Oct 01, 2009
By Cathy Munford, RN, CIC

Should influenza vaccination be mandatory?

This is one of the questions that come up regularly for those of us responsible for vaccination programs in facilities and those of us involved with influenza outbreak management. Now as the world faces its first influenza pandemic in 40 years, the questions take on new urgency. Should health-care workers be forced to take the H1N1 vaccine once it becomes available? Will there be a rush to get this vaccine because people are scared? Will we see more of an uptake of the seasonal and the H1N1 vaccines as a result? 

I have examined the evidence for and against immunization. Before I got the flu myself, I was one of those who insisted that influenza vaccination was not necessary. The next year my husband’s grandmother, an independent 75-year-old, picked up influenza from the adult daycare she attended and died shortly after from pneumonia. Since then I have re-examined my thoughts about flu and flu vaccine.

With all the hype around “swine flu,” most people forget that the symptoms of this disease are the same as those of seasonal influenza. The only difference we’re seeing is that young people are getting sick instead of the very old. This is because the older population has been exposed to a very similar strain during the influenza outbreak of 1957 and has some residual immunity. Between 4,000 and 6,000 Canadians die each year from seasonal influenza complications. As of Sept. 11, 2009, only 74 Canadians had died of H1N1.

Annual vaccination will help prevent infection caused by the three main circulating strains of influenza seen yearly. This vaccine is 70 to 90 per cent effective in adults under 65 when closely matched to the circulating strain and 50 to 77 per cent effective when the vaccine is not a close match. Many of those who are older do not respond effectively to vaccination; however, vaccination is 90 per cent effective in preventing influenza-related hospitalizations. Yet only 40 to 50 per cent of health-care workers are vaccinated against influenza. Will these numbers change this year because of the pandemic scare? What will happen to the numbers once the new vaccine becomes available?

Nurses are in close contact with high-risk populations and with those actively infected with the influenza virus. But how are we going to be able to meet our obligation to provide safe, compassionate, competent and ethical care if we are not protected from the virus ourselves? Individuals can be contagious up to 24 hours prior to having symptoms. By not getting vaccinated, we risk harming those who are most vulnerable. I have personally witnessed health-care professionals with influenza coming to work — and working at multiple sites. What will nurses do when H1N1 starts showing up on their units? How will they cope when there is no one to replace colleagues who have to stay home?

My hope is that influenza vaccination won’t need to become mandatory and that all health-care professionals will meet their ethical obligations by deciding to protect themselves against the seasonal and pandemic strains of the virus.

Cathy Munford, RN, CIC, is an Infection Control Practitioner at the Victoria General Hospital in Victoria, British Columbia, and President of the Community and Hospital Infection Control Association – Canada.
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