Margaret McCartney: What use is mass flu vaccination?
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6182 (Published 20 October 2014) Cite this as: BMJ 2014;349:g6182
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
There is no question in my mind, that - regardless of the practical inability to perform an RCT to prove the epidemiological effect of mass flu vaccination - changing the current recommendation will be inexcusable. As someone who works in an ED, and every winter sees the massive number of influenza cases we are confronted with, it seems to me that we do not have to prove again that parachutes work in order to suggest, that avoiding most (even if not all) the cases that would have occured in unvaccinated individuals saves lives.
Competing interests: No competing interests
Flu vaccination is yet another evidence poor policy being used as a stick with which to beat medical staff. As with all medical interventions it has its own set of risks and side effects, all for little or no benefit. It is about time the medical establishment starting standing up to such measures.
Competing interests: No competing interests
I personally take annually flu vaccine and I have found it to be very effective at least here; in use, for a long time I have not caught a cold.
Competing interests: No competing interests
We were concerned to read Dr McCartney’s article ‘What use is mass flu vaccination?’ [1] and feel it will exacerbate the current reluctance amongst healthcare professionals to take up the flu vaccine. She has expressed doubts about the effectiveness of vaccinating healthcare professionals, directly in opposition to current government policy [2]. The majority of her conclusions appear to be based on the outcome of only a small reduction in days off work in those who receive the flu vaccine. However, it has previously been argued that utilising nonspecific outcomes, such as days off work saved, leads to an underestimation of the true vaccine effectiveness [3]. This is mainly because of the effect of controlling for other confounding factors.
Dr McCartney has correctly identified that we need more robust evidence to support the mass vaccination of healthcare workers but it is erroneous to suggest that no evidence exists. During an influenza season many healthcare professionals will become infected with influenza [4, 5] and of these many will continue to work, [4, 6] shedding the virus even before the onset of symptoms [7]. It is quite clear then, that infected healthcare professionals may transmit influenza to their patients and for those working within paediatrics or with higher risk patients, the consequences may be much more serious. A systematic review in 2013 [8] showed that vaccination of healthcare professionals can enhance patient safety. Pooled risk ratios indicated all cause mortality reduced by 29% amongst long term patients. More recently a cluster randomised trial [9] reported that vaccination of healthcare professionals was associated with reduced influenza and/or pneumonia in hospital patients.
It is always easy to suggest that we need more expensive, time consuming randomised controlled trials but decisions which may affect the safety of our patients this winter must be taken based on what is currently known. Rather than waiting, like Dr McCartney argues, for a high quality trial to conclusively demonstrate the flu vaccine is effective, healthcare workers should be doing all they can to ensure the safety of their patients. The default position should therefore be for healthcare workers to have the flu vaccination until there is strong evidence of its ineffectiveness.
References
1. McCartney, M., Margaret McCartney: What use is mass flu vaccination? Vol. 349. 2014.
2. Health, D.o., The national flu immunisation programme. Public Health England, NHS England, 28 April 2014.
3. Orenstein, E.W., et al., Methodologic issues regarding the use of three observational study designs to assess influenza vaccine effectiveness. Int J Epidemiol, 2007. 36(3): p. 623-31.
4. Elder, A.G., et al., Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. Bmj, 1996. 313(7067): p. 1241-2.
5. Wilde, J.A., et al., Effectiveness of influenza vaccine in health care professionals: a randomized trial. Jama, 1999. 281(10): p. 908-13.
6. Lester, R.T., et al., Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol, 2003. 24(11): p. 839-44.
7. Bell, D., et al., Non-pharmaceutical interventions for pandemic influenza, international measures. Emerg Infect Dis, 2006. 12(1): p. 81-7.
8. Ahmed, F., et al., Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis, 2014. 58(1): p. 50-7.
9. Riphagen-Dalhuisen, J., et al., Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on influenza vaccine coverage among hospital healthcare workers and nosocomial influenza in the Netherlands, 2009 to 2011. Euro Surveill, 2013. 18(26): p. 20512.
Competing interests: No competing interests
Pages
- « first
- ‹ previous
- 1
- 2
- 3
Re: Margaret McCartney: What use is mass flu vaccination?
It's the time of the year when patients call or ring asking whether they should have the flu vaccine or telling me that they have already had theirs (incidentally, they usually ask about the Pneumococcus vaccine as well). As long as they fall within the defined at-risk groups I raise no eyebrows or objections, although I agree with the author's critical stance on the issue. However, when asked about my own status, I tell them that I was only vaccinated in the H1N1 epidemic year. There is a lot of hype in the flu field (and also a large waste of money), which leads to high expectations of the general public with disproportionately little actual benefit. Most of these people will get their common colds anyway, regardless of flu jabs. As regards repeat vaccination in February/March, I always advise against it.
Competing interests: No competing interests