the vaccine works.
There is more than enough data to prove them wrong.
Since 1981 the Centers for Disease Control and Prevention (CDC) has recommended annual influenza vaccination for all health care workers because of the risk of transmission to vulnerable patients. And since 2007, the Joint Commission (TJC) has included the same recommendation in their infection control standard.
Some states have mandated vaccination for health care workers as a condition of employment. This strategy has been demonstrated to result in vaccination rates above 94 percent a significantly higher rate than in states without such a mandate. In New York, health care workers who have direct patient contact and who have declined influenza vaccination must wear a mask while in areas where patients or residents are present. Unfortunately, the effectiveness of surgical masks, even when worn properly, in preventing the transmission of influenza is controversial at best, and influenza may be transmitted by non-respiratory contact anyway.
But these rules and regulations have not impacted enough of the medical worker population to reduce transmissions.
In a typical year, flu peaks in the U.S. between December and February. By the end of a typical flu season between 5 and 20 percent of the U.S. population has become infected and 200,000 have been hospitalized because of the flu. Up to 25 percent of those infected die. The death rate from influenza is twice as high among people over 85. Tragically, 90 percent of deaths from flu in children occur in those who are unvaccinated. These facts are typically not reported publically.
Given the massive interaction between influenza and the healthcare system that these numbers illustrate, it should come as no surprise that healthcare professionals are a high risk for catching the infection themselves. It’s time we called attention to the risk posed by hospital staff who go out of their way to encourage vaccinations for the general public – but often avoid getting vaccines themselves.
It has been estimated that approximately three percent of US patients hospitalized with influenza actually catch the infection in the hospital while they were there previously for another purpose. Significant underlying medical conditions are more common in these hospital patients than in those who catch flu in the community. The length of hospitalization has been shown to more than double for these patients compared to those who acquired influenza in the community and the need for intensive care for these patients was significantly increased according to one large study.
The strategies to control transmission of the flu by the CDC and Joint Commission were based in sound and well-documented research. A large randomized study published in 2000 found that when healthcare workers in 20 long-term care hospitals were routinely offered vaccination half got the vaccination. In facilities where they were not routinely offered only 5 percent — one in twenty — were immunized. In this study, the death rate was 50 percent higher in the facilities where vaccination was not offered. Tests for influenza virus were positive at autopsy in 20 percent of the patients from hospitals where staff was not offered vaccine. Autopsies at facilities that offered the vaccination found that no patients had influenza at death. Because of this risk, it is the goal of the U.S. National Healthy People 2020 that 90 percent of hospital healthcare workers are vaccinated within three years.
The effectiveness of vaccinating healthcare workers against influenza to protect patients has been challenged over and over again, and the research that I have cited has been considered flawed by some. However, the fact is, the risk has been demonstrated to be minimal and, in fact, the vaccine is remarkably safe. Guillain-Barre syndrome, a possible (though unproven) side effect of the vaccine occurs in approximately 1 to 2 per million people vaccinated at most, and some studies have suggested no association at all. Egg allergies no longer keep people from getting the vaccine.
The question for me is: How much proof do we require that vaccinating ourselves against an easily transmissible and dangerous infection protects our patients and carries almost no risk to us?
Joseph R. Masci is an infectious disease physician and a fellow ambassador, New York Academy of Medicine.
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