UAMS Medical Center sees 92 percent compliance with flu shot

Less than half of U.S. residents received the influenza vaccine shot this past year, some because of doubts about its effectiveness and concerns about potential side effects. But some healthcare workers who decline the flu shot are finding that it could cost them their job.

More than a 1,000 healthcare workers in Rhode Island signed a petition protesting the state’s strict law for flu vaccinations for healthcare workers, claiming this violated the HIPAA patient privacy law. A pregnant nurse in Chicago filed a wrongful termination lawsuit in 2013 after she was fired for refusing the flu shot. But that case was dismissed by the court.

University of Arkansas for Medical Sciences (UAMS) Medical Center CEO Roxane A. Townsend, MD said they receive few complaints from workers because most understand that this is a requirement of employment, just as is being immunized for Hepatitis B and measles.

There are workers who don’t take the flu shot for health reasons such as allergies to eggs or formaldehyde. They aren’t fired, but must wear a facemask.

“Wearing a mask is difficult for the caretakers, but our primary concern is to protect patients and other employees,” Townsend said. “We don’t want someone to come to work and potentially transmit that virus before they have realized they have the flu.”

Townsend doesn’t consider the requirement a violation of HIPAA. Often patients and staff wear masks for many reasons.

“At a teaching facility like this where there are many students and faculty, there is not a bright line between those who have direct interaction with patients and those who don’t,” Townsend said. “So we encourage everyone to take the flu shot. This year we had 92 percent compliance with all our employees, which total more than 10,000. The only employees who don’t get vaccinated are those who have a reason not to. We are pretty impressed with our compliance rate.”

Hospitals without at least a 90 percent compliance rate can be penalized, since it is one of the quality measures that affects reimbursement by the Centers for Medicaid and Medicare Services.

Minor side effects can include arm soreness and a slight increase in temperature. More serious concerns are an allergic reaction or contracting Guillain-Barré Syndrome (GBS), which results in the body's immune system attacking part of the peripheral nervous system. GBS can lead to paralysis.

“We have much better diagnostic capabilities now and better supportive care for GBS,” Townsend said. “Many people do recover from GBS.”

Jennifer Dillaha, MD, medical director for the immunization program at Arkansas Department of Health, said the risk of GBS from the flu vaccine is one in a million vaccinations. There is a higher risk of GBS from flu than from the flu shot.

“There was a Canadian study published last year in The Lancet Infectious Diseases that found that the risk of GBS was 15.81 times more likely with influenza illness compared to the risk with influenza vaccine,” Dillaha said. “Of all the GBS cases, 1 percent was found to be caused by the influenza vaccine, while 17 percent were found to be caused by influenza illness. The remainder was caused by a variety of other causes.”

For healthcare workers and others with an egg allergy, Dillaha recommends an egg-free formula that is approved for adults through age 49. But many allergists and primary care providers are giving the standard inactivated flu shot to people with a history of egg allergies.

“Even though egg is listed on the ingredients, it is present in only trace amounts, and most people don’t react to it,” Dillaha said. “If you are concerned about it, see an allergist or primary care doctor with experience in the recognition and management of severe allergic conditions. They can you give the shot and then monitor you for 30 minutes. Once you have safely received the shot, you can feel confident about getting it the next year.”

The U.S. government has a National Vaccine Injury Compensation Program created to pay for illnesses caused by vaccinations. But an AP article in November 2014 concluded that the program is overwhelmed with delays in receiving compensation stretching ten years or longer. The fund was established primarily for children injured by childhood vaccinations, but now is dominated by people who got GBS after receiving the flu shot.

Also controversial is the effectiveness of the vaccine that is manufactured ahead of the flu season before it is certain which flu viruses will dominate. In years where this is a good match between the vaccine and the strains of flu in circulation, the flu vaccine is 50 to 70 percent effective in preventing the disease. If you do get the flu, the vaccine greatly reduces the risk of severe illness. Studies have shown that vaccination is associated with approximately a 70 percent reduction in flu-related hospitalizations for adults and an 80 percent reduction in flu-related deaths.”

Dillaha said that in the 2013-2014 flu season the FluMist nasal vaccine was not effective against the predominant H1N1 virus. The strain included in the vaccine was not a good match for the circulating flu strain. “The manufacturer is looking at trying to understand why that has happened, whether it was a flaw in the manufacturing of their vaccine or some other reason,” Dillaha said.

Healthcare workers being required to get the immunization is a patient safety issue that Dillaha considers on par with washing your hands. It just makes sense.

In addition to the dangers of employees transmitting a virus, often healthcare facilities are short staffed.

“Employees have pressure or personal drive to come into work when they are not well because there are very sick people that we need to take care of,” Dillaha said. “Although we may not feel sick enough to stay home, sometimes we still have the flu. If people are partially immune to the flu, they may not have such a severe case that they would be too sick to come to work. But they could still be contagious.”

Healthcare workers are at an increased risk for being exposed to the flu because of the people served. And if there is influenza pandemic, every healthcare worker will be needed.

“We really need the healthcare workforce immunized because many times the pandemic will show up in an unpredictable way,” Dillaha said. “Healthcare professionals need vaccines in order to take care of the sick population.”

For more, visit: www.cdc.gov/flu/