H1N1 vaccine embraced, but also feared

Physicians are among those lining up for vaccinations. But some health care professionals say they won't get the vaccine, despite urging from federal health officials.

By Susan J. Landers — Posted Oct. 21, 2009

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Sandy Arnold, MD, stood in line with her colleagues Oct. 5 at Le Bonheur Children's Medical Center in Memphis, Tenn., to receive the influenza (A)H1N1 nasal spray. She didn't hesitate to take the vaccine, and she plans to have her children vaccinated as well.

"I have done my best as my own little [public relations] factory to convince people that [being vaccinated] is a safe thing to do," said Dr. Arnold, associate professor of pediatrics at the University of Tennessee Health Science Center. "People perceive [the vaccine] as being new and unusual, and my tactic is to tell them it is really not new and unusual. It is the same flu vaccine you have always gotten -- with a different virus in it."

As the H1N1 vaccine rolled out in early October, Dr. Arnold and other physicians lined up, signaling the start of a massive campaign to immunize millions of Americans. Health officials urged health care workers to get vaccines for both H1N1 and seasonal flu, but officials know it's an uphill battle. Only 38% of health care workers traditionally get vaccinated for seasonal flu, according to the Centers for Disease Control and Prevention.

New York state's attempt to mandate seasonal and H1N1 vaccinations for health care workers and others was met with a flurry of lawsuits filed by nurses, public employees and teachers. On Oct. 16, a state Supreme Court judge temporarily blocked the mandatory vaccination; a hearing is scheduled for Oct. 30.

The New York State Nurses Assn. issued a statement saying that while nurses are encouraged to voluntarily receive flu vaccine, "the emergency regulation is unwarranted in the absence of a declared emergency. The rule appears to interfere with the freedom to contract between employers and employees and violates the free exercise of religion by denying exemptions to employees whose religious beliefs prevent them from being vaccinated."

Nurses have joined protest marches held in Albany, N.Y., but local medical society officials said they did not think physicians have been involved.

Since the H1N1 vaccination season is just starting, it is difficult to know how many physicians, nurses and others will ultimately receive the vaccine. But a survey of pharmacy directors at 341 hospitals nationwide found gaps in seasonal flu vaccination rates for their workers. Just 37% of the pharmacy directors reported hospital staff vaccination rates of more than 70%.

Ari Brown, MD, a pediatrician in Austin, Texas, intends to be vaccinated and will vaccinate her patients. She has harsh words for the health care professionals she encounters who refuse the vaccine: "Why do you even have this job if you are not willing to be on the front line and protect yourself for the protection of others? You need to find a new career."

David Shulan, MD, a member of a six-physician allergy and immunology practice in Albany, N.Y., said his patients, many of whom have asthma, are eager to get vaccinated. People with underlying health conditions, especially respiratory diseases, are among priority groups for the H1N1 vaccine.

Dr. Shulan said that in his role as president of the Medical Society of the County of Albany he has received e-mails from physicians who object to New York's mandate. But other physicians support it.

Doctors have an obligation to protect patients and preserve the work force by getting vaccinated, said Peter Sosnow, MD, an emergency physician at Albany Memorial Hospital.

"I personally support the state mandate for health care providers as being appropriate and necessary," said Dr. Sosnow, director of employee health at Northeast Health, a nonprofit system in the Albany area. He supervises the health of several thousand workers. "The last thing we need is for our staff to be ill and unable to provide needed care."

Health officials say the need to vaccinate is clear: H1N1 influenza was reported to be widespread in 41 states for the week ending Oct. 10, up from 37 states the week before, according to the CDC. The proportion of outpatient medical visits was also reported to be higher than normal throughout the country. In addition, the CDC received reports of more than 15,000 hospitalizations and more than 2,000 deaths from flu or pneumonia syndromes. Weekly updates are available from the CDC (link).

"Influenza is in virtually the entire country, and nearly all the virus is H1N1," said Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases.

As of Oct. 14, 11.4 million doses of the expected 250 million doses had been allocated to states, Washington, D.C. and the territories and nearly 6 million had been shipped. Vaccine will continue to become available until the end of the year. Physicians are asked to check with local and state health departments to see when vaccine will arrive in their areas.

When vaccine does arrive, the public wants physicians and other health care professionals to take it, according to a poll by C.S. Mott Children's Hospital, part of the University of Michigan Health System.

The National Poll on Children's Health found that 87% of respondents believe health care professionals should be required to be vaccinated against H1N1 flu.

"We were surprised by the strength of public opinion," said Matthew Davis, MD, director of the poll and an associate professor of pediatrics and internal medicine at the University of Michigan Medical School. "The public is relying on health care workers to be prepared -- not just with hand-washing and masks, but with the vaccine."

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