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No flu vax? No job.

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Parents who refuse to let their children have their childhood vaccines get a fair amount of attention from the press. The people who should get just as much, or more, coverage are the health care workers who refuse to get their flu shot. It’s bad enough they aren’t always washing their hands. (PDF, discussion of a three-year study to improve hand hygiene starts on p. 19, if your day isn’t exciting enough.)

There are no federal guidelines that require providers to get flu shots, but Paul Offit, M.D., Chief of Infectious Diseases and Director of the Vaccine Education Center for the Children’s Hospital of Philadelphia is not messing around:

“If you don’t want to get the vaccine, you have two weeks of unpaid leave to think about it, and if you still don’t want to get it, you’re fired.”

[…]

“Healthcare workers have a responsibility to their patients, and it is not their inalienable right to catch and transmit a potentially fatal infection. It’s not their right to not be vaccinated,” Offit said.

Several years ago, a child with cancer “came into this hospital for care, but caught the influenza virus in this hospital and died from it,” he said. “She no doubt caught it from us.”

That’s a very clear statement of policy from Dr. Offit. Can workers wear a mask instead?

There’s no provision to let workers wear a mask instead, like many healthcare facilities allow, because he said, “masks aren’t particularly effective.”

There’s no mention of the policy for non-employee physicians at CHOP (winner of the worst acronym for a children’s hospital), but I can imagine Offit sneaking up on them with a needle and an alcohol swab.

Based on the article, CHOP is on the extreme end of enforcement, alas. The article also discusses the efficacy of masks in preventing flu transmission, religious/personal belief exemptions in hospitals and health care systems, what labor union National Nurses United has to say about immunizations, and other things you never see in an episode of ER.

As for those of us who receive, rather than give health care – don’t be shy about asking your health care providers if they’ve had their shots.

And make sure they wash their damn hands.

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  • Gwen

    I would support a Presidential executive order requiring all federal employees and federal contractors to either get the flu shot, or to provide documentation for a bona fide medical or religious exemption.

    I’m sure the usual bunch of knuckleheads will try to raise a RFRA issue, though (government forms are for atheists, after all, just ask the nuns).

    BTW, I work for a federal software vendor, so this would include myself!

    • BiloSagdiyev

      This sounds like a potentially very popular plan! But it could be even more popular! Call it Obamashots and only have them administered by transgendered Mexican nurses with temporary visas.

      I’m sure there are other ways to get the hinterlands screaming, but that’s my first draft.

      Wait, make that Syrian nurses.

    • Donalbain

      I agree, except I would not allow a religious exemption.

      • Origami Isopod

        +1

        • Mrs Tilton

          +2

  • Denverite

    The health department in Colorado requires some facilities (hospitals, SNFs, but not ALFs) to have their employees get flu shots. Employees who don’t have to wear a mask. Pretty much all healthcare facilities have to have policies, report immunization rates, etc.

    This can be a big deal. My grandmother died earlier in the year after contracting the flu in an rehab facility. It’s unclear if the flu killed her or if she would have died anyway (she had end stage heart disease), but it certainly didn’t help, and it definitely made her last few months a lot more unpleasant than they could have been.

  • Philip

    Of course, it’s not just health care workers. Anyone who has contact with vulnerable people like the very young, the elderly, or immunocompromised people has a moral obligation to get their damn shots. And since essentially every person in this country has at least indirect contact with some of those people, that means everyone. If you are healthy enough to have them, you have a moral obligation to get your fucking shots on time. It is a crime how many people on this planet still die of things we have reasonably effective vaccines against.

  • Steve LaBonne

    Fuck religious exemptions. If your religion obliged you to murder people, should you get a free pass? People who won’t get vaccinated do actually kill other people.

    • Joseph Slater

      I would also oppose religious exemptions. Accommodations are fine if they don’t interfere with getting the job done, but “posing a real risk of infecting people with really bad diseases” is not consistent with the job of at least most hospital personnel.

      • Mrs Tilton

        Even given the highly unwise legislating that is the RFRA and a Supreme Court willing to so read it as to make federal law optional for Christian fundamentalists, I would hope that permitting clinical healthcare workers to refuse vaccinations on religious grounds is pretty much the dictionary-margin illustration of “unreasonable accommodation”.

  • pianomover

    Please all of you get your shot.

    • The Temporary Name

      Got mine.

    • DrDick

      Got mine a month ago and have gotten all my recommended vaccinations. I still remember the polio survivors I went to grade school with.

    • sharculese

      Back during the Ebola scare, I was talking on the phone with my mom, who is a public health expert. She asked me what I thought about the whole thing and I said I didn’t think about it, because I trusted CDC to handle this kind of thing.

      Her response: “Good, but just so you know, there is a virus that’s going to kill a bunch of people this winter. It’s called the flu, so go get your shot.”

  • Vance Maverick

    The benefits of the flu shot are less clear-cut than for other vaccines. Still I think it’s worth taking, individually and collectively, especially for health-care workers. No jab, no job is rough justice.

    • sherm

      Much less clear-cut. Last year’s was particularly ineffective, and the flu stats are all guesswork because very few people are actually tested for the seasonal flu. Having said that, I have no problem requiring health-care workers to get the shot.

      • weirdnoise

        I’m not an epidemiologist, but here is my understanding of how even an imperfect vaccine can have a large effect. The simplest model of contagion is an exponential function. This assumes that each person infects N other people. P(t+1) = P(t)^N where P(x) is the number infected at time x.) If N is greater than one the infected population grows until something makes N less than one (conditions for infection lessen, the fraction of readily infectable people declines, etc). Even an imperfect vaccine reduces N and can help push it below one, making a considerable difference over an entire season.

    • malraux

      That seems to indicate that the amount of good a flu vaccine does varies substantially from year to year. That is not the same thing as saying that it’s not clear cut. On average it still does a lot of good, it’s just hard to know how much good any particular years vaccine will do.

      • Vance Maverick

        Not sure what we’re disagreeing about here. I am saying it does good, but not 100% and not predictable. A pretty cut-and-dried case of not-clear-cutness, if you ask me.

        • Yankee

          Totally depends on what you’re cutting. If you’re an individual figuring your personal cost=benefit tradeoff, yes you need to consider the benefits of free-riding in any particular year. If you’re a social thinker, mass flu immunization is clearly socially beneficial. If you’re a social actor, you will even go get one.

  • Karen24

    I used to get the nasal mist vaccine, but since my doctor won’t approve it for anyone past 50, I don’t get the vaccine. I have a crippling pathological terror of needles, and no amount of “grow up” is going to change that. I. Do. Not. Do. Needles. When I was pregnant and had to get blood drawn, I routinely threw up at the sight of the needle. I always took a change of clothes to doctor’s appointments because of it.

    My kids got every vaccine available, incluing Gardosil, and since they’re boys that’s something, but unless it is an absolute requirement, nobody comes near me with anything that punctures. Luckily I don’t have a job that requires contact with immunocompromised people and no one in my family is in that condition. If you have any suggestions, I’m open, but please be aware that it isn’t that easy for some of us.

    • Moondog

      If your kids get the live vaccine, they’re shedding some virus after, so you may pick up some immunity from that. So said my doctor, if I understood her correctly.

    • I’m strictly talking about health care providers here, but it’s odd your doctor won’t give you the intranasal spray. Medicare covers it. Has s/he said why?

      You might be able to get it from a drug store that offers immunization services, or an urgent/walk up care office.

      • sherm

        The spray is only for ages 2-49.

      • Denverite

        It’s not proven effective in adults over 50.

    • Lee Rudolph

      I have a crippling pathological terror of needles, and no amount of “grow up” is going to change that.

      I’ve never feared needles per se, but between the ages of about 23 through 40 or so, I routinely grew faint when having (even small amounts of) blood drawn, and regularly blacked out in full falling-out-of-the-chair-onto-the-doctor’s-floor-and-awakening-to-smelling-salts mode. Then suddenly it stopped giving me that reaction, and I am now suffused with equanimity in identical circumstances.

      So you may some day “grow up” without (or despite) being told to grow up. (But I don’t know how you’d find out; whereas I didn’t have a choice.)

    • cackalacka

      I sincerely sympathize.

      There is a large part of my id (all of it, in fact) that does not do needles. This part of my being also doesn’t do blood; it doesn’t watch shows that have blood. I hear you on the throw-up thing; one of my favorite formative moments involved a junior-high first aid video, and frosted mini wheats, but won’t trouble anyone with more details.

      Anyway, despite my id’s inclinations, there is a large part of my ego that recognizes that I have O-negative blood and an infant in my house.

      So last week my ego put my id in a head-lock, and dragged it to the Red Cross clinic to donate, and then the next day went to the pharmacy to get a flu shot.

      My suggestion, tell your practitioner that you don’t do needles, and find something to block the view of your arm, and something on the other side of the room to stare at. Over the past twenty years I’ve probably donated over sixty pints of blood, and never once seen the metal of the needle or the tube of crimson flowing out of my arm. The main secondary reason I donate is because a non-insignificant amount of diagnostics and interventions are handled intravenously. Might as well give my ego the better part of my youth and middle-age getting equipped to overcome my id. I know people who cannot fly and do not fly, and live (horribly compromised and insular lives.) I can avoid House and ER and Grays Anatomy all I want, but if I want to live the third act of my life, I gotta deal.

      Tell your nurse/doctor/dentist, don’t look at your arm, don’t look at what’s coming: you might not be good-good, but you’ll be good.

      • Every Man Jack of Yinz

        Last couple years I just get my shot at the pharmacy when I am picking up an rx. I have to get poked all the time so it’s no big deal. I make a show of how little I care to impress whoever the unlucky person who is poking me, especially if I think the person is attractive (it never works). My opening line is usually “well I hope this is your first time”. Used it on a young phlebotomist at Hopkins and the poor guy froze up. It wasnt his first time, but it was pretty close his first day on live patients. I had to talk him down a bit and he did fine.

        • Vance Maverick

          I’m confused. Why do you say you hope it’s their first time? And why do you want to make them uncomfortable?

          • Every Man Jack of Yinz

            Because they’ve never heard that before and I think it’s funny. I never figured I’d get a guy on his first day, but like it said I get poked alot and if you are totally relaxed it makes the job easier and hurts less.

      • Ahuitzotl

        congratulations on the insensitive-jerk award for telling her to do what she can’t do.

        • cackalacka

          Unless a terrible accident befalls Karen, it is a statistical certainty that she will be in a situation that requires she is punctured. As a fellow hemophobe, I know precisely how cripplingly terrifying that is. That reality can be mitigated by my suggestions above.

          Congratulations on the misplaced self-righteous empathy award for enabling a phobia that could one day significantly compromise someone else’s health.

      • Crissa

        To not panic, I have to actually see them drawing the blood. My imagination is far worse than the reality!

    • Arla

      If you have any suggestions, I’m open, but please be aware that it isn’t that easy for some of us.

      Would the Fluzone intradermal be an option?

    • Crissa

      Erf, yeah. I routinely pass out from injections. My doctor says she wouldn’t suggest the flu vaccine because the risk is hard to weigh between the two things.

      But I get all the others and already have annual blood draws. Takes me a lot of meditation and breath control and near perfect situations not to panic, but it happens once in awhile.

      There once was a time I routinely passed out at thinking about the damn things. I still dread the obligatory media scenes where they have to show a needle being stuck in horrid places.

  • StellaB

    The fall that my athletic and completely healthy mom turned sixty, she was too busy to get a flu shot. Instead she got the flu. She spent two full weeks on a ventilator in the ICU with ARDS, but since she was healthy and enrolled in a phase III trial of a new medication, she survived with no aftermath. Granted that needle is not pleasant, but trust me, several weeks in the ICU is worse.

    • sparks

      Plus the fact if you land in the ICU, you will have needles in you, and not the little ones they give injections with, either.

  • wibekah

    I really hate that flu shots are conflated with regular vaccines. I don’t think they should be mandatory. Each year’s vaccine is a best guess. There is no correlation with negative outcomes and how close the vaccine is to the actual virus. Years where they’ve been completely wrong have not resulted in more deaths or hospitalizations. So where is the evidence that flue vaccines are helpful?

    • Lee Rudolph

      So where is the evidence that flue vaccines are helpful?

      The one year I missed one, I had a chimney fire!

      • cackalacka

        Yeah, purely anecdotal for me, but the one year I didn’t get it, I was sick.

        Not a scientific rebuttal, but frankly ‘So where is the evidence that flue vaccines are helpful?’ isn’t a particularly epistemological question.

    • DrDick

      I used to get the flu every year, but in the 15-17 years since I started getting the flu shot, I have never had it. I work in a petri dish.

    • sherm

      So where is the evidence that flue vaccines are helpful?

      That is not open for debate. Its more than helpful. Take a look at the CDC stats some time. The only issue is how helpful in view of costs and risks.

    • Arla

      So where is the evidence that flue vaccines are helpful?

      This might be a good place to start.

      Each year’s vaccine is a best guess. There is no correlation with negative outcomes and how close the vaccine is to the actual virus.

      The fact that flu vaccines still have benefits even when the match is not perfect is, if anything, a compelling argument in favor of vaccination, not against it.

  • DrDick

    This really should be required for all medical facilities, as well as for all workers who handle food.

    • sherm

      as well as for all workers who handle food.

      The flu vaccine or hand washing?

      • DrDick

        Both.

      • efgoldman

        The flu vaccine or hand washing?

        Yes.

  • Lee Rudolph

    “masks aren’t particularly effective.”

    On the other hand, I am as sure as I can be without actually doing a Google search that there exists Japanese flu-mask-fetish porn.

    • BiloSagdiyev

      L’Hopital de Rule 34.

  • Lee Rudolph

    By the way, shouldn’t the title have been “No Jab, No Job”?

    • N__B

      No stick, no schtick.

  • As other folks have pointed out, it’s unfortunate the influenza vaccine is not one of our better ones. The virus is crafty and changes its two main antigenic sites on its surface every year or so Also immunity is not very long lasting. So each year’s batch of vaccine is a best guess based upon sentinel surveillance studies. Then a committee decides. My landlady when I was in medical school was a famous epidemiologist and she was on that committee — she said people on it do disagree and the vaccine content is sometimes a bit of a compromise. But population studies clearly show it helps reduce disease and death from influenza, although some years better than others.

    My hospital requires the vaccine. When you get it they put a sticker on your name badge. All facilities I know of do a similar thing, so you can just glance at a person’s badge to verify if they’ve been vaccinated.

    Also, Paul Offit does stellar work as a vaccine advocate and runs a great vaccine education service at CHOP. Of course anti-vax folks think he’s the devil.

    • If memory serves you’ve written before about parents of patients who are OK with risky procedures, but wary of vaccination.

      Does the policy apply to doctors who are not hospital-based? (Again, if memory serves you’re a pediatric intensivist.)

      • Yes, many parents just don’t understand the concept of relative risk. They’ll let me do fairly risky things to their child without batting an eye, yet some balk at things that carry risks on the order of 1 in a million, like vaccines.

        The influenza vaccine requirement is based upon having hospital privileges. So it would be possible for, say, a dermatologist who doesn’t have any hospital privileges not to be required to have the vaccine. Stupid, but possible. I assume large outpatient organizations like Kaiser would require vaccination even for physicians who don’t work in the hospital. But I’m not sure about that.

        And yep, I’m a pediatric intensivist. I’ve cared for horribly sick children with influenza, on mechanical ventilators for weeks.

        • I should add that I am part of a large nonprofit system, and it requires vaccination of all the physicians no matter where they work.

  • Shantanu Saha

    Can we apply this to the Republican candidates?

    • Gabriel Ratchet

      At the very least, someone should at least check Ted Cruz in case he tests positive for rabies.

  • asifis

    I personally know two people who have had family members disabled by Guillaine Barre that came on immediately after flu shots. The official line of “one in a million” doesn’t seem credible. I am aware that they say you’re more likely to get it after the flu than after being vaccinated, but no one’s selling you the flu.

    I’m a 60 year old man who has never gotten the shot or the flu, at least not worth noting. I suppose I’ll feel differently if I ever do get the flu. I’m generally vaccine positive but also feel that there is room for debate and I’m not sure why the folks here, generally skeptical of Big Pharma and the medical industrial complex are so confident that all vaccines are worth defending.

    • Just_Dropping_By

      +1 for being generally pro-vaccine, but foregoing the flu vaccine. That said, if I become a caretaker for an immuno-comprised person or otherwise end up in a situation where I have routine contact with a vulnerable person, I would get the vaccine (and I do plan to start getting the vaccine routinely when I turn 60), but, since I am not currently in such a situation, the cost-benefit analysis to me outweighs getting the vaccine.

    • Hogan

      Nobody’s getting rich off of vaccines; they probably have the thinnest margins in the pharma industry. Too much quality regulation, and too much bulk purchase by governments.

    • ajp

      I think you’re probably correct about GBS. Search for GBS on the court of federal claims website (vaccine court is in the CFC) and see how many show up. I know the DOJ likes to settle flu vaccine GBS cases-there are a lot of them.

      Other thing is, I think the flu vaccine is only like 23% effective this year. Plus, I try to get it at my doctor’s office when I do get it as opposed to someone at a pharmacy-don’t want SIRVA.

  • Cordonazo

    I’m surprised this is unusual. I work for a company that operates ten hospitals and a few hundred offices. Every single employee is required to receive the annual influenza vaccine as a condition of employment. This is regardless of job status or type. Medical exemption is the only one offered.

    I set foot in our hospitals maybe twice per year and have no patient care responsibilities, but I an glad to get mine every year and thrilled when those against it are shown the door.

  • ginos_way

    I was a labor union representative for 20 years. I represented (among others) county public health and mental health nurses, as well as clerical workers who supported the clinicians. In the final years, the county health officer required anyone in these county facilities to obtain a flu shot. Immediately, I was faced with resentful nurses/members demanding I grieve the requirement as a violation of their constitutional rights and the collective bargaining agreement. They could not, however, cite that portion of the constitution or the CBA entitling them to transmit a potentially deadly illness to their patients. Their anger fueled a stand-off with their union that put me as close as I’d ever been to facing a duty-of-fair-representation lawsuit. I called their bluff, and they resigned. I then received expressions of gratitude from union members who understood their responsibility to their patients–and a reminder to get my own shot.

  • Brad Nailer

    Well, now I’m feeling a little stupid. I never get the flu and so I never get the shot. Is it possible that even though I’m not sick I could still have a virus that could be infecting others? Is this a herd-immunity thing? If it is, I will definitely change my ways.

    • Cordonazo

      There is a herd immunity aspect. There’s also just the usual luck factors of why some people get sick abd others don’t.

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