Resisting the needle: why I won’t have the flu jab

In a recent article, Kinesh Patel wrote that he will refuse to be
vaccinated against influenza.(1) He feels the notion that he should be
vaccinated to protect his patients represents an infringement on his
personal liberty. One wonders if he feels the same way about handwashing.
After all, they are his hands, so his liberty is at stake, and both
techniques serve a similar function: To reduce the risk of infecting
patients with the germs one carries.

He offers the specious argument that "...the chance of a healthy
person dying from influenza was about four in a million last year,"
ignoring the obvious fact that hospitalized patients are not healthy
persons. Hospitalized patients are at far greater risk of influenza-
related morbidity and mortality(2) because there is so much overlap
between the hospitalized population and those at highest risk of influenza
-related complications, i.e.:

"* all children aged 6 months--4 years (59 months);

* all persons aged >50 years;

* children and adolescents (aged 6 months--18 years) who are
receiving long-term aspirin therapy and who might be at risk for
experiencing Reye syndrome after influenza virus infection;

* women who will be pregnant during the influenza season;

* adults and children who have chronic pulmonary (including asthma),
cardiovascular (except hypertension), renal, hepatic, hematological, or
metabolic disorders (including diabetes mellitus);

* adults and children who have immunosuppression (including
immunosuppression caused by medications or by HIV);

* adults and children who have any condition (e.g., cognitive
dysfunction, spinal cord injuries, seizure disorders, or other
neuromuscular disorders) that can compromise respiratory function or the
handling of respiratory secretions or that can increase the risk for
aspiration; and

* residents of nursing homes and other chronic-care facilities." (3)

As a result, nosocomial influenza outbreaks in the hospital setting
can have very high attack rates, and very high case-fatality rates.(2)

Increased vaccination uptake among hospital workers appears to lower
the risk to patients,(4) but a report by the Department of Health
concluded that only 34.7% of all frontline healthcare workers in NHS
England (and 37% of non-GP doctors like Dr. Patel) were vaccinated during
the 2010/11 flu season.(5)

"How bad," Dr. Patel asks, "can man flu be?" For your patients,
quite bad indeed. Your ward could see an attack rate of 30% and a case-
fatality rate of 67%.(2,6) For their sake, Doctor, please reconsider.

References

1. Patel K. Resisting the needle: why I won't have the flu jab. BMJ.
2011 Oct 17;343(oct17 2):d6554-d6554.

2. Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute
hospital setting. The Lancet Infectious Diseases. 2002 Mar;2(3):145-55.

3. Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, et
al. Prevention and Control of Influenza: Recommendations of the Advisory
Committee on Immunization Practices (ACIP), 2008. MMWR. 2008;57(RR07):1-
60.

4. Salgado CD, Giannetta ET, Hayden FG, Farr BM. Preventing
nosocomial influenza by improving the vaccine acceptance rate of
clinicians. Infection Control and Hospital Epidemiology. 2004
Nov;25(11):923-8.

5. Sheridan A, Begum F, Pebody R. Seasonal influenza vaccine uptake
amongst frontline healthcare workers (HCWs) in England - Winter season
2010/11. London: 2011.

6. Kapila R, Lintz DI, Tecson FT, Ziskin L, Louria DB. A Nosocomial
Outbreak of Influenza A. Chest. 1977 Dec;71(5):576-597.