Too few health professionals getting flu shots

In many ways, experts consider the 2011-12 influenza season off to a good start. Manufacturers, who are expected to produce a record number of seasonal flu vaccine doses, have not reported delays. Vaccine is arriving in physician offices across the country. And this year's flu season is expected to be typical, similar to last season.

But experts worry that not enough health professionals and others who have contact with patients will get the flu vaccine.

Data show that 63.5% of health care personnel were vaccinated against influenza during the 2010-11 season, according to a Centers for Disease Control and Prevention study of 1,931 health care workers in the Aug. 19 Morbidity and Mortality Weekly Report. That is a slight increase from the 61.9% who received the seasonal flu vaccine during the influenza A (H1N1) pandemic in 2009-10.

Physicians and dentists, who were grouped together in the CDC's figures, had the highest immunization rate of 84.2% in 2010-11. The rate was 69.8% for nurses and 57.2% for administrative staff. Also included in the study were nurse practitioners, physician assistants, allied health professionals and technicians.

Despite the slight uptick, the vaccination rate for health care workers still falls below the Healthy People 2020 target rate of 90%.

This "is really discouraging," said Norman Edelman, MD, chief medical officer of the American Lung Assn. Health professionals "should know the flu vaccine is safe. They should know that transmitting the flu to people who are debilitated or with an impaired immune system can result in very severe illness."

Vaccinating health care workers against influenza has been shown to reduce transmission of the illness among employees and patients, some of whom are too young or sick to be immunized themselves, infectious diseases experts say. But persuading them to get the shot has been a challenge for years.

Similar to the public, some health care personnel have the mistaken impression that the vaccine will cause the flu, experts say. Some health workers also question whether the flu shot is effective, and they have the misconception that the flu is not a serious illness.

To help remedy the problem, medical organizations have focused on educating health professionals about influenza and how to prevent its spread. They also have urged getting the seasonal influenza shot every year.

The American Medical Association says physicians have an obligation to be immunized against highly transmissible diseases that pose a significant medical risk for vulnerable patients or colleagues, or threaten the availability of the health care work force.

Individuals with a medical, religious or philosophical reason to not get the shot should be willing to wear face masks or refrain from direct patient care to prevent passing the illness, the AMA says.

In 2010, the Society for Healthcare Epidemiology of America recommended that the annual seasonal flu vaccine be required for initial and continued employment of all health care employees, regardless of whether they had direct patient contact. The organization reissued the recommendation in August.

Experts say such efforts have helped increase the vaccination rate among health workers in recent years. For example, during the 2006-07 season, only 44.4% were immunized against the flu, according to CDC data.

In addition, health care personnel had a higher vaccination rate during the 2010-11 season than did Americans 6 months and older (42.8%).

But experts insist that more needs to be done to boost rates to protect patients. Many say education is no longer enough.

"We've been working on this now for over a decade and seem to be stuck at a vaccine rate of around 60%," said infectious diseases expert William Schaffner, MD, chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn. "This leaves 30% to 40% of us unprotected and capable of transmitting infection to our patients. That's by far not good enough."

He said he has become a "reluctant advocate" of mandating the flu vaccine for all health care staff. "It's simply not going to work any other way."

Mandatory flu shot policy

Thirteen percent of participants in the CDC study worked at facilities where annual flu vaccination was mandatory. Among these workers, 98.1% were immunized.

Vaccine coverage was substantially less -- 58.3% -- for people who did not have an immunization mandate.

The first flu vaccine requirement for health care personnel was implemented in 2004 by the Virginia Mason Medical Center in Seattle, according to the epidemiologists' organization. Since then, facilities across the country, including Loyola University Health System in Maywood, Ill., have taken similar steps.

Loyola began requiring flu vaccination of all employees during the 2009-10 season, said Jorge Parada, MD, MPH, medical director and committee chair of Infection Control at Loyola University Health System. Before the mandate, about three in four health system employees were vaccinated. Since the requirement was implemented, the vaccine rate has climbed to about 99%, he said.

"Why should this even be considered an optional vaccine?" Dr. Parada asked. "There is ample, solid evidence to show that the vaccine is safe, protects people from getting the flu and decreases transmission" of the flu.

Infectious diseases expert Greg Poland, MD, said hospitals already require staff to have proof of immunity to an assortment of diseases, including measles, mumps and rubella. He said flu shots should be added to the mandatory list.

"It's a natural extension of the idea that you don't transmit diseases to patients that you could prevent," said Dr. Poland, a professor of medicine and infectious diseases at Mayo Clinic in Rochester, Minn.

But there are challenges involved in requiring seasonal flu vaccination, including employee resistance, because it is an annual vaccine, Dr. Poland said.

Starting in each practice

Dr. Poland encourages primary care physicians to require the immunization among employees in their practices. He suggests starting with a staff meeting to discuss the seriousness of influenza.

He said heads of the practice should serve as role models and receive the vaccine in front of staff. He encourages them to tell employees that vaccination is expected unless they have a valid medical contraindication to the immunization.

"Here we are at a point in history where we have more education and more available vaccine than at any other time in all of human history, and yet we cannot get ourselves immunized," Dr. Poland said. "It haunts me that vulnerable patients could have severe complications and even die as a result of the disease we pass on to them."