In order to protect patients from flu, health care workers should be made to have the annual influenza vaccine, Ken Flegel, Senior Associate Editor, CMAJ (Canadian Medical Association Journal) wrote today.

Why is it that between 55% and 65% of doctors do not take the annual seasonal flu jab, but they all say they would never deliberately harm patients, or fail to take measures that might lead to patient harm?

The concept of no harm to patients is enshrined in the Latin dictum primum non nocere (first, do no harm).

Flegel explains that in Canada:

  • Between 5% and 10% of all Canadians get flu each year
  • Approximately 20,000 hospitalizations each year are linked to flu
  • Between 4,000 to 8,000 people each year die of flu
  • 20% of health care workers catch the flu each flu season
  • 28% to 59% of all young healthy adults who become infected with an influenza virus have no symptoms

Among those who do have symptoms when they get flu, they may be shedding the virus up to 24 hours before the onset of symptoms.

Flegel wrote:

“It is time that all people who work in a health care institution be vaccinated.”

What are the benefits of vaccinating health care workers?

  • When the vaccine strain and circulating strain are well matched, efficacy rates are approximately 86%
  • Fewer patients come down with flu
  • Health systems lose fewer man-hours from employees who miss work because of flu
  • Fewer residents in chronic care institutions die

A recent assessment of four randomized human studies demonstrated that when staff vaccination rates in chronic care institutions were at 51% to 70%, overall seasonal mortality of residents in such institutions fell between 5% and 20%. Patients in acute care hospitals are much weaker than the ones in the four studies, and much less able to resist a new infection.

According to another study which looked at the cost-benefit from a health system perspective, for every $1 spent on vaccination of health care workers, there is a cost saving of $1.6 (US dollars).

Vaccinations, many argue, should be a personal choice; not something people should be forced to do.

Flegel writes that a health care worker’s personal choice may sometimes come into conflict with the best interests of the patient. Who then, should come first?

Today, surgeons who become infected with HIV are not allowed to operate – an example of the patient coming first.

The argument could be extended to influenza – the best interests of the patient, surely, should come first.

People do not get flu jabs because:

  • They forgot
  • They are afraid of becoming ill from the jab
    In a very small number of cases, there may be runny nose, local reaction, and low-grade fever. The risk of developing Guillain-Barre syndrome is about 1 in 100,000. When creating flu vaccines, strains linked to Guillain Barre risk are generally avoided.
  • They are afraid the jab will give them flu.
    The flu jab has inactivated viruses; it is impossible to get flu from them.
  • They say there is no proof that flu jabs protect patients from the flu.
    There is proof. Flu vaccines do help protect patients from the flu.

To implement a mandatory vaccination program, there needs to be an outbreak of serious illness, low immunity levels, an effective, safe vaccine needs to be available, and uptake for the vaccine needs to be low. Flegel says that these conditions exist during the flu season. Possibly, in cases of deep philosophical or religious conditions, as well as medical contraindications, exceptions within a mandatory policy could be made, he suggests.

Public information campaigns and drives to encourage higher uptakes of flu vaccines do pay off, Flegel stressed. Over the last fifteen years, influenza vaccination rates have increased from 22% to 52%. Where mandatory programs for health care workers have been implemented, over 95% were vaccinated.

Public Health Ontario recommends a compulsory vaccination program. For a hospital to be able to interrupt transmission and prevent importation, participations rates have to be higher than 90%.

Resistance to flu vaccines among healthcare workers is common globally. A report published in the BMJ (British Medical Journal), in August 2009, found that about half of all Hong Kong health care professionals and healthcare workers said they would not take the swine flu jab because of fears regarding its effectiveness and possible side effects. The authors added that this is unfortunate, because “vaccination is one of the most effective ways to reduce illness and death linked with pandemic flu”.

Whenever a school has a measles outbreak, non-vaccinated children, teachers and other school staff are not allowed in. Perhaps it is time to apply the same system for health care institutions regarding vaccinations.

Flegel wrote:

“Our patients’ lives depend on this change.”

An article in The Lancet Infectious Diseases, in October 2007, stated that the benefits of giving seniors the flu vaccine have been greatly exaggerated. All developed nations encourage the vaccination against flu for people aged over 65 years – the aim is to reduce the burden of influenza mortality.

According to the authors, led by Dr Lone Simonsen, George Washington University, Washington, DC, USA, vaccinating healthy elderly people more often than their frail peers, as well as the use of non-specific endpoints, such as all-cause mortality, have produced exaggerated results.

Dr Lone Simonsen said:

“The remaining evidence base is currently insufficient to indicate the magnitude of the mortality benefit, if any, that elderly people derive from the vaccination program.”

Written by Christian Nordqvist