What are your thoughts about mandatory flu shots for hospital workers?

[houseelf]

I'm trying to frame my thoughts as respectfully as possible, but I have to say that I'm mildly suprised that this is debatable amongst medical families.

I will try to speak about our personal experience and stay away from broad strokes. DH's hospital admits some of the sickest kids from around the world that other hospitals can not help. Some of these kids undergo multiple organ transplants, others are battling through cancer treatments, many are immuno comprimised, and the littlest ones are micropreemie weighing as little as 500 grams. A simple shot by their caregivers gives these kids a better chance at surviving. IMveryHO, immunizations hold equal standing as a prerequisite for employment as licensing and criminal background checks.

[Michele]

Rabies vaccination was mandatory for me in vet school. It's not like I was gonna go bite some random dog and infect it....geez!

I'm trying to frame my thoughts as respectfully as possible, but I have to say that I'm mildly suprised that this is debatable amongst medical families.

I will try to speak about our personal experience and stay away from broad strokes. DH's hospital admits some of the sickest kids from around the world that other hospitals can not help. Some of these kids undergo multiple organ transplants, others are battling through cancer treatments, many are immuno comprimised, and the littlest ones are micropreemie weighing as little as 500 grams. A simple shot by their caregivers gives these kids a better chance at surviving. IMveryHO, immunizations hold equal standing as a prerequisite for employment as licensing and criminal background checks.

I understand where you're coming from but I still am very against flu shots being mandatory. It was never mandatory at most hospitals before, and it should not be mandatory now that the swine flu pandemic is over. I think it still should be up to each health care professional to decide whether or not he or she will take the shot, as it was in years before the swine flu pandemic. This policy of "recommended" but not "mandatory" seemed to work well enough before, and I think it should remain the policy now.

I haven't had time to do a lot of searching (lots of kid activities going on today). But I didn't find any studies done in regular hospitals, just long-term care facilities. That research showed that staff AND inpatients have to be vaccinated in order to reduce influenza outbreaks.

Please, anyone else feel free to look stuff up. www.pubmed.gov is an index of all articles published in peer-reviewed medical journals. I don't have access to the full articles, but some of you might. Here are a few links to get you started, if anyone is interested:
http://www.ncbi.nlm.nih.gov/pubmed/19682118 (staff vaccination had somewhat limited results in lowering patient flu outcomes)
http://www.ncbi.nlm.nih.gov/pubmed/11387913 (higher staff & patient vaccination resulted in reduced flu outbreaks)
http://www.ncbi.nlm.nih.gov/pubmed/17095421 (higher staff & patient vaccination resulted in reduced flu outbreaks)
http://www.ncbi.nlm.nih.gov/pubmed/20170008 (staff AND patients must be vaccinated for reduced flu outbreaks)

IMO, this is an area that needs more research, given the recent protests against mandatory vaccinations for hospital workers. I'm surprised the CDC doesn't have a report on it.

I do know that some people's beliefs about vaccinations are almost at the level of religion, but does anyone know of any religion where "no vaccines" truly is a major tenet? I know Jehovah's Witnesses won't do blood transfusions, but I don't know anything else about their beliefs.

[scrub-jay]

I've been researching this all day and although I found many articles, there are few that are freely available. (I'm exclusively looking at peer-reviewed journal articles from reputable journals). I will continue to update this over the next few days as I find more openly available information.

Here is a background to the mandatory vaccination policies, this is from the American Academy of Pediatrics on September 13, 2010.

http://pediatrics.aappublications.or...ds.2010-2376v1

[houseelf]

It was never mandatory at most hospitals before, and it should not be mandatory now that the swine flu pandemic is over. I think it still should be up to each health care professional to decide whether or not he or she will take the shot, as it was in years before the swine flu pandemic. This policy of "recommended" but not "mandatory" seemed to work well enough before, and I think it should remain the policy now.

I very respectfully disagree. To be clear, we're talking about at will employees and not Government mandated compliance, which is entirely different universe.

A history or tradition of not requiring something that protects other citizens and society in general fails to be a cogent argument in this case. It would be different if the healthcare providers were mandated to undergo immunizations for their own health benefit and/or job attendance. In that case there would be an equally compelling argument that the hospital deprived that person's personal freedoms and choices. (Again private employer, not a government agent). In this case, however, the immunizations protect other citizens, namely the very customers the hospital proposes to help, from the employee's inaction.

Not only is mandatory immunization fair, it is prime fodder for a sensational lawsuit. If a parent can verifiably demonstrate that their preemie or recent transplant recipient acquired flu and died from an employee that refused immunization, the hospital has just found its way into yet another malpractice suit.

[scrub-jay]

If a parent can verifiably demonstrate that their preemie or recent transplant recipient acquired flu and died from an employee that refused immunization, the hospital has just found its way into yet another malpractice suit.

2009: Children's Hospital of Philadelphia had a child die after contracting influenza in the hospital. I have not found information regarding a lawsuit, but that may not be public at this point. They were one of the first hospitals to require mandatory flu vaccinations and for those that had religious objections - they were required to wear masks instead.

Another fact to consider: many healthy adults can have the flu, be asymptomatic AND still shed virus. This is an extreme risk put onto patients that cannot protect themselves with a vaccine.

"A couple of years ago, a child who had cancer came into our hospital who didn't have influenza. She caught influenza while here and then died from that disease. This is not unusual. Every year, children come into our hospital who are less than 6 months of age and can't be vaccinated because they're too young, or there are children who are on chemotherapy for their cancers or immunosuppressant therapies for their rheumatologic diseases or transplants and they can't be vaccinated. They depend on those around them to be vaccinated, and that's what we feel is our responsibility. It's our responsibility to watch out for these children."
-Paul Offit, MD
Offit, P. (2010, September 13). Mandating Influenza Vaccine: One Hospital’s Experience. Medscape Infectious Diseases. Retrieved from http://www.medscape.com/viewarticle/728352

Thanks, Crystal! Page 4 (health risks to patients from unimmunized health care providers) had some of the info I was looking for. Great resource, with references listed.

To be clear, we're talking about at will employees and not Government mandated compliance, which is entirely different universe.

YES. I'm opposed to government-mandated, but not employer-mandated. (The delineation gets a little fuzzy, with other ethical/moral issues, because of government "funding," such as Medicare/caid reimbursements.)

Cassy - didn't know that about the base - ew.

[houseelf]

I'm opposed to government-mandate....

Yes, yes, & yes, in broader issues than just this vaccine debate.

[Pollyanna]

Eh, you get that vaccine to protect your patients, simple. It's one of those things you sign on for when you become a doc. Side effects or not, you do it. Hell, the side effects of the flu-vax are nothing compared to the side effects of the medicine lifestyle.

[MarissaNicole]

Just to throw two more perspectives in the mix:

I am all about the vaccine - I have severe asthma and as already mentioned, the flu (or an infection or any illness) can and has put me in the hospital twice in my lifetime and so I get my shot every year. I also got the H1N1.

DH however is not necessarily a fan - this is something we fight about every year. But unlike anything mentioned here, DH just doesn't like getting the vaccine for HIMSELF, but doesn't think they are harmful or have anything against them. DH gets sick about every two years and feels that he would rather be exposed to germs/viruses and fight them off - he feels that that gives him greater/stronger immunity than being exposed via vaccination. However I think DH has a really strong immune system. I on the other hand get sick at least 3-4 times a year. This is why I think we view them so differently.

I'm not sure what the policy is at DH's program is, but I certainly understand the point of making them mandatory as a protection to patients.

[Meenah]

Marissa, your DH should get the vaccine to protect you!!!!!

Sunnysideup, I am curious as to what region you live in that has so many docs who are against the flu vaccine. Are you in the U.S.? Does your DH work in a hospital, or does he do something like Rehab where the patients are not necessarily medically ill or immunocompromised? I have been around a long time, and have rarely met a DOC/NP/Nurse who was against the Flu Vaccine. I'm not trying to be argumentative, just curious.

[Vanquisher]

I can see how some docs do not want to be mandated to get the shots because they simply don't want to be mandated to do anything. I can see how they don't want to take time out of their schedules to schlepp over to employee health and wait with the commoners. I can see how some of them think that they are "above it all." I can even see how some of them don't like getting shots; however, I cannot see how a doctor who went through medical school could be against vaccinations in general. It just doesn't compute to me.

Anyone remember or old enough to have had a small pox shot? My aunt died from her small pox vaccination (direct result) when she received it as a child. The rest of her siblings who were younger than her, but not her twin sister who already got the shot, did not have the shot, including my father. My grandmother, who lost her child to a vaccination, gets her flu shot. She was wary about the H1N1 shot last year, but got it anyway in her assisted living home.

however, I cannot see how a doctor who went through medical school could be against vaccinations in general. It just doesn't compute to me.

There are a lot of things that doctors aren't taught in medical school. For instance, they don't teach doctors about how much dangerous radiation is inherent in tests like CAT scans. A chest or abdominal CAT scan is equivalent to something like 800 chest x-rays and is extremely over-prescribed. There have been tons of articles in the news about this from time to time--patients have no idea that they're getting so much extra radiation when another test, like an MRI, that doesn't have radiation can often be prescribed instead, and a lot of the time doctors have no idea either how much radiation CAT scans are exposing patients to. I know my DH never learned this sort of thing in med school.

[Vanquisher]

Did you ask your DH if he learned that in medical school, or are you assuming that he didn't? Mine did. I'm pretty sure that your DH learned that too, and you are mistaken. If he didn't there is a serious problem. It's called evidence based medicine. They also take courses in epidemiology, immunology, virology, pathology, etc. They absolutely learn that there are inherent risks to giving patients CT scans. They also know that the risks of ordering a CT scan are often outweighed by the risks of not ordering one. They learn that there is a cost/benefit analysis that comes with EVERY medical decision that they make. The cost/benefit analysis is applied to every medical decision from ordering and prescribing medications to chemotherapy to radiation to not doing anything.

Do doctors learn everything about medicine and the human body in medical school? No. Obviously, that would be impossible. Most physicians that I know, and even the raging assholes, do a cost/benefit analysis on their medical decisions, even if that cost benefit analysis contains not getting sued for malpractice.