Should the H1N1 flu vaccine be mandatory for all health care workers?

[brentoli]

5. Had many of us taken the same opinion on smallpox or polio vaccines, it would never had been irradicated, and we would still be dealing with it.

I am still undecided, and the vaccine hasn't been offered to me yet. But this point is where I take exception... We are not eliminating any flu virus, and it can be argued, that we aren't doing much to slow the spread. If this was a mandatory shot, the numbers today indicate it would be mid-december before we could vaccinate a large sample of people in the USA. Thats roughly 8+ weeks of transferring this virus person to person. Something is to be said for vaccines that do their part in eliminating a virus from the world, but this doesn't do it. I suppose when the time comes to put my name on a list is when I will decide.

[VentMedic]

http://www.1010wins.com/NY-Officials-Rescind-Mandatory-H1N1-Flu-Shot-Order/5502143

New York Officials Rescind Mandatory Flu Shot Order

ALBANY, N.Y. (AP/ 1010 WINS) -- New York state health officials have suspended a ruling that would have forced health care workers across the state to get vaccinated against the swine flu by the end of November or risk losing their jobs, saying in a decision issued Thursday that they did so because the vaccine is in short supply.

1010 WINS Swine Flu Resource Center

New York will be getting only about 23 percent of its anticipated supply of the vaccine for the swine flu virus -- also called H1N1 -- by the end of the month, and that should be reserved for those most at risk for serious illness and death, according to Gov. David Paterson's office.

"New evidence is showing that H1N1 can be especially virulent to pregnant women and young people -- so they should get vaccinated first,'' said Dr. Richard Daines, the state health commissioner.

Workers had protested Daines' earlier order that health care workers receive the vaccine, arguing it was unfair to force them to put a substance into their body. Unions and health workers sued the state, and a judge issued a temporary restraining order last week.

"This is welcome news,'' said Carl Korn, a spokesman for the New York State United Teachers union. "This suit was never about the safety of the vaccine, or the merits of it. The suit was always about giving individuals the choice, as adults, as to whether or not they wanted to be vaccinated without the threat of termination.''

It's unclear what will happen with the lawsuits. Thursday's action was a suspension of the order, and the Health Department plans to pursue making the order permanent in 2010, as long as there's enough vaccine for that flu season, said Diane Mathis, an agency spokeswoman.

The Health Department initially had said the workers must be vaccinated by November 30. Institutions had to determine how to enforce the mandate, leaving some workers concerned about possible disciplinary action, including dismissal.

"This was the proper and appropriate action for the state to take,'' said Kenneth Brynien, president of the Public Employees Federation, one of the unions that sued. ``This was an extremely passionate issue for many of our members.''

PEF said it encourages members to get flu vaccinations, but opposes the emergency regulation requiring the vaccine as a condition of employment.

This week the Centers for Disease Control and Prevention allowed the state to order 146,300 doses of vaccine, but health care providers across the state have requested more than 1.4 million doses.

[Richard B the EMT]

Can someone list all ingredients of the vaccine?

What the heck, I can't even list the ingredients in the "Special Sauce" of a Micky D's Big Mac burger, and I worked at a Micky D's in 1970.

On a more serious note, I am going to work 4 days of double tours on one of the FDNY EMS Major Incident Response Vehicles (MIRVs) as a part of "BioPOD 2009". That translates to Biological Points Of Distribution, usually a drill to do mass vaccinations against a manufactured "bug" set loose against the people of New York City, taking care of the EMTs, Paramedics, and Fire Fighters. The theory is, if we remain healthy by getting innoculated against the bug, we can continue taking care of the rest of the city and it's visitors.

OK, normally, it's just a test to see if we could get to all the FDNY members, and they had, in past years, offered the regular flu shot to any members who wanted it.

This year, instead of just being a one day, 20 hour session, it's going to be 16 hours a day, for 4 days running. This covers all tours and work schedules.

[tniuqs]

Though I don't think the immunization should be mandatory, I will be getting mine, as will my family.

Mandatory no, and why because Darwin will always win.

Ok first off I am rather astounded that the EMS general misunderstanding of infectious disease control is so lame, let alone just what H1N1 really is ... H1N1 is NOT a stomach flu (one can have GI upset as some of the symptoms) its a respiratory tract viral infection and latest stats today were 1000 dead out of the US, Quebec has started vaccinating HCP today because of an resurgence in one school. Question is have we not progressed just a bit since SARS (didnt see that comming did we) and as ERDoc states I too will be standing in line my kids first ahead of me and then I will volunteer to assist in inoculations. I did not blink an eye with Hep B, Hep A, Polio, Diphtheria, Typhoid, +++ and take antimalarials when travelling, had to take Rifampin being exposed to an active case of TB, and funny thing I am still breathing.

Here is the latest info from Health Canada and forget the CNN or newspaper hype because thats what it is simply stated, add to this informative educational conversation, it will answer the difference between an adjuvanted and non-adjuvanted vaccine.

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/faq_rg_h1n1-eng.php

But lets put this in a different light just for comparisons sake shall we ? Monsanto chemical corporation introduces hybridized canola seed that can withstand much higher concentrations of "round up" a defoliant, then we crush the seed's that before humans ever even tried eating, those crops, then we hydrolyse the vegetable protein so it spreads on bread when cold (yummy) our beef is injected with antibiotics, BGH injected into cattle to increase milk production, our chicken is treated with tetracyclines, we drink aspartame because its less expensive to produce than sugar (and marketing) btw Phenylalanine makes up 50% of aspartame (I will spare you gory details) we eat processed anything deep fried in trans fat crap, not to mention the myriad of "preservatives" in bread alone.

And no word of a mention what is in Rotten Ronnie's special sauce ... sorry spenac.

But you asked ...... http://www.hc-sc.gc.ca/dhp-mps/prodpharma/legislation/interimorders-arretesurgence/prodinfo-vaccin-eng.php

Arepanrix™ H1N1 (AS03-adjuvanted H1N1 pandemic influenza vaccine) is a two-component vaccine consisting of an H1N1 immunizing antigen (as a suspension), and an AS03 adjuvant (as an oil-in-water emulsion).

The H1N1 antigen is a sterile, colorless to slightly opalescent suspension that may sediment slightly in a 10mL vial. The antigen is prepared from virus grown in the allantoic cavity of embryonated hen's eggs. The virus is inactivated with ultraviolet light treatment followed by formaldehyde treatment, purified by centrifugation and disrupted with sodium deoxycholate.

The AS03 adjuvant system is a sterile, homogenized, whitish emulsion composed of DL-α-tocopherol, squalene and polysorbate 80 in a 3mL vial.

Immediately prior to use, the full contents of the AS03 vial is withdrawn and added to the antigen vial (mix ratio 1:1). The mixed final product for administration is an emulsion, containing enough product for 10 doses.

2.0 Qualitative and Quantitative Composition

After combining and mixing the two components, 0.5mL of the resultant emulsion is withdrawn into a syringe for intramuscular injection. The final composition of each vaccine component per 0.5mL dose is as follows:

Antigen:

Split influenza virus, inactivated, containing antigen* equivalent to:

A/California/7/2009 (H1N1)v-like strain (X-179A) 3.75µg HA** per 0.5mL dose

* isolated from virus propagated in eggs

** HA = haemagglutinin

Preservative content is 5µg Thimerosal USP per 0.5mL dose or 2.5 micrograms organic mercury (Hg) per 0.5mL dose

Adjuvant:

DL-α-tocopherol 11.86 milligrams/0.5mL dose

Squalene 10.69 milligrams/0.5mL dose,

Polysorbate 80 4.86 milligrams/0.5mL dose

The suspension and emulsion vials, once mixed, form a multidose vaccine in a vial. See section Nature and Contents of Container for the number of doses per

Theres more Vitamin E and Polysorbate in a bag of potato chips.

And we are worried about a very well researched vaccination, I thought we are supposedly professional health care providers and directly in the line of fire to help out to stamp out disease and pestulance ? Well just me, but I will happily take my extremely skinny risk assessment and if it kills me well then at least I will make a good statistic for the next Spanish flu, because its just a matter of time before that associated mutant form of that will raise its very ugly head.

Oh in addition in an unmentioned 3rd world country as a control they killed all the pigs (a country that does not eat them) to find a resurgence of Bubonic Plague, because the Pigs were eating garbage but now the rats took over ... ah the black death over an influenza ... clever bunch their too.

cheers

Edited October 25, 2009 by tniuqs

[ERDoc]

I can't find the link, but a person with the CDC said that if the H1N1 had started about a month earlier, it would have been included in this year's seasonal flu vaccine and no one would have known any better. Because we are suddenly developing this "new" drug people are up in arms.

I hate to say it, but Crotchity was right. We've been doing this flu vaccine for years and have it down pretty well. Some years we miss the boat and then we have the abberancy seen in the 70s. Let's think of this another way. The rate of a reaction such as Guillanne-Barre is 1-2 per million. Let's say we vaccinate every American, which is currently about 307 million people. So we expect to see 307-614 GBS like reactions. This is a 0.000001% chance of having an adverse event. In a normal flu season, approximately 36,000 people die from flu-related causes (from CDC website). So, in an average year you have a 0.0001% chance of dying from the flu (this does not include other serious problmes such as pneumonia, organ system failure, need for intubation, etc). In an average flu season, you are 100 times more likely to die from the flu than you are to have a GBS like reaction to the vaccine.

Another eye opener is the mortality associated with the flu this year. The following is a list of the number of deaths in children due to the flu in a given flu season (CDC website):

2004-2005 47 deaths

2005-2006 46 deaths

2006-2007 76 deaths

2007-2008 83 deaths

I don't have the data for 2008-2009. So far, this year there have been 95 pediatric deaths and we haven't even hit the usual start of the flu season. I'm not trying to preach, just lay out the facts and show why I have chosen to get the vaccine for me and my kids. I'm not the doomsday, end-of-the-world kind of person, but this scares the hell out of me, especially since it deals with the health and safety of my kids.

As someone else said, the "stomach flu" is not the flu. It is just a virus that causes GI symptoms and is not related to the influenza virus. Flu shots will not stop the stomach flu.

I do have a problem with making the vaccine mandatory. But, I'll leave you all with a question to consider. Let's say we cannot make the vaccine mandatory. Do health care facilities/ambulance services have to right to tell you not to come to work? I'm not talking about firing you, but saying, "You have the right to refuse the vaccine, but we have the right to protect our patients and do not want anyone who has not been vaccinated working in a patient care postion."

[crotchitymedic1986]

Have not looked at it from that perspective doc, but I have to agree with you about making the employee stay home, but the problem is that you can be an asymptomatic carrier for two weeks. The good news is that I think most of us will be just that, the asymptomatic carrier; the bad news is that we will most likely be the carrier that takes it home to our families.

[tniuqs]

Have not looked at it from that perspective doc, but I have to agree with you about making the employee stay home, but the problem is that you can be an asymptomatic carrier for two weeks. The good news is that I think most of us will be just that, the asymptomatic carrier; the bad news is that we will most likely be the carrier that takes it home to our families.

Not trying to thread jack just FYI with other "shady" vaccines yes stats are great, but just me but I like to boil things down a bit, have watched a few children / adolesent die and it becomes much more personal.

We are observing a resurgence of Bordetella pertussis and directly due to non compliant patients in now TB resistant strains ie Mycobacterium tuberculosis is the primary causative bacterium although other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti are also causes.

This in a demographic population that believe that this is a rights issue .... so to be politically correct I will leave that group blank, I just call them stoopid.

So big question to ME is why do I as a HCW expose myself when others under a supposed "rights issues" and chose to ignore evidence based medical advice, hey I have rights too and I didn't sign off when I put on a uniform, should we not have the right to refuse based on unsafe work hazard ... just for debates sake ....

Before a vaccine against pertussis was available, pertussis (whooping cough) was a major cause of childhood illness and death in the United States. From 1940-1945, over one million cases of pertussis were reported.With the introduction of a vaccine in the late 1940s, the number of reported pertussis cases in the U.S. declined from approximately 200,000 a year in the pre-vaccine era to a low of 1,010 cases in 1976.

While kinda on that topic ..... the Meningococcal vaccine http://www.vaccineinformation.org/menin/photos.asp

ps put the Big Mac down before you check this link .... just saying.

Meningococcal diseases are caused by a germ (a kind of bacteria) called meningococcus. This germ can cause two serious diseases: meningitis, an infection of the fluid and lining that cover the brain and spinal cord, and septicemia, a serious blood infection. You can protect your children from these diseases with a vaccine.There are two kinds of meningococcal vaccine available in Canada and each provides different protection:

One is more effective in babies and young children. It only protects against one type of the meningococcus germ (type C). In Canada, the vaccine is available under these brand names: Menjugate (Novartis), NeisVac-C (GlaxoSmithKline) and Meningitec (Wyeth).

Another vaccine is called MCV4 and helps protect children 2 years and older against all 4 preventable types of the meningococcal germ called: Menactra (sanofi Pasteur). Your doctor may offer this vaccine to your child to reduce the chance of her getting meningococcal infection from the 3 groups not already covered. This vaccine is recommended for people at higher risk of getting meningococcal infection. It is not covered by all provincial or territorial health plans.

Your doctor will know which vaccine is best for your child.

The Canadian Paediatric Society and the National Advisory Committee on Immunization recommend that all babies and young children get the vaccine to protect them against type C meningococcus.

How common is meningococcal disease?

In Canada, there are about 200 cases of meningococcal disease every year.

The germs that cause the most infections are known as group B. Group C, W135 and Y cause the rest.

Since 1989, there have been outbreaks of group C disease among teenagers in many parts of Canada. These outbreaks usually happen in one or two schools in an area and result in less than 5 cases. How serious are these diseases? Without treatment, all children who get meningitis will die or suffer damage that lasts the rest of their lives. Even with treatment, about 1 in 20 children will die. About 1 in 20 children who survive meningitis will have brain damage. Septicemia can kill very quickly. Even with treatment, about 1 in 4 children with meningococcal septicemia will die or have permanent damage. How do meningococcal diseases spread?

The germs that cause meningococcal diseases are quite common. They live in the back of the nose and throat of about 1 in 5 teenagers and adults without causing any sickness. These people are called “healthy carriers.”

The germs are not very strong. They die quickly outside the body.

The germs are spread mostly by healthy carriers, and not by people who are clearly sick with the disease.

For the disease to spread, people must have close, direct contact such family members living in the same house or others with similar close contact.

The germs can also be spread through saliva when people share things such as cigarettes, lipstick, food or drinks, cups, water bottles, cans, drinking straws, toothbrushes, toys, mouth guards and musical instruments with mouthpieces.

Smoking and overcrowding increase the risk that the germs will spread.

If someone has meningococcal disease, doctors will often give antibiotics to their family members or people who come into close contact. This can stop the germs from spreading.

[medic5880]

Well... there seems to be a very active rumor out there...

there has been a push to make influenza vaccine many times in the past many years due to suddent drifts or shifts in the virus. This vaccine was made in the same way as the others in the past - a single 10 day old hen egg inocculated with the virus. The process has not changed in many years so I dont understand where all the hype is coming from.

The testing is more to determine the antibody response - not to determine if its safety so to speak.

Studies show that if no vaccine was available more than 80 million US citizens would get H1N1 in 150 days or so. Take the current mortality and morbidity and what you have is 76,000 deaths and tens of thousands of people who may need critical care beds that are not there! Damn the few paranoid folks and get the vaccine... overall, the risk is lower than the alternative. And the cost to the healthcare system is increadibly lower if folks get the vaccine.

Just my two cents. And - I have had the vaccine for seasonal and H1n1 already.

They are in too much of a hurry to get this out there. They moved the release date up before clinical trials were even over.

Think HPV vaccine. They put on the full court press on this, claiming it was safe, etc. Then, even before it was released, more information came out- like it wasn't nearly as effective as we were led to believe. It did not prevent all forms of the disease. Then we find out that there were significant side effects, and girls actually died from receiving the HPV vaccine. Unfortunate, and yes, it does happen with even supposedly "safe" vaccines but why push something like this, especially when it's efficacy and safety is such an issue?

I've never received a flu shot before, and I am just getting over the first cold I have had in about 5 years. Are there instances where people NEED these vaccinations-yep. My wife has asthma and before it became well controlled by Advair, even a simple cold had the potential to put her in the hospital. She still gets a flu shot every year- and has the sore arm today to prove it.

I'm also of the opinion that we overmedicate ourselves today anyway- our immune systems are wasting away. Medicine is a wonderful thing, but I think we have become overly dependent on popping a pill for every ache, pain, or sniffle. If there is a valid medical reason- an underlying illness, obviously it's a good idea.

Unlike the general public, we have the capability to protect ourselves and the patient should the need arise.

Mandatory- no friggin way.

[bbledsoe]

Everybody should make their own decision about the vaccine. I don't believe that any vaccine should be mandatory UNLESS failure to vaccinate puts the rest of the population at risk. I remember, as a grade schooler, going to my elementary school and getting the flu vaccine in the 1960s (it was mandatory). I am taking the shot as soon as I get to Las Vegas early next week. As a group of emergency physicians (at UNSOM), we decided not to take the nasal vaccine because it is a weakened (attenuated) form of the H1N1 virus and we were afraid that we would shed some of the virus which might adversely affect some of our patents who may be immunocompromised. But, we are taking the injection. I am making sure my two kids (in their 20s) and my son's pregnant wife (also in her 20s) get the injection vaccine.

I intubated two people last shift at UMC who had H1N1. I had one patient, a male in his 20s, who was in the hospital for 7 weeks, spent 5 weeks on the vent, had bilateral chest tubes, a DVT, and ARDS. He was low sick.

This H1N1 is scary and if you are in your early adult years or pregnant, you should be concerned.

The Obama administration has done a horrible job of providing information about the H1N1. While in Texas last Friday (I am in San Jose now), the TDSHS web site showed that two pharmacies near my Texas house was supposed to have the vaccine. I went by both to try and get the vaccine for me and my family. Neither pharmacy had the vaccine and neither knew when they would get it. It is available in Clark County, Nevada. Go figure.

I was in Mexico when this H1N1 emerged several months ago. The way it affected children in the Mexico City area was scary. Although the predominant strain in the US appears to be less virulent than the one on Mexico City, it is still a bad deal.

Vaccines save lives. If you give people enough of a substance, be it vaccine, drug or placebo, a few will have an adverse effect. This does not mean that the vaccine is dangerous. The links between childhood vaccines and autism are pseudoscience. Far more kids will die from not being vaccinated than will suffer ill effects from the vaccine itself.

Look at the evidence and make your own decision. I, for one, will get my vaccine next Monday.

[tniuqs]

OK I will make a stand here if DR bbledsoe does not rate an immediate 500000 or AT LEAST An honorary membership then EMT City ADMIN ....you will never see a post from me ever again again.

Dustdevil are You in Favor ? of motion presented ie attention AKflightmedic ? Terror ? spleac, 4cmK6? SA_Medic? Ventmedic ? Firefly? RidRider 911? Dwayne? auzzieplil you pevevert roo humping freak? Richard B? Lp flight? rock _shoes? Doc harris? kiwi? scobbie doo, and all other reprobates .... and all I for got to mention .....

ALL IN FAVOUR say EH!!

CHEERS

WE so need a Leader in EMS for solidarity, being world wide.

<end crazy insane rant>

Edited October 26, 2009 by tniuqs