A recent bug that tied my vocal cords got me thinking about dreaded influenza and my trusted doctor, who prescribed the meds to assure I wouldn't stay sick long.
Most Americans look up to their healthcare providers, as well they should. Doctors, nurses and other professionals deserve our admiration.
They of all people know not only what's important to stay healthy. They also understand they serve as role models for patients and coworkers alike.
That's why it was disappointing to learn from a Centers for Disease Control and Prevention report this spring that more than one in three healthcare providers in the U.S. did not bother to get last year's seasonal influenza vaccine (38.1%).
Moreover, about two in three chose not to get vaccinated against 2009 pandemic influenza A (H1N1), which became available last August, even as the nation was swept up with fear of the dreaded "swine flu."
Fewer than two in three providers (64.3%) obtained either one or the other of these vaccines but only a third (34.7%) received both, said the report, published in the CDC's Morbidity and Mortality Weekly Report.
This, by the way, was the good news.
Because even though these rates are much lower than they should be, they show vaccination among healthcare providers has been increasing.
Between 2004 and 2008, vaccination among healthcare providers has fluctuated between 46% and 49%, according to the U.S. National Health Interview Survey, which says the last season it has never been higher.
The MMWR also detailed the great disparity among types of healthcare workers in their compliance with federal vaccination recommendations.
For example, 71.7% of providers in hospitals get seasonal flu vaccine, but only 54% of those in long-term care settings receive innoculation. Doctors, physician assistants, dentists, and nurses get vaccinated at similar rates, but those are much higher than the rates for allied health professionals and non-clinical staff.
About 70% of those working near seriously ill patients such as those in burn or obstetric units get vaccinated, a rate much higher than other healthcare workers (59%).
The better educated the healthcare provider, the more likely they are to get vaccinated against H1N1. "HCP with a bachelor's degree or higher were more likely to be vaccinated for 2009 H1N1 compared with HCP with a high school diploma or less (41.9% versus 27.6%)," the MMWR said.
Okay. I get that there's disparity.
But what reasons motivate these relatively well-educated health professionals—hard workers who work with sick people—not to get vaccinated? When I posted the question to the CDC last week, a spokesman directed me to this monograph issued last summer by the Joint Commission, which reviewed dozens of studies that asked health providers that very question.
By and large, the biggest reasons why providers decline influenza vaccination listed were:
1. They fear getting influenza or influenza-like illness from the vaccine.
2. They fear the vaccine's side-effects.
3. They think the vaccine is ineffective.
4. They don't think they have a high likelihood of getting sick from influenza so they don't need the vaccine.
5. They fear needles
6. They didn't have time, or it was inconvenient or they forgot.
7. They rely on homeopathic products to ward off viruses.
8. They believe their host defenses will work better.
9. They think other preventive measures minimize or eliminate risk.
10. They lack a physician recommendation to get vaccinated.
11. They believe that influenza is not a severe disease.
12. Vaccines aren't free.
The Joint Commission monograph reminded health providers that "transmission of influenza to patients by health care personnel (HCP) is well documented. HCP may acquire influenza both in the health care setting and in the community, and they can easily transmit the virus to patients in their care."
The monograph continued: "Health care organization leaders and staff need to mount a concerted effort to improve influenza immunization rates among HCP. Increasing influenza vaccination rates among HCP would reduce the burden of the disease and its associated health care costs."
The CDC's Advisory Committee on Immunization Practices has recommending that all healthcare providers be immunized against influenza since 1984. But obviously, there's a long way to go.
"Vaccination rates of 80% or higher may be needed to provide the 'herd immunity' that prevents healthcare-associated influenza by immunizing those who care for and live with susceptible patients who may not develop an optimal protective response to the influenza immunization.
That may require more healthcare settings, such as hospitals, surgical centers, clinics, and physician practices, to require that its workers get vaccinated, or to encourage vaccination with campaigns or department contests.
The Joint Commission monograph listed many ways to increase facility compliance and includes case studies from many institutions that were successful. One obvious technique is to provide vaccination for free. Another is to make it convenient, and a third is to create incentive programs.
CDC officials say they are pleased vaccination rates among providers are increasing, although they acknowledge much more work needs to be done to educate providers who won't or don't.
"Vaccination levels are now known to be much higher in some groups than among others namely physician’s levels are around 70% and allied health and support workers around 40% . Nurses are in the middle at about 60%," says Gary L. Euler, CDC epidemiologist.
Hospital workers in general have higher levels than do HCP in outpatient facilities such as physician practices with levels the lowest among HCP working in nursing homes CDC is glad to now be able to measure and report levels by occupation and by facility type so that effective interventions can be targeted where they are most needed, he explains.
Many hospitals and clinics have had success with declination programs, in which healthcare employers require workers to actively decline to get vaccinated in writing. That seems to spur workers to launch discussions about their reasoning, and does away with many providers who don't get vaccinated simply because they forgot to do it or postponed it too long.
Last week, the CDC revised its estimates of influenza mortality, saying that rather than using the 36,000 per year figure that is based on average death rates from the 1990s, each season is more variable, spanning a range of between 3,349 deaths to 48,614 over the last 31 years.
CDC officials say that while Virginia Mason Medical Center in Seattle, WA was the first healthcare institution to mandate influenza vaccination for its workers in 2005, only 66 other hospitals and clinics have followed with such policies nationally, according to an "honor roll" maintained by the Immunization Action Coalition.
I hope the dreaded pandemic flu never comes, of course. But if it does, I hope that my health providers I might depend on for care will not have to stay home because they're sick too.