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Flu Shot Ethics

 

 

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Photo Credit – CDC PHIL

# 5866

 

This week I’ll stop by my local pharmacy and get my seasonal flu shot. No, I don’t particularly like taking the time, or spending the $30 (my insurance doesn’t cover it), to do this every year.

 

And I usually end up with a sore arm for a couple of days.

 

But I get the shot not only to protect my own health, I do it to protect those around me; family, friends, and even casual contacts I might meet.

 

People like my Dad, who will be 87 in November.

 

Last year he contracted an ILI (influenza-like-illness) over the Christmas holidays which evolved into pneumonia, and we almost lost him. 

 

I don’t know for sure that his flu-cum-pneumonia was vaccine preventable (for reasons why, see BMC Study: A Crowded Viral Field), but when the stakes are this high, I consider it my duty to try to reduce the risks as much as I possibly can.

 

While I can’t do much (beyond practicing good flu hygiene) about catching the various adenoviruses, rhinoviruses, coronaviruses, Parainfluenzas, or Human metapneumoviruses out there, I can significantly reduce my odds of catching . . . and spreading the flu.

 

And yes, Dad got the flu vaccine last year.  But at the age of 86, his immune system doesn’t mount as robust of a response to the vaccine as would a younger person.

 

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Earlier this year, NFID - the National Foundation for Infectious Diseases - convened a panel of experts to address the issues of influenza and the elderly that included such familiar names in public health as Arnold Monto, MD; Kristin Nichol, MD, MPH; H. Keipp Talbot, MD, MPH; and William Schaffner, MD.

 

From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.

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Although the elderly generally see less protection from the flu vaccine, older individuals may still mount a robust immune response. In populations 65 and older, the brief points out that:

 

  • Hospitalization rates for influenza and pneumonia are lower in community-dwelling adults who received the seasonal influenza vaccine.
  • Immunization is associated with reduced hospitalization of older patients for cardiac, respiratory, and cerebrovascular diseases.

 

While the goal of vaccinating the younger population is to prevent infection, the authors point out that:

 

. . . the goal in older adults is to prevent severe illness, including exacerbation of underlying conditions, hospitalization, and mortality.

 

In other words, even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.

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But it isn’t just the elderly (and myself) that my flu shot helps to protect. 

 

By denying the virus a susceptible host, I help limit its ability to spread in my community. And that means I’m helping to protect younger adults, children, and even infants (who, under 6 mos. of age can’t be vaccinated). 

 

Unfortunately, based on the most recent flu vaccination numbers published by the CDC’s MMWR (see FluVaxView Report ), last year only a little over 1/3rd of the residents in my state took it upon themselves to do the responsible thing and get vaccinated.

 

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Even in the top five states (Maryland, Hawaii, Massachusetts, Rhode Island, and South Dakota) coverage was less than 60%.

 

And among healthcare workers (HCWs) – who have the opportunity to spread the flu to the most vulnerable members of our society – uptake of the vaccine in the United States last year was reported recently to have been just over 60%.

 

Despite resistance from some HCWs, calls for mandatory flu vaccination among health care workers have been coming from many directions. Earlier this year, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Numerous professional medical organizations, however, have adopted policies calling for mandatory vaccination of HCWs.  A few earlier blogs on that include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs
AAP: Recommends Mandatory Flu Vaccinations For HCWs
SHEA: Mandatory Vaccination Of Health Care Workers
IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

Today, with another flu season approaching, Katherine Harmon writing for Scientific American asks a number of infectious disease experts:

 

Are Health Care Workers Who Decline Flu Shots Irresponsible?

More than a third of U.S. health care employees were not vaccinated last flu season. Research shows that the unvaccinated staff have a decent chance of getting sick--and passing that infection on to at-risk patients

 

 

While the answers vary in terms of diplomacy, the consensus is that HCWs who do not get vaccinated against influenza are putting their patients at unreasonable (and unnecessary) risk.

 

Which is why – despite protests from some employees – an increasing number of hospitals and medical offices are making flu vaccination mandatory this year. A few recent headlines illustrating this growing trend include:

 

Mandatory Flu Shots For Children's Medical Center Employees

Hospital's 'Cocoon Strategy' Aimed At Protecting Young Patients

 

Local health system mandates flu vaccine for upcoming season

 

Hospitals Making Flu Vaccine Mandatory for Employees

 

 

Increasingly, hospitals are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare. 

 

But no matter your job description, unless you live alone in a cave somewhere, you have the potential to spread the serious – and sometimes life-threatening – influenza virus.

 

Getting a flu shot every year can significantly reduce (but not completely eliminate) that risk.

 

That, and practicing good flu hygiene (covering coughs, sneezes, washing hands, staying home when sick), can literally save lives.

 

Which makes getting the flu shot not only smart in terms of protecting your own health, but it also makes it, without a doubt, the ethical thing do do. 

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