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Vol. LXII, No. 19
September 17, 2010
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‘Shot of Truth’
CC Offers Reasons Not to Decline Flu Vaccine

In 2008, the Clinical Center medical executive committee mandated that all staff who have patient contact—nurses and doctors but also clerks, housekeepers and others—must be vaccinated against influenza or complete a declination form.

The mandate caused a dramatic rise in flu vaccination among NIH staff. Still, close to 11 percent of required staff (both employees and contractors) declined the seasonal flu vaccine the last 2 years, and 14 percent declined the H1N1 vaccine last year.

Staff who decline must give their reason for declination. Common responses include beliefs that the vaccine is ineffective and that the employee is not at risk of infection.

Past studies have shown that in years when flu strains in the vaccine match well with the strains circulating in the community, the vaccine can reduce the chances of getting flu by 70 to 90 percent in healthy adults, said CC deputy hospital epidemiologist Dr. Tara Palmore. The vaccine may be somewhat less effective in elderly persons and very young children, but vaccination can still prevent serious complications from flu. In healthy adults younger than age 65, the flu vaccine can also prevent lost work days and unnecessary doctor visits and antibiotics. Hospitalized patients who are ill or immunocompromised, though, do not usually mount effective immune responses to the flu vaccine, so vaccination is not enough to protect them from getting flu.

The most common reason for declination is concern about side effects. Minor consequences such as soreness of the arm or inflammation at the vaccination site are relatively common, but serious or lasting side effects are rare.

The discomfort of vaccination is minor compared to the proven benefit that flu vaccination of health-care workers provides, said Palmore. “

Flu vaccination of health-care staff saves patient lives. That has been shown repeatedly,” she said.

For example, a study in the Journal of Infectious Diseases (Potter, 1997) showed a statistically significant reduction in patient mortality among a population of patients in long-term care facilities when health-care workers were vaccinated against influenza.

Many people who have the flu don’t realize they have it, Palmore said. Symptoms may be mistaken for those of a cold, but if immunocompromised patients contract the virus it could have more severe consequences.

Palmore wants to set the record straight on more myths about the flu vaccine:

  • “A misconception cited by a number of people was that they could get flu infection from the vaccine. That is not possible because it contains only killed virus,” she said.
  • This year the product contains agents to address the seasonal and H1N1 flu.
  • Well-publicized adverse reactions have caused unnecessary anxiety about the vaccine, Palmore said. The 1976 swine flu vaccine was associated with cases of Guillain-Barre syndrome, a paralyzing neurologic response that is usually reversible. “The rate of Guillain-Barre syndrome associated with flu vaccination is miniscule—one in one million vaccinees—and most patients recover completely,” she said.
  • Last year, some children in Australia experienced fevers and febrile seizures after vaccination with one specific company’s flu shot. NIH has not purchased that vaccine.
  • Some people have declined vaccination on the basis that even if they become infected with the flu, they will likely recover without incident. As health-care workers, however, Palmore said, staff should make the safety of their patients a priority.

A vaccine clinic for patient-care staff only will be held on the CRC’s seventh floor from Sept. 20 through Oct. 1, including select times for first, third and weekend shifts. Qualifying employees and contractors will be notified by email that they fall under the mandate. If you do not receive an email identifying you as a health-care worker with patient contact, do not visit this clinic. Flu vaccination for all NIH employees will be offered in October. If you believe you qualify as patient-care staff but do not receive an email, check with your supervisor or contact the CC Hospital Epidemiology Service. For clinic times and more information, visit http://foiltheflu.nih.gov. NIHRecord Icon

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