Flu shots a tough sell to health care workers

[October 16, 2008]  DES MOINES, Iowa (AP) -- Operating room nurse Pauline Taylor knows her refusal to get a flu shot is based on faulty logic.

But ever since she got sick after getting a shot a few years ago, she's sworn off the vaccine.

"I rarely get sick. The only thing I could narrow it down to is that I had gotten this shot," said Taylor, who works at University Hospitals and Clinics in Iowa City. "I know that it's not a live virus. It just seemed pretty coincidental."

Such stories frustrate Dr. William Schaffner.

As chairman of the Department of Preventive Medicine at Vanderbilt University, he hears that kind of talk frequently and knows it's in part to blame for a surprising statistic -- nearly 60 percent of health care workers fail to get a flu shot.

That's despite recommendations from the Centers for Disease Control and Prevention that all health care workers get vaccinated, from hospital volunteers to doctors.

"It is a professional obligation on the part of health care workers to make sure that they are as protected against influenza as possible," Schaffner said.

Schaffner argues that getting vaccinated for the flu should be standard for doctors and nurses, just like washing their hands. That's because the flu virus can be spread so easily.

"Being in close proximity to patients, having conversations with them, bending over their bed, seeing them in the clinic while you're doing procedures, you would be breathing out viruses and spreading influenza into your patients," said Schaffner, who is also president-elect of the National Foundation for Infectious Diseases.

The nonprofit group educates the public and health care industry about the causes, treatment and prevention of infectious diseases. It gets about 75 percent of its budget from major vaccine makers, but executive director Len Novick said the money comes with no strings attached.

Despite the attention given to the problem, there are few well documented cases of flu outbreaks caused by health care workers.

Schaffner said that's because it's tough to prove sick health care workers are to blame for hospital outbreak.

According to the foundation, likely cases of flu outbreaks between health care workers and patients include:

• 19 babies in a neonatal intensive care unit in Ontario, Canada, infected in 2000; one died. Health care workers, only 15 percent of whom were immunized, were the likely source.

• 65 residents of a nursing home in New York got the flu during the 1991-1992 flu season, and two died. Only 10 percent of health care workers had been vaccinated before the outbreak, according to a report by the CDC.

Schaffner said health care workers opt not to get vaccinated for the same reasons others are hesitant. Some also don't realize how easily they can spread the disease, sometimes before they know they're infected or even if they have only a mild case.

And, he said, there's the "myth" that you can get flu from the vaccine.

The CDC recommends that health care facilities offer free flu vaccines to employees annually at work, and that hospitals obtain signed statements from workers who refuse.

The CDC also recommends a flu shot for people age 50 and over, the chronically ill, and women who will be pregnant during the flu season. This year virtually all children from 6 months to 18 years were added to the list.

Several states have laws requiring hospitals to make the vaccines available.

In Iowa, University Hospitals requires documentation that all health care workers were offered the vaccine, but workers are free to decline, as Taylor, the ER nurse, did. Dr. Patrick Hartley, who heads the hospital's employee health clinic, said in the last flu season, 84 percent of employees got their flu shots.

At Allen Hospital in Waterloo, Iowa, the flu shot is mandatory for those with direct patient contact and recommended for everyone else. Those with allergies to the vaccine or other conditions can take a pass, but they must supply a note from their doctor. The hospital says the vaccination rate is 93 percent.

Some hospitals take a tougher stand on vaccinations.

In Seattle, at Virginia Mason Medical Center, even sales reps, vendors and volunteers must be vaccinated unless they seek exceptions for religious or medical reasons. Even then, those who don't get a shot must wear a mask whenever they are in the hospital during the flu season.

About 99 percent of the hospital's more than 5,000 employees were vaccinated.

Dr. Joyce Lammert, the hospital's chief of medicine, said they lost around seven employees when the policy took effect four years ago.

"A lot of reasons we heard about people not wanting flu shots was all about them -- it's my freedom, I don't want to get it, I get sick when I get it," Lammert said. "Now, the culture has really changed to thinking about patients. This is what we do to protect our patients."

Lammert said patients should ask their doctors if they've gotten their flu shot.

"I wouldn't go to anybody who didn't," she said.

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On the Net:

CDC flu information:
http://www.cdc.gov/flu/protect/vaccine/index.htm

[Associated Press; By MELANIE S. WELTE]

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