Re: Medical workers and flu shot - anyone care to comment?

November 25, 2008

The link given for comments at the end is broken, or phony. Perhaps

they really don't want anyone's comments.

Here's my comment anyway: In the 1980's pharma went to congress and

said that if the government wanted them to make more vaccines, they

would have to pass a law to protect them from lawsuits because of the

risk that vaccines could cause some people serious harm.

So, it is not too far fetched to conclude that if vaccines are risky

enough to require an act of congress to protect from lawsuits, they

just might be too risky to inject into one's body. Could it be that

the 60% of health care workers who don't vaccinate aren't stupid

enough to fall for the mantra " vaccines are perfectly safe " ? US

Congress didn't believe it.

Lenny

>

> Patients Can Join the Fight Against Flu Without Firing a Shot

>

> By Manoj Jain

> Special to The Washington Post

> Tuesday, November 25, 2008; HE06

>

> Last month at a luncheon marking International Infection Prevention

> Week at the National Press Club, some speakers reminded me of a

> shameful and frightening statistic: Almost 60 percent of American

> health-care workers do not receive the flu vaccine.

>

> Let me put that in context: Influenza, commonly called the flu,

> strikes 5 to 20 percent of Americans annually. In an average year,

> more than 200,000 people are hospitalized with flu complications;

> nearly 36,000 die, either from the flu itself or from complications

> such as pneumonia or a heart attack.

>

> A flu shot is the best defense.

>

> Obviously, health-care workers -- a category that includes not only

> doctors and nurses but also such hospital personnel as dietary and

> cleaning staff -- are likely to come into close contact with a lot of

> highly vulnerable patients. That's why such workers are one of the

> specific population groups, such as pregnant women and adults older

> than 50, that the Centers for Disease Control and Prevention

> recommends get the vaccine every year.

>

> Yet, as the CDC showed in a 2006 study, only 41.8 percent of health-

> care workers surveyed got a flu shot. A back-of-the-envelope

> calculation shows that if 58.2 percent of the 11 million health-care

> workers in America are unvaccinated and if a modest 10 percent

> acquire the flu virus, then we have more than half a million

> potentially contagious workers in our hospitals and clinics.

>

> " It is a patient safety issue, " says Schaffner, chairman of

> the department of preventive medicine at Vanderbilt Medical Center in

> Nashville and a nationally known expert on immunization. " It is

> inexcusable for health-care workers not to be vaccinated. "

>

> Simple logic would make you think that health-care workers, most of

> whom have more education in health and medical issues than other

> people, would be more likely to be vaccinated. But since 1997 the

> vaccination rate among health-care workers nationwide has remained

> around the same depressing 40 percent. That is more than 20

> percentage points lower than the average for the largest at-risk

> group, adults older than 65.

>

> For a decade, as chairman of the infection control committee at my

> hospital, I have cajoled and pleaded with my fellow health-care

> workers to get vaccinated. This year, after I came home from the

> infection prevention meeting, I decided to ask my colleagues about

> the issue.

>

> One day I struck up a conversation around the nurses station in the

> intensive care unit.

>

> " I know people believe you get the flu from a flu shot, " one nurse

> said. " But I still get one. "

>

> Another nurse emerged from a room where he'd been tending a

> ventilated and sedated patient, his gloves and isolation gown

> evidence of our concern about transmitting disease. " What kills me is

> that people still believe that stuff " about getting sick from the

> vaccine, he said. " But it's made from a dead virus. "

>

> Another nurse chimed in defiantly: " I got a shot last year and got

> sick. I'm not sure if I am getting it this year. "

>

> Later, on another floor, a secretary expressed similar

> suspicions: " My cousin died the day after he got the flu shot. I just

> don't trust it. " I told her that the death was certainly unrelated to

> the vaccine. She remained skeptical -- and unvaccinated.

>

> My brief conversations reflected what researchers have long known. A

> 2006 analysis of 32 studies of why health-care workers chose not to

> be vaccinated showed four main reasons.

>

> First is a fear of side effects, in particular the misconception that

> the dead virus the vaccine contains can cause disease.

>

> A recent experience helped me understand how even professionals can

> feel that way: At my bank one day, a financial adviser stopped

> blowing his nose long enough to reach out for my hand. So as not to

> appear rude, I shook it and then forgot to wash my hands afterward.

> That evening, I began to have sniffles. Instinctively, I attributed

> my stuffy head to the bank employee, even though I know better than

> any layman that it takes two to four days after an exposure to a

> virus for illness to develop.

>

> It's only human to look for causes when we become ill. In a given

> year, the average American gets two to four episodes of the common

> cold; if one of those occurs within a week or two of a flu shot, that

> average American is likely to blame the vaccine.

>

> The second reason is that health-care workers falsely believe they

> are too healthy to get the flu or have natural defenses against it.

> Again, studies show otherwise. One study in 1999 showed that in any

> given year, 7 to 26 percent of unimmunized health-care workers had

> evidence of influenza virus in their blood. But of those infected

> people, fewer than half recalled being ill. Those asymptomatic

> workers, however, were contagious and could infect patients who were

> presumably less robust. (A person who has acquired the influenza

> virus is contagious for nearly a week, starting a day before any

> symptoms appear.)

>

> The third reason why some health-care workers do not get vaccinated

> is that they believe the vaccine is not effective enough. There is

> some truth to that. Because there are new strains of influenza virus

> every year, it's sort of a moving target. Scientists must constantly

> develop new vaccines, and in any given year the vaccine is only 50 to

> 70 percent effective. But why should a worker not do everything

> possible to reduce the risk of transmission?

>

> The fourth reason health-care workers give for not getting vaccinated

> is that it is inconvenient. It seems to me that any busy worker could

> make that argument. In any case, many hospitals are addressing the

> issue, vaccinating staff members in the hallways and at health fairs.

> I got vaccinated just before our annual medical staff meeting.

>

> That kind of attempt can make a profound difference. In 1988 there

> was an outbreak of influenza at the University of Virginia Health

> System in Charlottesville, where only 4 percent of health-care

> workers had been vaccinated. That prompted the hospital to promote

> employee vaccinations and ensure that workers stayed home if they got

> sick. A decade later, the vaccination rate was 67 percent, the

> confirmed influenza cases among health-care workers declined from 42

> percent to 9 percent, and transmission of influenza to hospitalized

> patients was dramatically reduced. A similar impact has been shown in

> nursing homes, with decline in overall mortality rates.

>

> At the infectious-diseases gathering I attended in Washington, Don

> , the principal deputy assistant secretary for health in the

> Department of Health and Human Services, said various other agencies

> are working to improve the situation. For example, HHS is tracking

> and vaccinating its own health-care employees.

>

> But I think we can do more. HHS Secretary Mike Leavitt's initiative

> on transparency and value-based purchasing could be applied to flu

> vaccination; that is, providers who receive Medicare funding can be

> required to publicly report their employee vaccination rates. Also,

> future payments could be aligned with improvement in the rate. That

> would get the providers' attention.

>

> Meanwhile, I believe patients can and should act in their own defense.

>

> So last week I told one of mine -- a man recovering from robotic

> laparoscopic prostate surgery -- that nearly 60 percent of health-

> care workers do not get an annual flu shot. His jaw dropped. " Oh, my

> gosh, " he said.

>

> Then I told him that there might be something he could do about it.

>

> " Ask every hospital worker you encounter -- in a respectful way --

> 'Have you had your flu shot?' " I said. " Put them personally on the

> spot. "

>

> Who knows? Maybe that will have an effect.

>

> Manoj Jain is an adjunct assistant professor at the Rollins School of

> Public Health at Emory University in Atlanta. Comments:

> http://health@...

>

November 25, 2008

You can respond to health@.... I tried to access the

comments online but it hasn't been working. If I get thru, mind if I

post your comment? It will appear under my sign-in though.

> >

> > Patients Can Join the Fight Against Flu Without Firing a Shot

> >

> > By Manoj Jain

> > Special to The Washington Post

> > Tuesday, November 25, 2008; HE06

> >

> > Last month at a luncheon marking International Infection

Prevention

> > Week at the National Press Club, some speakers reminded me of a

> > shameful and frightening statistic: Almost 60 percent of American

> > health-care workers do not receive the flu vaccine.

> >

> > Let me put that in context: Influenza, commonly called the flu,

> > strikes 5 to 20 percent of Americans annually. In an average

year,

> > more than 200,000 people are hospitalized with flu complications;

> > nearly 36,000 die, either from the flu itself or from

complications

> > such as pneumonia or a heart attack.

> >

> > A flu shot is the best defense.

> >

> > Obviously, health-care workers -- a category that includes not

only

> > doctors and nurses but also such hospital personnel as dietary

and

> > cleaning staff -- are likely to come into close contact with a

lot of

> > highly vulnerable patients. That's why such workers are one of

the

> > specific population groups, such as pregnant women and adults

older

> > than 50, that the Centers for Disease Control and Prevention

> > recommends get the vaccine every year.

> >

> > Yet, as the CDC showed in a 2006 study, only 41.8 percent of

health-

> > care workers surveyed got a flu shot. A back-of-the-envelope

> > calculation shows that if 58.2 percent of the 11 million health-

care

> > workers in America are unvaccinated and if a modest 10 percent

> > acquire the flu virus, then we have more than half a million

> > potentially contagious workers in our hospitals and clinics.

> >

> > " It is a patient safety issue, " says Schaffner, chairman

of

> > the department of preventive medicine at Vanderbilt Medical

Center in

> > Nashville and a nationally known expert on immunization. " It is

> > inexcusable for health-care workers not to be vaccinated. "

> >

> > Simple logic would make you think that health-care workers, most

of

> > whom have more education in health and medical issues than other

> > people, would be more likely to be vaccinated. But since 1997 the

> > vaccination rate among health-care workers nationwide has

remained

> > around the same depressing 40 percent. That is more than 20

> > percentage points lower than the average for the largest at-risk

> > group, adults older than 65.

> >

> > For a decade, as chairman of the infection control committee at

my

> > hospital, I have cajoled and pleaded with my fellow health-care

> > workers to get vaccinated. This year, after I came home from the

> > infection prevention meeting, I decided to ask my colleagues

about

> > the issue.

> >

> > One day I struck up a conversation around the nurses station in

the

> > intensive care unit.

> >

> > " I know people believe you get the flu from a flu shot, " one

nurse

> > said. " But I still get one. "

> >

> > Another nurse emerged from a room where he'd been tending a

> > ventilated and sedated patient, his gloves and isolation gown

> > evidence of our concern about transmitting disease. " What kills

me is

> > that people still believe that stuff " about getting sick from the

> > vaccine, he said. " But it's made from a dead virus. "

> >

> > Another nurse chimed in defiantly: " I got a shot last year and

got

> > sick. I'm not sure if I am getting it this year. "

> >

> > Later, on another floor, a secretary expressed similar

> > suspicions: " My cousin died the day after he got the flu shot. I

just

> > don't trust it. " I told her that the death was certainly

unrelated to

> > the vaccine. She remained skeptical -- and unvaccinated.

> >

> > My brief conversations reflected what researchers have long

known. A

> > 2006 analysis of 32 studies of why health-care workers chose not

to

> > be vaccinated showed four main reasons.

> >

> > First is a fear of side effects, in particular the misconception

that

> > the dead virus the vaccine contains can cause disease.

> >

> > A recent experience helped me understand how even professionals

can

> > feel that way: At my bank one day, a financial adviser stopped

> > blowing his nose long enough to reach out for my hand. So as not

to

> > appear rude, I shook it and then forgot to wash my hands

afterward.

> > That evening, I began to have sniffles. Instinctively, I

attributed

> > my stuffy head to the bank employee, even though I know better

than

> > any layman that it takes two to four days after an exposure to a

> > virus for illness to develop.

> >

> > It's only human to look for causes when we become ill. In a given

> > year, the average American gets two to four episodes of the

common

> > cold; if one of those occurs within a week or two of a flu shot,

that

> > average American is likely to blame the vaccine.

> >

> > The second reason is that health-care workers falsely believe

they

> > are too healthy to get the flu or have natural defenses against

it.

> > Again, studies show otherwise. One study in 1999 showed that in

any

> > given year, 7 to 26 percent of unimmunized health-care workers

had

> > evidence of influenza virus in their blood. But of those infected

> > people, fewer than half recalled being ill. Those asymptomatic

> > workers, however, were contagious and could infect patients who

were

> > presumably less robust. (A person who has acquired the influenza

> > virus is contagious for nearly a week, starting a day before any

> > symptoms appear.)

> >

> > The third reason why some health-care workers do not get

vaccinated

> > is that they believe the vaccine is not effective enough. There

is

> > some truth to that. Because there are new strains of influenza

virus

> > every year, it's sort of a moving target. Scientists must

constantly

> > develop new vaccines, and in any given year the vaccine is only

50 to

> > 70 percent effective. But why should a worker not do everything

> > possible to reduce the risk of transmission?

> >

> > The fourth reason health-care workers give for not getting

vaccinated

> > is that it is inconvenient. It seems to me that any busy worker

could

> > make that argument. In any case, many hospitals are addressing

the

> > issue, vaccinating staff members in the hallways and at health

fairs.

> > I got vaccinated just before our annual medical staff meeting.

> >

> > That kind of attempt can make a profound difference. In 1988

there

> > was an outbreak of influenza at the University of Virginia Health

> > System in Charlottesville, where only 4 percent of health-care

> > workers had been vaccinated. That prompted the hospital to

promote

> > employee vaccinations and ensure that workers stayed home if they

got

> > sick. A decade later, the vaccination rate was 67 percent, the

> > confirmed influenza cases among health-care workers declined from

42

> > percent to 9 percent, and transmission of influenza to

hospitalized

> > patients was dramatically reduced. A similar impact has been

shown in

> > nursing homes, with decline in overall mortality rates.

> >

> > At the infectious-diseases gathering I attended in Washington,

Don

> > , the principal deputy assistant secretary for health in

the

> > Department of Health and Human Services, said various other

agencies

> > are working to improve the situation. For example, HHS is

tracking

> > and vaccinating its own health-care employees.

> >

> > But I think we can do more. HHS Secretary Mike Leavitt's

initiative

> > on transparency and value-based purchasing could be applied to

flu

> > vaccination; that is, providers who receive Medicare funding can

be

> > required to publicly report their employee vaccination rates.

Also,

> > future payments could be aligned with improvement in the rate.

That

> > would get the providers' attention.

> >

> > Meanwhile, I believe patients can and should act in their own

defense.

> >

> > So last week I told one of mine -- a man recovering from robotic

> > laparoscopic prostate surgery -- that nearly 60 percent of health-

> > care workers do not get an annual flu shot. His jaw dropped. " Oh,

my

> > gosh, " he said.

> >

> > Then I told him that there might be something he could do about

it.

> >

> > " Ask every hospital worker you encounter -- in a respectful way --

> > 'Have you had your flu shot?' " I said. " Put them personally on

the

> > spot. "

> >

> > Who knows? Maybe that will have an effect.

> >

> > Manoj Jain is an adjunct assistant professor at the Rollins

School of

> > Public Health at Emory University in Atlanta. Comments:

> > http://health@

> >

>

November 25, 2008

Thanks , but I already sent it there, myself.

Here is the final draft of my comment (what I previously posted was a

banged out first draft). Everyone is welcome to steal my arguments:

RE: Patients Can Join the Fight Against Flu Without Firing a Shot, by

Manoj Jain.

In the early 1980's vaccine manufacturers went to congress and

complained that if the government wanted them to make more vaccines,

the government would have to pass a law to protect them from lawsuits.

The manufacturers argued the need for this product protection was

because of the real documented risk that vaccines could cause some

people serious harm.

So, it is not too far fetched to conclude that if vaccines are risky

enough to require an act of congress to protect from lawsuits, they

just might be too risky to inject into one's body. Could it be that

the 60% of health care workers who don't vaccinate are intelligent

enough not to fall for the public health propaganda that vaccines are

perfectly safe?

On Nov. 14, 1986, the National Childhood Vaccine Injury Act of 1986

went into law protecting vaccine makers against lawsuits and damages

caused to children from unsafe vaccines. Like health care workers,

apparently the US Congress and the President didn't believe that

vaccines were perfectly safe, either.

Lenny Schafer

Schafer Autism Report

www.sarnet.org

> > >

> > > Patients Can Join the Fight Against Flu Without Firing a Shot

> > >

> > > By Manoj Jain

> > > Special to The Washington Post

> > > Tuesday, November 25, 2008; HE06

> > >

> > > Last month at a luncheon marking International Infection

> Prevention

> > > Week at the National Press Club, some speakers reminded me of a

> > > shameful and frightening statistic: Almost 60 percent of American

> > > health-care workers do not receive the flu vaccine.

> > >

> > > Let me put that in context: Influenza, commonly called the flu,

> > > strikes 5 to 20 percent of Americans annually. In an average

> year,

> > > more than 200,000 people are hospitalized with flu complications;

> > > nearly 36,000 die, either from the flu itself or from

> complications

> > > such as pneumonia or a heart attack.

> > >

> > > A flu shot is the best defense.

> > >

> > > Obviously, health-care workers -- a category that includes not

> only

> > > doctors and nurses but also such hospital personnel as dietary

> and

> > > cleaning staff -- are likely to come into close contact with a

> lot of

> > > highly vulnerable patients. That's why such workers are one of

> the

> > > specific population groups, such as pregnant women and adults

> older

> > > than 50, that the Centers for Disease Control and Prevention

> > > recommends get the vaccine every year.

> > >

> > > Yet, as the CDC showed in a 2006 study, only 41.8 percent of

> health-

> > > care workers surveyed got a flu shot. A back-of-the-envelope

> > > calculation shows that if 58.2 percent of the 11 million health-

> care

> > > workers in America are unvaccinated and if a modest 10 percent

> > > acquire the flu virus, then we have more than half a million

> > > potentially contagious workers in our hospitals and clinics.

> > >

> > > " It is a patient safety issue, " says Schaffner, chairman

> of

> > > the department of preventive medicine at Vanderbilt Medical

> Center in

> > > Nashville and a nationally known expert on immunization. " It is

> > > inexcusable for health-care workers not to be vaccinated. "

> > >

> > > Simple logic would make you think that health-care workers, most

> of

> > > whom have more education in health and medical issues than other

> > > people, would be more likely to be vaccinated. But since 1997 the

> > > vaccination rate among health-care workers nationwide has

> remained

> > > around the same depressing 40 percent. That is more than 20

> > > percentage points lower than the average for the largest at-risk

> > > group, adults older than 65.

> > >

> > > For a decade, as chairman of the infection control committee at

> my

> > > hospital, I have cajoled and pleaded with my fellow health-care

> > > workers to get vaccinated. This year, after I came home from the

> > > infection prevention meeting, I decided to ask my colleagues

> about

> > > the issue.

> > >

> > > One day I struck up a conversation around the nurses station in

> the

> > > intensive care unit.

> > >

> > > " I know people believe you get the flu from a flu shot, " one

> nurse

> > > said. " But I still get one. "

> > >

> > > Another nurse emerged from a room where he'd been tending a

> > > ventilated and sedated patient, his gloves and isolation gown

> > > evidence of our concern about transmitting disease. " What kills

> me is

> > > that people still believe that stuff " about getting sick from the

> > > vaccine, he said. " But it's made from a dead virus. "

> > >

> > > Another nurse chimed in defiantly: " I got a shot last year and

> got

> > > sick. I'm not sure if I am getting it this year. "

> > >

> > > Later, on another floor, a secretary expressed similar

> > > suspicions: " My cousin died the day after he got the flu shot. I

> just

> > > don't trust it. " I told her that the death was certainly

> unrelated to

> > > the vaccine. She remained skeptical -- and unvaccinated.

> > >

> > > My brief conversations reflected what researchers have long

> known. A

> > > 2006 analysis of 32 studies of why health-care workers chose not

> to

> > > be vaccinated showed four main reasons.

> > >

> > > First is a fear of side effects, in particular the misconception

> that

> > > the dead virus the vaccine contains can cause disease.

> > >

> > > A recent experience helped me understand how even professionals

> can

> > > feel that way: At my bank one day, a financial adviser stopped

> > > blowing his nose long enough to reach out for my hand. So as not

> to

> > > appear rude, I shook it and then forgot to wash my hands

> afterward.

> > > That evening, I began to have sniffles. Instinctively, I

> attributed

> > > my stuffy head to the bank employee, even though I know better

> than

> > > any layman that it takes two to four days after an exposure to a

> > > virus for illness to develop.

> > >

> > > It's only human to look for causes when we become ill. In a given

> > > year, the average American gets two to four episodes of the

> common

> > > cold; if one of those occurs within a week or two of a flu shot,

> that

> > > average American is likely to blame the vaccine.

> > >

> > > The second reason is that health-care workers falsely believe

> they

> > > are too healthy to get the flu or have natural defenses against

> it.

> > > Again, studies show otherwise. One study in 1999 showed that in

> any

> > > given year, 7 to 26 percent of unimmunized health-care workers

> had

> > > evidence of influenza virus in their blood. But of those infected

> > > people, fewer than half recalled being ill. Those asymptomatic

> > > workers, however, were contagious and could infect patients who

> were

> > > presumably less robust. (A person who has acquired the influenza

> > > virus is contagious for nearly a week, starting a day before any

> > > symptoms appear.)

> > >

> > > The third reason why some health-care workers do not get

> vaccinated

> > > is that they believe the vaccine is not effective enough. There

> is

> > > some truth to that. Because there are new strains of influenza

> virus

> > > every year, it's sort of a moving target. Scientists must

> constantly

> > > develop new vaccines, and in any given year the vaccine is only

> 50 to

> > > 70 percent effective. But why should a worker not do everything

> > > possible to reduce the risk of transmission?

> > >

> > > The fourth reason health-care workers give for not getting

> vaccinated

> > > is that it is inconvenient. It seems to me that any busy worker

> could

> > > make that argument. In any case, many hospitals are addressing

> the

> > > issue, vaccinating staff members in the hallways and at health

> fairs.

> > > I got vaccinated just before our annual medical staff meeting.

> > >

> > > That kind of attempt can make a profound difference. In 1988

> there

> > > was an outbreak of influenza at the University of Virginia Health

> > > System in Charlottesville, where only 4 percent of health-care

> > > workers had been vaccinated. That prompted the hospital to

> promote

> > > employee vaccinations and ensure that workers stayed home if they

> got

> > > sick. A decade later, the vaccination rate was 67 percent, the

> > > confirmed influenza cases among health-care workers declined from

> 42

> > > percent to 9 percent, and transmission of influenza to

> hospitalized

> > > patients was dramatically reduced. A similar impact has been

> shown in

> > > nursing homes, with decline in overall mortality rates.

> > >

> > > At the infectious-diseases gathering I attended in Washington,

> Don

> > > , the principal deputy assistant secretary for health in

> the

> > > Department of Health and Human Services, said various other

> agencies

> > > are working to improve the situation. For example, HHS is

> tracking

> > > and vaccinating its own health-care employees.

> > >

> > > But I think we can do more. HHS Secretary Mike Leavitt's

> initiative

> > > on transparency and value-based purchasing could be applied to

> flu

> > > vaccination; that is, providers who receive Medicare funding can

> be

> > > required to publicly report their employee vaccination rates.

> Also,

> > > future payments could be aligned with improvement in the rate.

> That

> > > would get the providers' attention.

> > >

> > > Meanwhile, I believe patients can and should act in their own

> defense.

> > >

> > > So last week I told one of mine -- a man recovering from robotic

> > > laparoscopic prostate surgery -- that nearly 60 percent of health-

> > > care workers do not get an annual flu shot. His jaw dropped. " Oh,

> my

> > > gosh, " he said.

> > >

> > > Then I told him that there might be something he could do about

> it.

> > >

> > > " Ask every hospital worker you encounter -- in a respectful way --

> > > 'Have you had your flu shot?' " I said. " Put them personally on

> the

> > > spot. "

> > >

> > > Who knows? Maybe that will have an effect.

> > >

> > > Manoj Jain is an adjunct assistant professor at the Rollins

> School of

> > > Public Health at Emory University in Atlanta. Comments:

> > > http://health@

> > >

> >

>

November 25, 2008

do you have the link so we can write to them?

thanks, M

Subject: Medical workers and flu shot - anyone care to comment?To: EOHarm Date: Tuesday, November 25, 2008, 1:50 PM

Patients Can Join the Fight Against Flu Without Firing a ShotBy Manoj JainSpecial to The Washington PostTuesday, November 25, 2008; HE06Last month at a luncheon marking International Infection Prevention Week at the National Press Club, some speakers reminded me of a shameful and frightening statistic: Almost 60 percent of American health-care workers do not receive the flu vaccine.Let me put that in context: Influenza, commonly called the flu, strikes 5 to 20 percent of Americans annually. In an average year, more than 200,000 people are hospitalized with flu complications; nearly 36,000 die, either from the flu itself or from complications such as pneumonia or a heart attack.A flu shot is the best defense.Obviously, health-care workers -- a category that includes not only doctors and nurses but also such hospital personnel as dietary and cleaning staff -- are

likely to come into close contact with a lot of highly vulnerable patients. That's why such workers are one of the specific population groups, such as pregnant women and adults older than 50, that the Centers for Disease Control and Prevention recommends get the vaccine every year.Yet, as the CDC showed in a 2006 study, only 41.8 percent of health-care workers surveyed got a flu shot. A back-of-the- envelope calculation shows that if 58.2 percent of the 11 million health-care workers in America are unvaccinated and if a modest 10 percent acquire the flu virus, then we have more than half a million potentially contagious workers in our hospitals and clinics."It is a patient safety issue," says Schaffner, chairman of the department of preventive medicine at Vanderbilt Medical Center in Nashville and a nationally known expert on immunization. "It is inexcusable for health-care workers

not to be vaccinated."Simple logic would make you think that health-care workers, most of whom have more education in health and medical issues than other people, would be more likely to be vaccinated. But since 1997 the vaccination rate among health-care workers nationwide has remained around the same depressing 40 percent. That is more than 20 percentage points lower than the average for the largest at-risk group, adults older than 65.For a decade, as chairman of the infection control committee at my hospital, I have cajoled and pleaded with my fellow health-care workers to get vaccinated. This year, after I came home from the infection prevention meeting, I decided to ask my colleagues about the issue.One day I struck up a conversation around the nurses station in the intensive care unit."I know people believe you get the flu from a flu shot," one nurse said. "But I still

get one."Another nurse emerged from a room where he'd been tending a ventilated and sedated patient, his gloves and isolation gown evidence of our concern about transmitting disease. "What kills me is that people still believe that stuff" about getting sick from the vaccine, he said. "But it's made from a dead virus."Another nurse chimed in defiantly: "I got a shot last year and got sick. I'm not sure if I am getting it this year."Later, on another floor, a secretary expressed similar suspicions: "My cousin died the day after he got the flu shot. I just don't trust it." I told her that the death was certainly unrelated to the vaccine. She remained skeptical -- and unvaccinated.My brief conversations reflected what researchers have long known. A 2006 analysis of 32 studies of why health-care workers chose not to be vaccinated showed four main reasons.First is a fear of side

effects, in particular the misconception that the dead virus the vaccine contains can cause disease.A recent experience helped me understand how even professionals can feel that way: At my bank one day, a financial adviser stopped blowing his nose long enough to reach out for my hand. So as not to appear rude, I shook it and then forgot to wash my hands afterward. That evening, I began to have sniffles. Instinctively, I attributed my stuffy head to the bank employee, even though I know better than any layman that it takes two to four days after an exposure to a virus for illness to develop.It's only human to look for causes when we become ill. In a given year, the average American gets two to four episodes of the common cold; if one of those occurs within a week or two of a flu shot, that average American is likely to blame the vaccine.The second reason is that health-care workers

falsely believe they are too healthy to get the flu or have natural defenses against it. Again, studies show otherwise. One study in 1999 showed that in any given year, 7 to 26 percent of unimmunized health-care workers had evidence of influenza virus in their blood. But of those infected people, fewer than half recalled being ill. Those asymptomatic workers, however, were contagious and could infect patients who were presumably less robust. (A person who has acquired the influenza virus is contagious for nearly a week, starting a day before any symptoms appear.)The third reason why some health-care workers do not get vaccinated is that they believe the vaccine is not effective enough. There is some truth to that. Because there are new strains of influenza virus every year, it's sort of a moving target. Scientists must constantly develop new vaccines, and in any given year the vaccine is only

50 to 70 percent effective. But why should a worker not do everything possible to reduce the risk of transmission?The fourth reason health-care workers give for not getting vaccinated is that it is inconvenient. It seems to me that any busy worker could make that argument. In any case, many hospitals are addressing the issue, vaccinating staff members in the hallways and at health fairs. I got vaccinated just before our annual medical staff meeting.That kind of attempt can make a profound difference. In 1988 there was an outbreak of influenza at the University of Virginia Health System in Charlottesville, where only 4 percent of health-care workers had been vaccinated. That prompted the hospital to promote employee vaccinations and ensure that workers stayed home if they got sick. A decade later, the vaccination rate was 67 percent, the confirmed influenza cases among health-care workers

declined from 42 percent to 9 percent, and transmission of influenza to hospitalized patients was dramatically reduced. A similar impact has been shown in nursing homes, with decline in overall mortality rates.At the infectious-diseases gathering I attended in Washington, Don , the principal deputy assistant secretary for health in the Department of Health and Human Services, said various other agencies are working to improve the situation. For example, HHS is tracking and vaccinating its own health-care employees.But I think we can do more. HHS Secretary Mike Leavitt's initiative on transparency and value-based purchasing could be applied to flu vaccination; that is, providers who receive Medicare funding can be required to publicly report their employee vaccination rates. Also, future payments could be aligned with improvement in the rate. That would get the providers'

attention.Meanwhile, I believe patients can and should act in their own defense.So last week I told one of mine -- a man recovering from robotic laparoscopic prostate surgery -- that nearly 60 percent of health-care workers do not get an annual flu shot. His jaw dropped. "Oh, my gosh," he said.Then I told him that there might be something he could do about it."Ask every hospital worker you encounter -- in a respectful way --'Have you had your flu shot?' " I said. "Put them personally on the spot."Who knows? Maybe that will have an effect.Manoj Jain is an adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta. Comments: http://health@ washpost. com

November 25, 2008

I found it. Here: http://is.gd/90hI

>

> Subject: Medical workers and flu shot - anyone care to comment?

> To: EOHarm

> Date: Tuesday, November 25, 2008, 1:50 PM

>

> Patients Can Join the Fight Against Flu Without Firing a Shot

>

> By Manoj Jain

> Special to The Washington Post

> Tuesday, November 25, 2008; HE06

>

> Last month at a luncheon marking International Infection Prevention

> Week at the National Press Club, some speakers reminded me of a

> shameful and frightening statistic: Almost 60 percent of American

> health-care workers do not receive the flu vaccine.

>

> Let me put that in context: Influenza, commonly called the flu,

> strikes 5 to 20 percent of Americans annually. In an average year,

> more than 200,000 people are hospitalized with flu complications;

> nearly 36,000 die, either from the flu itself or from complications

> such as pneumonia or a heart attack.

>

> A flu shot is the best defense.

>

> Obviously, health-care workers -- a category that includes not only

> doctors and nurses but also such hospital personnel as dietary and

> cleaning staff -- are likely to come into close contact with a lot of

> highly vulnerable patients. That's why such workers are one of the

> specific population groups, such as pregnant women and adults older

> than 50, that the Centers for Disease Control and Prevention

> recommends get the vaccine every year.

>

> Yet, as the CDC showed in a 2006 study, only 41.8 percent of health-

> care workers surveyed got a flu shot. A back-of-the- envelope