08 Oct 2018

If You Want Your Patient To Live, Get Your Flu Shot!

Influenza virus is a prolific serial killer, killing 20,000 to 80,000 people in the US every year, yet is very preventable. We can learn from the history of epidemics to see how devastating it can be. Every 3-5 years we have an epidemic of a novel influenza strain that spreads rapidly and increases the US death rate into the 50,000 to 80,000 range. Every 20 years we have a pandemic which affects a majority of the population. The most cited epidemic, because it was so deadly, was the Influenza Pandemic of 1918, now over 100 years ago. It started in a military base in Kansas, and within 9 months 600,000 Americans died and there were 20 million deaths in the world. It killed more people than World War I. There were casket shortages and mass funerals. The most recent illnesses with H1N1 Influenza starting in 2009 has also had a big impact on the population,and we are continuing to see infections many years later. Had we not had antiviral medications, it would have been just as deadly as 1918, and it still killed hundreds of thousands of people worldwide.

In those months starting in the late spring and summer of 1918, there were dozens of rumors, lies, and hysteria as the deaths piled up. It was believed that bathing in a bathtub full of onions or wearing goose grease poultices would ward away the flu. There were signs warning that spitting on sidewalks caused the deadly disease. There were many who blamed the poor, Jewish and Italian immigrants, and other countries. It was thought to have spread from Spain, hence the Spanish Flu title, but in reality the first cases were in Fort Riley, Kansas and spread from there to Europe.

And this will be your most difficult task – to combat internet misinformation and outright lying by staff members that do not want the vaccination. People will tell you they have a religious objection. They will tell you they have an allergy. They will even say they suffered from Guillain Barre syndrome. While there is not a lot you can do about someone making these claims,if you can provide more education that is the best you can do. However, if you can keep the rate of staff vaccination above 90%, it does not matter the abuse you had to endure to accomplish it, you will have saved lives.

This is because study after study shows that if you have a hospital or nursing facility with greater than 90% compliance with hospital staff vaccination, it will have a lower overall mortality. And not just by a little bit. And not just influenza or pneumonia patients. Even a heart attack patient has a lower mortality because of hospital staff members’ thoughtfulness to obtain an influenza vaccination. Let’s think about that for a few minutes. We have been searching for drug after drug that can decrease mortality from just one illness and it is elusive. However, with this one measure that we don’t even have to give the patient a single medication and their mortality already will be decreased just by stepping in the doorway of your institution. Incredible!

Now, with that said you will (and we all will) still have to fight all of the ignorance of the world. There are a myriad of reasons why people do not want to receive the influenza (and any other) vaccine. Just recently a 71 year old told me that she didn’t believe any of the “scientists’ guesses” were right. Your goal in showing that these scientific studies are right is showing the probabilities are less than 5% on any statistically significant study that it is not predicting the correct result.  If you couple this with dozens of studies there is no room for error. So let’s go through the studies.

Most studies have found that there is a 50% reduction in mortality from influenza if a patient receives a timely influenza vaccination. Not all of the studies show this, however. There are a few studies that have controlled for some confounding variables that say that influenza vaccinations may only be 5% effective at reducing mortality.  Even this modest reduction of mortality is worth the expenditure.  With the majority of studies showing a benefit, and the hospital staff vaccination study showing mortality benefit, it is hard to argue against increasing vaccination rates as a strategy.

A common attempt at misinformation, is anyone (including healthcare providers) stating that they never get the influenza vaccine and they never get the flu, as though they never get sick. However, what this does not take into account is sub-clinical illness. One study of healthcare providers found that 23% of these healthcare providers had serologic (antibody) evidence of recent influenza infection during a mild influenza season. However, of these 59% could not recall having influenza.  Taken along with the facts that persons with sub-clinical illness still shed the virus to unsuspecting contacts, this debunks this claim.

Another excuse is providers saying they received the vaccination once, and they subsequently contracted the flu. In a randomized trial of influenza vaccine among healthcare providers, 13% of placebo recipients subsequently had reported an influenza infection due to the flu vaccine.  Moreover, most everyone knows that if you receive any vaccine, there is a good likelihood of having 24 hours of fever and achiness.

One way to increase the compliance among your staff in receiving the influenza vaccine is showing them the study by Saxen H, et al who demonstrated that the vaccine decreased absence from work by 28%.  Perhaps, they don’t want to waste their precious vacation time on feeling ill.  A simple literature search will identify a multitude of studies showing decreased absence from work or school with influenza vaccination.

Over the past few years, there has been much to do regarding the low efficacy of the vaccine in preventing ILI (influenza like illness).  This is not a new finding, yearly for decades the effectiveness has been between 40-80%.  It has very little to do with matching the strain in the vaccine which is almost always accurate.  The beauty of the influenza vaccine is not in preventing illness, however the magic lies in preventing hospitalization and death, especially in the elderly and the very young or frail.  Looking beyond oneself, to others, lies the true reason to obtain an influenza vaccination every year, whether it be to protect your grandmother or your patient.  Regardless of whom it protects, get yours today!

We are only a few years away from a universal influenza vaccine, one which protects from all strains of the flu and reportedly will be more effective than the standard deactivated vaccine.  Until then, if you continue to get the present vaccine, your patients will thank you…. from home.

Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients.  The Journal of Infectious Diseases 1997; 175:1-6.

Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandoeski RA  The efficacy of influenza vaccine in elderly persons: a meta-analysis and review of the literature.  Ann Intern Med. 1995; 123: 518-527.

William F Carman, PhD, Alexander G Elder, MPH, Lesley A Wallace, PhD, Karen McAulay, BSc, Andrew Walker, PhD, Gordon D Murray, PhD, et al.  Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. VOLUME 355, ISSUE 9198, P93-97, JANUARY 08, 2000.

Talbot, TR, et al  Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel.  Infect Control Hosp Epidemiol 2010; 31(10):987-995.

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