Health staff are more likely to question effectiveness of the flu vaccineBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k284 (Published 25 January 2018) Cite this as: BMJ 2018;360:k284
All rapid responses
Jason Wilson asks why it is "surprising that some staff dig in their heels" when it comes to getting vaccinated against influenza.
The answer is that they are often subjected to inaccurate data and disinformation about flu that pervades all forms of media, and this includes correspondence to the BMJ like Dr Wilson's. It is rather unfortunate that his letter was published in the print edition of the journal which gives it wider exposure than warranted.
Wilson claims that "effectiveness of the flu vaccine is only 10% in Australia this season". That is incorrect. That was the effectiveness against one strain only, Influenza A (H3N2). The overall effectiveness of vaccine was determined to be 33% (not great, I will agree, but much better than nothing). Against influenza B the vaccine was 57% effective (1). This is relevant, because Influenza B is the prevalent strain that has been seen in the UK this winter, and hence vaccination with quadrivalent influenza vaccine which covers type B strains should provide fairly good clinical protection.
Wilson states the vaccine has "harms related to absenteeism" in 1% to 10% of recipients. However, his referenced source for this claim does not seem to verify this, and I sincerely doubt that there is up to 10% absenteeism among HCWs following vaccination. In Blackpool at the time of the pandemic H1N1 swine flu outbreak, in conjunction with Occupational Health I conducted a survey among vaccine recipients which showed that less than 1% had needed to take time off following their immunisation (and the Pandemrix vaccine had a higher side effect profile than the seasonal flu vaccine did).
Also cited by Wilson is the Cochrane review which indicated that residents in longterm institutional care did not gain significant protection via staff vaccination. However, this scenario is different to that which applies in the acute hospital care, where the susceptibility and casemix of clinically ill patients is quite different. The Cochrane review is not the only systematic review on the topic; one recent appraisal of other sytematic reviews indicated that there may be a protective effect for patients, albeit modest (2). The benefits for staff are less controversial. If vaccine is 60% effective (as may nearly be the case with Influenza B this season), the number of staff needed to vaccinate to prevent one case of influenza in a normal season is estimated to be 40. This winter, with flu much more prevalent than in other seasons, the NNV might even be lower.
Given that misconceptions among health care staff about influenza vaccination are so rife, it is imperative that accurate and up to date information is given to them in a format that can address their possible questions about the benefits and risks of flu vaccination. It would be helpful for this information to be provided to HCWs via their occupational health departments as part of the annual "flu vaccine" drive within hospitals and healthcare organisations.
Competing interests: No competing interests