Health care workers often shun flu shot

Every year, top U.S. health officials send out widely publicized reminders to get vaccinated against seasonal flu. And every year, more than 60 percent of the public looks the other way, deciding against the shots either out of fear or simple disinterest.

Even more surprising, nearly 50 percent of the nation's health care workers also ignore the reminder, often for the same reasons. They think they don't need it, doubt its efficacy or are convinced the vaccine carries risks of dangerous side effects.

The combination of laxity and resistance is a big concern this season as the U.S. faces a double-barreled blast of seasonal flu and a renewed outbreak of an even more widespread H1N1 swine flu.

H1N1 has spread as a worldwide pandemic since it appeared in the U.S. last April, and it is picking up strength here again. The concern is that with both flus spreading, patients seeking help at hospitals and clinics could overtax health services and a lot of sick health workers would compound the problem.

Failure of a significant number of health care workers to take either or both vaccines could pose a danger to their patients if they contract the sickness and help spread it, and also to their own families and friends if they take it home with them, experts warn.

"The last thing we should be doing is putting our patients at risk when it is totally unnecessary," said Jorge Parada, director of infection control at Loyola University Health System in Maywood. "In a patient-care sort of setting, this is a big, big safety issue."

This month, Loyola announced it was doing something deemed rather drastic by others in the medical community: The medical center has told all 7,825 of its employees -- from doctors to housekeepers -- that being vaccinated for seasonal flu is a condition of employment. Get it or leave.

In October, when swine flu vaccine is expected to be ready for mass distribution, Loyola may also make it mandatory.

Loyola's decision to require regular flu vaccinations made it only the third hospital in the country to do so, Parada said, though New York state is mandating vaccinations for all health care facility employees in the state this year.

The risk, he said, is two-fold. First, hospital employees might be infected by the flu virus and come to work before flu symptoms appear, spreading the virus to patients already weakened and hospitalized with other ailments.

Second, healthy hospital workers might pick up the flu virus from patients, taking it home from work to spread it even more widely to their own family and community.

There are other hygiene protocols, like wearing masks and sterile gloves, that can impede disease transmission during hospital staff/patient interactions, but health officials say that vaccination is the only 100 percent effective protection with the flu. The Centers for Disease Control and Prevention in Atlanta lists health workers among the first who should get inoculated once the vaccines are available.

The number of unvaccinated health workers "is a bit surprising," said Katherine Harris, a RAND Corporation researcher who studies flu vaccine acceptance in the U.S. "We think health care workers should understand how viruses work, how they are transmitted and the dangers posed to their patients if they should be exposed to somebody actively shedding the virus."

In any given year, less than 40 percent of all adult Americans get the seasonal flu shot, according to the CDC. Last year, the figure was 37 percent, and until the last couple of years it hovered around 30 percent annually.

Traditionally only about 40 percent of health care workers have received the seasonal shot. Thanks to concerted pressure by the CDC and other national health agencies, the percentage of health workers getting vaccinated has inched up to 53 percent.

"Health care facilities have had to jump through a lot of hoops to convince some to be vaccinated," Harris said. "They have given away prizes, staged pizza parties, entertained with silly videos to get them to sit down for a shot. It's a lot of expensive hassle to reach people who are supposed to vow to do no harm to protect themselves and their patients."

Doctors and nurses are most likely to get vaccinated, she said. Less likely are workers like lab technicians, receptionists, orderlies and housekeepers. The least likely to get the vaccine are nursing home workers.

"Vaccines are a touchy issue these days," said Barbara Burlingame, a veteran emergency room nurse at Elmhurst Hospital. "There are a lot of people who say flu vaccines are causing an increase in autism, for example. Is it? I don't know, but there are something like 32 vaccines now given to kids, and it is becoming a loaded question."

Burlingame said she has always taken the optional seasonal flu vaccine at Elmhurst, but knows co-workers "who say there is no way they are going to take it." She said she would make up her mind about the swine flu shot after safety tests are completed.

Harris, the RAND researcher, said early indications are that more health care workers are willing to get a swine flu shot when it becomes available, but what percentage is the "$64,000 question."

State and local health departments also have trouble getting their employees vaccinated for flu, lacking formal policies on the issue other than to strongly encourage them to get the shot.

Neither the Illinois or Chicago departments of public health has a flu vaccine policy, either for swine flu or seasonal flu, other than to "strongly encourage" employees to get them. The Cook, DuPage, Will, Lake, Kane and McHenry county public health departments have only "voluntary" vaccination policies, too.

Last flu season, 63 percent of Du Page County Department of Public Health workers were vaccinated, and they expect higher coverage this year because of the additional swine flu threat.

"We have been making an effort to make it easier for our own employees to get the flu vaccine, setting up areas to get the shot in our lobby and taking carts around the building right to where they work," said Dave Hass, the department spokesman.

Mandatory flu shots for health care workers is not be a novel idea, said Loyola's Parada, who pointed out that hospital workers everywhere must be vaccinated for mumps, measles, hepatitis B and rubella as a condition of employment.

Loyola for the last few years successfully increased seasonal flu vaccination coverage of its employees on a voluntary basis, reaching 73 percent last year.

"That was good, but it was far from good enough in a health care setting, leaving a quarter of your people unprotected," he said, explaining the decision to make flu vaccines mandatory. "It is the right thing to do."
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