Get your flu shot, or else
The Great Flu Shot Flap of 2009 rages on, with some folks steadfastly refusing to get vaccinated despite being urged constantly to do so. I guess Bill Maher melted down over it last week, and a couple of the dim bulbs of the right are also urging their lifeless audience to skip the shots.
Closer to home, a reader who works at OHSU up on Pill Hill wrote me the other day to complain that everyone who works at that fine institution is being pressured to get flu shots, even if he or she doesn't work around patients. Reportedly, every employee is being asked to sign a document stating that they have been vaccinated, or affirmatively refuse. If one refuses, apparently the requirement is to wear a mask in clinical areas of the institution. It's not clear whether the refusers will also be required to wear some sort of other identification. Perhaps a badge with a fat swine on it?
A recent e-directive reportedly sent around to managers up there explained:
Employees will be asked to complete and sign an Immunization Election/Declination Form whenever possible at the immunization site where vaccines are being given, once the period for tracking declinations is determined by the Influenza Planning Cabinet (IPC). Employee Health will collect and retain this information.The reader adds:Managers will receive regular reports indicating each of their employees' vaccination status for both seasonal and H1N1. It is each manager's responsibility to follow up with any employee for whom no form or vaccination is recorded by Employee Health and remind the employee to either get vaccinated or return the form declining vaccination. The timeline for securing completed Immunization Election/Declination Forms will be communicated as determined by the Influenza Planning Cabinet (IPC).
Employees who wish to decline vaccination may complete and sign a form and send directly to Employee Health at any time. A separate form must be signed for each type of vaccine the employee is declining.
* Immunization Election/Declination Form - Seasonal [pdf 35k]
* Immunization Election/Declination Form - H1N1 [pdf 35k]
* Vaccine Information StatementIf employee refuses to sign form declining vaccination:
1. Note refusal to sign form in the presence of a witness.
2. Advise employee that refusal to sign does not release employee from compliance with wearing a mask. Inform employee that refusing to comply will be considered insubordination and may be subject to disciplinary action, including immediate termination. Repeated failure to comply may also result in discipline, up to and including termination of employment.
3. Document Immunization Election/Declination Form as follows: "Form delivered. Employee refused to sign. Compliance expectations explained." Sign and date the form, have witness sign and date, and send to Employee Health.
I’m finding the whole thing rather panic-driven and faintly double-speak, given all of the emphasis upon HIPAA requirements... all of a sudden, they’re collecting health data on each and every employee, to which departmental managers will have access. The implication is that decliners will be "tracked"... whatever that means.I don't know. At a hospital it's probably better to be safe than sorry. And if they ever develop a vaccine against arrogance or stupidity, I'd like to see this kind of program instituted at City Hall. Get the shot or wear a gag mask.I’m frankly puzzled, and a bit alarmed, as a civil libertarian. But maybe I’m be alarmist....
I’m not a big fan of influenza vaccinations in that they tend to treat the viral source from the prior year. Viruses mutate quickly. By the time a vaccine is developed, a new virus has usually arisen. The people who benefit the most, so far as I can tell, are the pharmaceutical companies involved in developing and producing vaccines in a panic.
I don’t think *every* employee at OHSU desperately needs to be vaccinated. I think we can be a whole lot more judicious in our application of a very limited resource, especially in the case of the H1N1 vaccine… if it ever arrives in time.
Meanwhile, my big challenge, having skipped a couple of opportunities to get the ball rolling, is figuring out who's got seasonal flu shots available this week.
Comments (33)
I work at another Portland area hospital, and our policy for direct-patient-care staff is similar to OHSU's policy described above. I'm in favor of it--even if a worker doesn't care about protecting him/herself, there are a lot of others in the healthcare setting who are vulnerable.
I'm too old for the intranasal vaccine (over 49) which has been given out over the past few weeks, and am eagerly waiting for our supply of the injectible vaccine to arrive.
Posted by Kathy W | October 20, 2009 4:43 AM
More change. Brace up.
Posted by Abe | October 20, 2009 6:28 AM
I just dont see what all the panic is about. H1N1 isnt any worse than the regular flu, and the last time I had the flu, I got it from a flu shot given to me through my work. I have not had the shot OR the flu since.
Posted by Jon | October 20, 2009 6:29 AM
I just dont see what all the panic is about. H1N1 isnt any worse than the regular flu...
I completely agree. This flu has the best marketing campaign behind it in history. Better than SARS, better than Avian flu. Better than West Nile. It's truly the Summer of Sharks out there, only we're paying for this one on both ends. Big Pharma is pushing this big time. But we really don't need any sort of reform.
Posted by Chris Snethen | October 20, 2009 6:41 AM
The real scandal is that if you have insurance and/or money, you cannot get a swine flu shot anywhere. But, if you are uninsured and/or illegal, the state is giving it away for free>/a.
Posted by Garage Wine | October 20, 2009 7:18 AM
Got this from a friend. Couldn't verify, but seems to me, that one should
> be cautious when our government rushes development of new drugs.
> Do you have any info, as to whether one should get the shot, or not?
>
>
> Hi All,
>
> I sent out a serious
> warning about the Swine Flu vaccine program to all
> of you last
> night. But, in the urgency of the moment I did not have the
> time
> to properly explain the basis for my concerns (For those of you who
> might not know, I have a long research
> history and direct involvement
> in this field since the early 1970s -- so
> my speculations and concerns
> are far from "idle.").
>
> You deserve to know the details of my concerns, and why I
> have these
> concerns -- So here goes:
>
> In
> response to several follow-up questions that I have received since my
> vaccine warning letter of last evening, I have prepared some thoughts to
> further explain my position on this issue.
>
> Some
> people asked if I thought this Swine Flu problem could become a
>
> pandemic. The short answer is that I do not believe swine flu is
> going
> to create a pandemic of any significance (Remember, classification as a
> pandemic is not based on
> total numbers of patients involved -- it is
> based on total numbers of
> distinct countries which have diagnosed
> patients of any number -- large
> or small. Example, twenty countries with
> 10-15 patients each =
> pandemic!).
>
> My concern about the vaccine is
> twofold: First, it was "fast-tracked" into
> production (always dangerous
> in the field of vaccinology) with a virus
> strain known to be associated
> with potentially long-lasting neurological
> side effects (In 1976, a similar vaccine caused tens of thousands of
> adult
> patients to contract a debilitating neurological disease
> {Guillain-Barre'
> Syndrome} that changed their lives
> forever!).
>
> Second, it is being focused for priority use in young
> children and pregnant
> mothers -- populations far more vulnerable to
> potential adverse reactions
> than mature adults. Using this in pregnant women is particularly alarming
> to
> me, since there is no knowledge, or data, about what could happen to
> the
> developing fetus of pregnant mothers receiving this vaccine.
> Without
> such information, I find the uncontrolled administration of a
> "new" vaccine
> to pregnant women unconscionable! That lack of
> information is precisely
> what led to the Thalidomide catastrophe back in
> the early 1960s! In the
> worst case scenario, I think that we may
> be facing another potential
> Thalidomide disaster by administering
> this particular vaccine to pregnant
> women -- and we will only
> realize that outcome too late!
>
> The real
> danger of a swine flu infection is failing to recognize its presence
>
> early enough. However, because of the widespread public knowledge
> and
> concern about this infection, I would bet that early recognition
> (even
> over- and/or - misdiagnosis) will be the "rule."
>
> It is also important to remember that the severity and
> deaths in flu-infected
> patients is caused by the secondary bacterial
> pneumonia that the virus
> initiates -- so early diagnosis and early
> initiation of proper antibiotic
> therapy to control the pneumonia
> should minimize the impact of this
> infection on affected patients (young
> or old).
>
> Given the choice, I would opt for
> dealing with the flu -- rather than risking
> the potential dangers of the
> vaccine reactions (for which little or nothing
> can be done)!
>
> Simply put, the risk of vaccine-related adverse events far
> outweighs the
> benefit of being vaccinated -- especially since a
> flu-infected patient can
> be easily managed with proper, and judicious
> medical care!
>
> A deformed offspring has a
> totally different, and unfathomable, manage-
> ment problem -- for a
> lifetime!
>
> And since no one knows if, or to what
> extent, this may happen -- the risk
> should be totally
> avoided!
>
> That is what I pledged to follow when
> I took my Hippocratic Oath when I
> graduated Medical School in
> 1968.
>
> I hope this helps to add clarity to my
> concerns. I am happy to provide
> you with any additional thoughts
> about this situation if you so wish.
>
> David
Posted by phil | October 20, 2009 8:03 AM
I can see vaccines and inoculations for those most prone, but this thing is in a panic mode.
Vaccinations should be on an as-needed basis and having govt officials decide for us is troublesome. If you vaccinate everyone, it will allow the resistant strains to flourish even more a la MRSA and giving everyone antibiotics.
Posted by Steve | October 20, 2009 8:09 AM
I have juvenile diabetes and if I get the flu I go to the hospital. It is serious to me. I think it perhaps selfish for people around me to come to work not feeling well or to not get a flu shot.
Also, H1N1 is more serious than the usual flu because it does kill very healthy kids and teens via cytokine storms. People with very strong immune systems can over react to this virus causing damage to their lungs, which in turn makes a good environment for bacterial pneumonia. And that is what kills them.
Posted by RW | October 20, 2009 8:28 AM
John, you cannot get the flu from a flu shot. The viruses in a flu shot are "killed viruses."
http://www.cdc.gov/FLU/protect/keyfacts.htm
Posted by Gordon | October 20, 2009 9:38 AM
So why isn't Bill Maher a "dim bulb" too?
Posted by Mike (the other one) | October 20, 2009 9:46 AM
It's the lemmings on the left, Jack.
here's the dim bulbs on the right:
http://rawstory.com/news/afp/Lawsuit_seeks_to_halt_US_swine_flu__10152009.html
Posted by Lawrence | October 20, 2009 9:47 AM
DEQ forces their way into our cars. The Feds require difficult childproof caps even if our only child has died. The TSA presumes to search and remove seemingly benign objects from out luggage without letting us see what they are doing. But at least we can choose to get the flu shots.
Anecdotes: An intelligent acquaintance mention to me her concern about science and the rumored (wrongly) connection between vaccines and autism.
A dancing acquaintance, an ER doc, said she was seeing mostly flu patients.
I've had my seasonal flu shot and will get the H1N1 when it's available to me. And I'm glad my responsibility, my choice.
Posted by Don | October 20, 2009 10:06 AM
John, you cannot get the flu from a flu shot. The viruses in a flu shot are "killed viruses."
They are now. That happened about 15 years ago.
Posted by Jon | October 20, 2009 10:13 AM
Vaccinations should be on an as-needed basis [...] If you vaccinate everyone, it will allow the resistant strains to flourish
Vaccination is not the same thing as medication. I know this may sound obvious, but I want to be sure you're not confusing the two because it sounds like you may be.
As-needed distribution of vaccinations is exactly what's going on right now. It probably doesn't look that way, though; that's largely because the vaccine does absolutely no good for someone who is already sick. In fact it takes up to two weeks for the immunity to take effect. (You could get the shot today and still catch the flu later this week.) That means it's currently healthy people getting the vaccine.
What they're trying to do is get a strong "herd" immunity in place among people who are in a high risk of being in contact with the disease or in contact with people who can be most harmed by the disease. Healthcare workers have been among the first to receive the vaccine because they are very likely to come in contact with the virus *and* are very likely to come in contact with people at the highest risk for adverse effects. I dunno about OHSU in particular, but in general a vaccine-or-mask policy is much less to protect the healthcare workers than it is to protect the patients.
The resistance issue is a good one to consider; we have really shot ourselves in the foot with the proliferation of antibacterial products. That said, it's not really an issue with flu vaccinations. There's basically no difference between the immune response provoked by the vaccine and the one provoked by getting sick... except you don't get sick. The flu is constantly changing anyway in response to our natural immune changes, and adding vaccines into the mix makes little to no difference.
(Antiviral medications - like Tamiflu for instance - may foster resistant strains, so minimizing its use is probably a good idea. How do you minimize it's use? Don't get really sick with the flu. In other words, get vaccinated!)
Anyway.
As for the article itself, it sure seems to me like they have a serious HIPAA problem going on there. Vaccination status is protected health information, I think, and one's supervisor at work is not entitled to the information due to "treatment" or "payment". Maybe it's okay under the "healthcare operations" exception, but that strikes me as a bit dubious.
Posted by Alan DeWitt | October 20, 2009 10:27 AM
"you cannot get the flu from a flu shot"
Sure you can - If you get a H1N1 shot formulated this spring and H1N1 mutates you can catch that regardless of getting the shot.
I know not exactly catching it from a flu shot, but they aren't silver bullets either.
Posted by Steve | October 20, 2009 10:27 AM
No, some are greatly weakened live viruses:
“An official at a large hospital in Maryland said none of its staff would be given the nasal spray vaccine because it is made with live virus, which, although greatly weakened, was feared could pose a risk to patients.”
http://www.google.com/hostednews/afp/article/ALeqM5gaiyT3ss0NGtXHvqrDl5xE-6nMmQ
Posted by Lawrence | October 20, 2009 10:33 AM
I just dont see what all the panic is about. H1N1 isnt any worse than the regular flu
My 4 year-old son had H1N1 two weeks ago -- at least, that's what the pediatrician said it almost certainly was, since they aren't seeing ANY seasonal flu at this point. It was bad, three days of fever between 104-105, five total days of lying on the couch feeling miserable. He recovered and is fine, but I would have loved to avoid that with a simple shot.
The point our pediatrician made is that with regular flu, 1 out of every 10 people exposed to the virus develops the flu. With H1N1, 3 out of every 10 get it, since immunity in the overall population is so much lower. Even if H1N1 is less serious than other flu, with three times as many people getting it, there are going to be lots and lots of deaths. If seasonal flu also strikes, you could have the "normal" 30,000 flu deaths, plus another 60,000 - 90,000 from H1N1. Even if H1N1 vaccine only reduces those deaths by 10%, that's 6,000 - 9,000 lives saved. I don't understand the cost/benefit analysis that suggests those people aren't worth saving.
For the record, I'm not a huge vaccine proponent. One of the major reasons we have gone from 10 shots for kids in the 1970s to over 30 shots today is the greed of the pharmaceutical companies and their collusion with the medical establishment. We spaced our kids vaccines out over a longer period of time because of the concern about overwhelming their immune systems. But sometimes there are public health things that we need to take seriously, and H1N1 is a good example.
Posted by AJS | October 20, 2009 10:40 AM
Don't want public-health-related requirements put on your job? Don't work in a hospital.
Freakin' babies.
Posted by Snards | October 20, 2009 11:24 AM
"It's the lemmings on the left, Jack.
here's the dim bulbs on the right":
Here I am...stuck in the middle with you.
Posted by PDXileinOmaha | October 20, 2009 12:51 PM
As a long term worker in health care, I'd like to eructate my observations and options.
1.To guess what next years flue will be, and develop a vaccine for that is an inexact science and has failed in the past.
2. In my 30 plus years of experience, the flu comes every year and the old, the very young, and those compromised by disease, will succumb.
3. I do not know of any deaths from simply the flu. It is always the primary chronic disease or or the secondary bacterial infections the kill.
4. Frequently we have to be educated on a new disease, not that it has not occurred before, but because they have formulated a drug that will, more often then not, treat this condition.
5. As commented by other posters, creating immunity from a couple conditions allow those not covered more latitude. This is found when we aggressively kill bacteria, so then the fungus will invade the patients mouth and crotch. It is happening with the flu in Canada. http://www.theglobeandmail.com/news/technology/science/study-prompts-provinces-to-rethink-flu-plan/article1303330/
6. This year the perfect storm has arrived. Journalism is desperately chasing every drifting balloon of a story. The viral folks have realized: To be payed you have to play! So we now have Bird flu and Swine Flu and next year someone will vomit a British desert and an Obama like epiphany will be the salvation for all: The Spotted Dick Flu has arrived!
Posted by dman | October 20, 2009 1:13 PM
It's been much easier to get into the supermarket since they installed those hand sanitizing stations near the shopping carts. While everybody else is crowded around the dispenser wiping everything in sight, I just walk in and start shopping. I can avoid rubbing my eyes and touching my face until I visit a bathroom, or visit the cleansing station AFTERWARD.
Get rid of ALL microbes, germs, etc. and, after a certain point, your sabotage your own natural immunity.
I get a kick out of the fact that the media is now identifying this thing almost exclusively as "H1N1" - a moniker more ominous than "Swine Flu" and less likely to offend the pork industry.
Notice that nobody ever explains what "H1N1" means? Will probably eventually figure it out . . . like coy pharmaceutical references to "ED."
Posted by NW Portlander | October 20, 2009 1:57 PM
NW Portlander: Wikipedia to the rescue. Short answer, it's a technical description of the antibody response to the virus shell.
And to amplify what AJS said, I know some pediatric folks. They have said that in the mid-valley, the normal seasonal flu has yet to be seen; every confirmed flu case so far is H1N1.
Posted by Alan DeWitt | October 20, 2009 9:20 PM
I've been looking for the estimated number of deaths which are estimated to be associated with influenza this winter.
The figure I found was approximately 90,000...for all influenzas.
Now, that's an interesting figure considering that it includes the "pandemic" sources.
It's interesting because the National Institute of Medicine study released in 2000 (To Err Is Human) indicated that there are 100,000 to 200,000 deaths a year attributable to iatrogenesis (disease caused by the caregivers, also called 'medical mistakes'). A follow-up study released this year notes that in the ten intervening years, not much has been done to address the problem and the extent of the morbidity and mortality associated with it has not changed.
So...That's 100K to 200K EVERY YEAR. Where is the panic to protect us from doctors, hospitals, and health care workers killing patients?
Posted by godfry | October 20, 2009 9:30 PM
.
H1N1 Vaccine Protest Planned At CDC Headquarters, Posted by Jane Akre, October 19, 2009
Posted by Tenskwatawa | October 20, 2009 11:16 PM
Wayne Madsen Report .COM (so-called 'WMR') is compiling H1N1 news developments all year, and adding original investigative reporting. Wayne's main 'hook', or reporting angle, is the man-made origins of the ('weaponized') virus, by whom, where, when, and always Why? (Almost always: political power.)
He is less concerned with the medical info about H1N1. (Or rather, his info is more speculative -- one news clipping forecast 50,000 H1N1 deaths in California alone.) But in Comment Blogs (at WMR .COM), a trove of impressive info -- 'intelligence' central, really -- readers can discover bookfuls of medical advice ... to pick and choose among, to adopt or ignore, according to personal taste and trust (of the info source). So, I am ingesting a qtr-teaspoon of Tumeric (in milk or water) daily as my choice of H1N1 prevention regimen. So far, so good.
Here is Madsen's most recent re-cap of the H1N1 story as he has developed it. He refers to his earlier reports, available archived. He puts daily worldwide H1N1 news clippings on the WMR front page, freely accessible; (but in rapid rotation, posted one day and gone the next).
Here's the (voucher) link of the following 're-cap' report but subscription (cheap) is required to click through, so I'll quote at length for a general readership.
www.waynemadsenreport.com/articles/20091004_1?
I suppose, then, each of us may have individual priorities for concerns -- whether to focus our own attention, (and money, or insured coverage) on cause, prevention, or treatment/cure.
Posted by Tenskwatawa | October 21, 2009 12:23 AM
It's funny you mention Tumeric, Tensky. I have a "two-day" pot roast on right now, slow cooked at very low heat in the crockpot for ages until the meat is just falling right off your fork. It's in kind of a weird curry-type sauce I like, that you wouldn't think would work on a roast, but it's really good:
Brown mushrooms, a whole red onion, red bell pepper, Poblano pepper, sun dried tomatoes, fresh tomatoes from the garden, garlic, Tarragon, Turkish bay leaves, green beans, red wine, a little yellow mustard, brown sugar, smoked Paprika, and loads...LOADS...of Tumeric. Gotta have the Tumeric.
I don't know if all that Tumeric really helps prevent the flu or not, but it sure tastes good.
Posted by Cabbie | October 21, 2009 2:15 AM
"... a "two-day" pot roast."
Oh, cabbie, babybabybaby, my kinda meal. So, y'know, I'll bring the all-you-can-drink beer ... where?
P.S. and you're still wrong saying inhumankind has NOT caused climate crisis, and humankind does NOT need to repair it. (You did say that, didn't you? 'Good' conversation starter could be film-worthy for, like, 'My Dinner With Cabbie.')
Posted by Tenskwatawa | October 21, 2009 11:59 AM
So...That's 100K to 200K EVERY YEAR. Where is the panic to protect us from doctors, hospitals, and health care workers killing patients?
I wonder if that will be addressed once we are all getting care from Uncle Sam?
Or will we have lawsuit limits like Oregon does with OHSU?
Posted by Jon | October 21, 2009 12:16 PM
Or will we have lawsuit limits like Oregon does with OHSU
I believe those were tossed out via litigation a couple of years ago.
Posted by Marti | October 21, 2009 12:31 PM
Re. the number of flu cases contracted . . . I find it hard to believe anything I hear anymore. Yesterday evening some health industry talking head on PBS actually said that, "millions of Americans have already contracted H1N1 and recovered within a week of two." It might even have been "tens of millions," I don't remember exactly except that whatever number he threw out didn't even remotely resemble anything else I'd heard.
There was also something about the younger group at "greatest risk". Of the percentage who died, 2/3 had other conditions that predisposed them and the remainder were unexplained.
While the smaller, latter group is a source of alarm, I'm not sure I see any significant increase in American deaths in general attributed to H1N1 than of any other seasonal flu.
IMO people are freaked out because H1N1 is a descendent of the 1918 flu and big pharma, the government and the media are hyping the hail out of something that hasn't yet satisfied the definition of a true pandemic.
Posted by NW Portlander | October 21, 2009 2:38 PM
I believe those were tossed out via litigation a couple of years ago.
The most recent legislature restored them, with new, higher liability limits that stand a good chance of surviving further challenge in court.
Posted by Jack Bog | October 21, 2009 6:25 PM
... uh, cabbie, it's tuRmeric.
Posted by Tenskwatawa | October 22, 2009 3:47 PM
NW Portlander-
Actually, H1N1 *does* meet the definition of pandemic. Check the following from the WHO website:
We're in stage 6.
Posted by Alan DeWitt | October 22, 2009 7:36 PM