This year, The AAP issued a statement urging pediatric hospitals and clinics to require mandatory immunization against influenza for all health care workers. They stated it’s “ethically justified, necessary, and long overdue.” The Advisory Committee on Immunization Practices (ACIP) began recommending influenza immunization (flu shots/mist) for health care workers back in the early 1980s. Even after 3 decades of the recommendation, overall immunization rates for health workers remain around only 40%. Evidence suggests a clinic or hospital unit needs an 80% immunization rate to protect themselves and their patients from the flu. In the US, we’re nowhere near it. Last year for example, the CDC estimated that for health care workers, only 61% got seasonal influenza shots, 37% got the HINI shot, and only 34.7% of workers received both.
Totally unimpressive for a group of people committed to protecting patients, curing illness, and preventing disease.
I believe the mandate is long overdue. No one likes to be told what to do, but there is reason behind this policy. For example, in the statement, The AAP used patient safety as part of their rationale, citing 2 studies:
- In a NICU, 19 of 54 (35%) infants were infected with influenza A as a result of health care–associated transmission; 6 became ill, and 1 died. Only 15% of staff survey respondents in this NICU had received influenza vaccine—67% of physicians and 9% of nurses.
- During an outbreak of influenza in a bone marrow transplant unit, there were 7 cases of health care–associated influenza; 6 patients developed pneumonia, and 2 patients died. Surveys revealed a vaccination rate of 12% among unit staff. The hospital took measures the following influenza season to implement a multifaceted voluntary education program aimed at improving immunization rates. However, even with these aggressive measures, 42% of the staff on the bone marrow transplant unit remained unimmunized the following year.
Pediatric health care can be better. Yesterday I participated in The Everett Clinic’s mandatory flu shot clinic. Fortunately, you can bring a child to clinic this year and worry less about an exposure to H1N1 or seasonal influenza (at least from staff/providers). At Children’s, employees and staff have to sign a waiver if they don’t get the shot. Both of these regulations will improve the numbers of health care workers vaccinated, layer protection around children and hopefully decrease illness in children.
As you can clearly see (from the 3rd photo where the needle is in my arm) doctors don’t like getting shots, either. Or at least this one. But I am thrilled to work in health systems with high standards of excellence. I am happy to protect myself, my family, and my patients from H1N1 and seasonal influenza this year. Even as I lift my sore R arm.
What is your thought about pediatric hospitals and offices with/without mandatory flu shot policies?
Thanks for this. Can you help me understand why some doctors here in Seattle are saying the flu shot is unnecessary this year? Meaning, because one of the strands is H1N1 and we were vacinated last year for this, and one of the strands/strains is the same as last year, we do not need an additional vaccine. I thought that you had to get it every year? Is is a lifelong immunity with the vaccine or is it an annual booster, or what? I don’t understand….
Wendy Sue Swanson, MD says
I haven’t heard any doctors say this. Where did you hear this?
Seasonal flu shots are typically “tri-valent” meaning they have 3 strains against Influenza that are anticipated for North America. Usually it is two strains against Influenza A and one against Influenza B.
The H1N1 strain in the flu shot this year is the exact same strain that was in the monovalent H1N1 flu shot last year. So if you had H1N1 shot last year, the H1N1 incorporated in this year’s shot is the same.
2009/2010 shot is different from the 2010/2011 shot therefore you will get added protection.
In the 2009/2010 seasonal flu shots the strains included:
* an A/Brisbane/59/2007 (H1N1)-like virus
* an A/Brisbane/10/2007 (H3N2)-like virus
* a B/Brisbane/60/2008-like virus
In 2010/2011 shots (this season) the strains included:
* A/California/7/2009 (H1N1)-like virus (the same strain as was used for 2009 H1N1 monovalent vaccines);
* A/Perth/16/2009 (H3N2)-like virus;
* B/Brisbane 60/2008-like antigens.
The 2010-11 influenza vaccine can protect you from getting sick from these three viruses, or it can make your illness milder if you get a related but different influenza virus strain.
Here’s a nice link on the CDC website that goes into more detail:
Thanks for the update. If I am not mistaken, Seattle Children’s had a >90% compliance rate with the flu shot last year. It is truly wonderful to work at a hospital that strives for excellence.
I really like the pictures!
I agree that all health care establishments should have a mandatory vaccination policy. In fact, it never occurred to me that my health care workers wouldn’t be vaccinated. Obviously, the data shows that I was wrong. But I simply assumed that anyone who recommends vaccines for me would get vaccines for themselves.
How awesome is it that you took pictures of yourself getting a flu shot?! Last year I was (1) pregnant, (2) with asthma, (3) working at a hospital, so I was a nervous wreck until the H1N1 vaccine finally became available! Glad we only need one shot this year.
What a great post! As an educator I still don’t understand when I hear parents of students and teachers say they don’t believe in the flu shot because they have “built up immunities over the years”. It’s different strains each year dummies! Then these same people go and get sick, and get others sick, and often then the students end up missing a lot of school for the flu. I applaud the mandate and your post, thank you!
Do hospitals and clinics maintain other vaccination records for health care workers? My sister teaches preschool and is required to be up-to-date on all her boosters in addition to receiving a flu shot each year. (Private school, so it’s part of the contract.)
Seems to me that many adults let their boosters lapse even if they keep up with flu shots. The friend of a friend and her teen-aged son here in the Seattle are contracted pertussis because they were “in-between” boosters. Because they had *some* amount of immunity, they didn’t become critically ill but they were still quite ill for a few weeks. It seems to me that if we believe in and promote “herb immunity” than the grown ups in the herb should demonstrate greater responsibility.
Wendy Sue Swanson, MD says
Great question, Viki. They do; in fact Seattle Children’s just implemented new rules that MDs going up for reappointment each year (or 2) have to prove immunity/immunization to many illnesses that could put patients at risk (Measles, mumps, Rubella, TB, Hep B, Chicken pox, etc). If they can’t prove it or are late getting shots or documentation, they are not allowed to see patients until they do. I’m unsure about staff and RN policies–of how often they have to do the same. Will look into it.
Wendy – This post is a classic example of how the connected physician conveys a message. The serial images are simple but add powerfully to the message. Let’s see 60,000 more AAP pediatricians generate similar content.
Seriously, you are TOO cute. I love that you practice what you preach AND show the proof of it!
Jamie Murray, MD says
I just started reading your blog and am so happy to see a pediatrician writing about good, evidence-based medicine! I am also thrilled to hear about Seattle Children’s policy of proving immunity to certain diseases upon reappointment. Now let’s hope that other hospitals follow suit.
Every year in my office, I get my flu vaccine as soon as it comes in, and every year I have to explain to my staff that the flu vaccine doesn’t make people sick. Hopefully with blogs like yours more people will start to understand the science of vaccines and medicine.
Sorry, I just checked back in on this and my original comment. I heard the no need for a flu shot if you had flu shot and H1N1 shot from reputable OB’s office here in Seattle.
I understand what you explained, but I still don’t understand if it you get vacinated for a strain one year, are you permanently immune from that particular strain forever or is it only a temporary immunity. I understand that most years, the flu strain is different in the flu shot. But, still want to understand if the flu immunity is forever or you need a booster for that strain.
wellness center los angeles says
I think that if they work with children they should get immunization. I am not sure about the whole H1N1 if I would get it though. Is it even still a threat? I heard there’s an high amount of mercury in the shot. That’s more dangerous the contracting H1N1.
I agree with seattlelawmom that there is confusion about the length of time that vaccination conferred upon an individual. does a flu vaccination wear off?
Just some added info on the 2010-2011 flu shot. The H1N1 vaccine strain is identical to the one used last year for 2009 H1N1 flu. Because it is relatively new, the strains of flu infecting with H1N1 this flu season are a great match for the vaccine strain. And if you didn’t get the flu last year or the flu shot, you are still exposed to the same risks of a more severe reaction to H1N1 than to a more normal flu.
What I think is a surprise is that there has been a fair amount of H3N2 found so far. This H3N2 strains doing the infecting are new for 2010-2011, so that there isn’t much protection from past years. Again, because it is new, there’s little chance that it won’t be a great match for the vaccine strain H3N2 vaccine which is also new for 2010-2011.
The antigen characteristics of the influenza B strains found in the last few months is an 88% match with the vaccine strain. There are two families of influenza B and with only one strain of influenza B in the vaccine, you can’t cover them as well.
So as of late October, there’s a great match of vaccine to infecting strains.
Here in British Columbia, Canada, health authorities require all staff (including admin staff who have minimal patient contact) to have a flu shot. As someone whose baby was premature and spent 4 weeks in NICU, and then had to be kept safe from RSV infections for several months at the height of flu season, I am very glad of this.
There is such folly in instituting a mandatory flu shot policy at any hospital. Only when doctors, themselves, experience the joy of vaccine-induced Guillain-Barre, will they understand how stupid they were to follow the advice of Pharma-funded “Thought Leaders” who sold them out. The only non-Pharma-funded studies on the efficacy of flu shots were done by the independent Cochrane Collaboration, and those studies indicate the true lack of efficacy of the flu shot. Why is the flu shot the only shot that requires annual re-vaccination, even if the same antigens are used in it for more than one year in a row? Wow, you only get one year of protective benefit from it, and yet, bear all the medical risk of taking it? If anyone touches an influenza infected shopping cart, and then visits and hugs a hospital patient, it matters not how many flu shots all the doctors treating that patient may have had. This is a dumb policy brought to you by the Phamaceutical industry. I wish doctors had the common sense to fight this nonsensical medical tyranny.
I think doctors should have the right to make their own medical health decisions, and not be forced to adhere to a mandatory policy when there are known medical risks, such as Guillain-Barre, from flu shots.
I don’t understand why a flu shot has to be administered on an annual basis, if the antigens remain the same over consecutive years. Shouldn’t antibodies last more than one year, if a vaccine is effective?
Therapist New York says
I really don’t know If I really agree with a mandatory immunizations. I feel that takes away from our freedom and write to choose. I understand an employer’s right to request immunizations but I really don’t like my freedom to choose being taken away from me.
Wendy Sue Swanson, MD says
Therapist New York,
If you make the choice to work in a place with a vulnerable population (ie a children’s hospital w many immunosuppressed or high risk children) then you make a choice that will demand certain actions to protect those children. I contend that immunizing is one of those actions. If you’re unwilling to get the shot, that’s fine, but then I would suggest finding a job in place where you don’t put others at risk.
JC Jones says
Wow. Come on people. Wash your hands. Practice some common hygiene techniques when working around suspected ill patients. Don’t you understand drug companies are making billions off of your willingness to give up your personal freedoms?
Anne Graham says
I agree with the mandatory immunization against influenza. This is for the benefit of the health care workers and at the same time the patients that they are taking care of. Health care workers must follow this mandatory immunization.