COMMENTARY

Healthcare Professionals: Get a Flu Vaccine or Be a Fool

Mark A. Crislip, MD

Disclosures

October 14, 2014

Editor's Note: Each year, Mark A. Crislip, MD, uses his blog to remind healthcare providers why they should get the flu vaccine. Below is the latest version, slightly edited for a prime-time audience. To see the frank, unedited version, check out the blog entry.

A Few Words for Healthcare Providers

This essay is directed at healthcare providers, not patients or the public. Healthcare providers have no excuse to avoid the flu vaccine; they have access to the world's medical knowledge and should be able to rise above superstition and ignorance.

There may be those who object to the term "fool" in medical writing. "Not professional," they say. Perhaps. But this is an opinion piece. Sure, an opinion supported by the medical literature and reality, but an opinion nonetheless. It is the milder form of the phrase that goes through my mind (and is my honest reaction) regarding healthcare workers who do not get vaccinated for any of the following reasons. If the shoe fits...

This essay is not meant to convince anyone to get the influenza vaccine. If you are not convinced by the voluminous information at the CDC and on PubMed, 2000 words are not going to change your mind.

So, like It's the Great Pumpkin, Charlie Brown, a fall tradition:

Healthcare Providers Who Don't Get a Flu Vaccine: Fools?

I wonder whether you are one of those dumb fools who do not get the flu shot each year. Yes. Dumb Fool. You may be allergic to the vaccine (most are not when tested, and there is an egg-free vaccine), you may have had Guillain-Barré (most can be vaccinated safely, and the risk of GBS is much higher from influenza than the vaccine), in which case I will cut you some slack. Not much, but some. But if you don't have those conditions and you work in healthcare and you don't get a vaccine for one of the following reasons, you are a Dumb Fool.

1. The flu shot gives me the flu. Dumb Fool. The shot is a killed vaccine. It cannot give you influenza. It is impossible to get flu from the influenza vaccine, either from the shot or the live attenuated vaccine.

2. I never get the flu, so I don't need the vaccine. Irresponsible Fool. I have never had a head-on collision, but I wear my seat belt. And you probably don't use a condom either. So far you have been lucky, and you are a potential winner of a Darwin Award, although because you don't use a condom, you are unfortunately still in the gene pool. As a healthcare worker, when you do get influenza and come to work, you can pass it on to the most vulnerable hosts. Nice going.

3. Only old people get the flu. Selfish Fool. Influenza can infect anyone, and the groups who are more likely to die of influenza are the very young, the pregnant, and the elderly. Often those most at risk for dying from influenza are those least able to respond to the vaccine, due to age or underlying diseases. Like your patients. You can help prevent your old, sickly grandmother or your newborn daughter from getting influenza by getting the vaccine, so you do not get flu and pass it on to her. Influenza, by the way, is highly contagious, with 20% to 50% of contacts with an index case getting the flu. However, Granny may be sitting on a fortune that will come to you, and killing her off with influenza is a great way to get her out of the way and never be caught. That would make a good episode of CSI.

4. I can prevent influenza or treat it by taking echinacea, vitamin C, vitamin D, oscillococcinum, or Airborne®. Gullible Fool cubed, then squared. None of these concoctions has any efficacy whatsoever against influenza. If you think oscillococcinum has any efficacy, I would like you to invest in a perpetual-motion machine I have invented. None of the above either prevent or treat influenza. And you can't "boost" your immune system either. Anyone who suggests otherwise wants your money, not to improve your health.

5. Flu isn't all that bad of a disease. Underestimating Fool. Part of the problem with the term "flu" is that it is used both as a generic term for almost any viral illness with a fever and to describe a severe viral pneumonia. Medical people are just as inaccurate about using the term as the general public. The influenza virus directly and indirectly kills 20,000 people (depending on the circulating strain and year) and leads to the hospitalization of 200,000 in the United States each year. Influenza is a nasty lung illness. And what is "stomach flu"? No such thing.

6. I am not at risk for flu. Denying Fool. If you breathe, you are at risk for influenza. Here are the groups of people who should not get the flu vaccine (outside of people with severe adverse reactions to the vaccine): Former President Clinton, who evidently doesn't inhale. Michele Bachmann. Wait, that's the HPV vaccine. And people who are safe from zombies. If you don't get the vaccine you do not have to worry about the zombie apocalypse, because zombies eat brains.

7. The vaccine is worse than the disease. Fool AND Wimp. What a combination. Your mother must be proud. Unless you think a sore deltoid for a day is too high a price to pay to prevent 2 weeks of high fevers, severe muscles aches, and intractable cough and decrease the chance of passing the virus on to your vulnerable patients.

8. I had the vaccine last year, so I do not need it this year. Uneducated Fool. Each year new strains of influenza circulate across the world. Last year's vaccine at best provides only partial protection. Every year you need a new shot.

9. The vaccine costs too much. Cheap Fool. The vaccine costs less than a funeral, less than Tamiflu®, and less than a week in the hospital.

10. I received the vaccine and I got the flu anyway. Inexact Fool. The vaccine is not perfect and you may have indeed had the flu. More likely, you called one of the many respiratory viruses (viri?) people get each year "the flu." Remember that there are dozens of potential causes of a respiratory infection circulating; the vaccine only covers influenza, the virus most likely to kill you and yours.

11. I don't believe in the flu vaccine. Superstitious, Premodern, Magical Thinking Fool. What is there to believe in? That is like saying, "I do not believe in reality." Belief is what you have when there are no data. Probably don't believe in gravity or germ theory either. Everyone, I suppose, has to believe in something, and I believe I will have a beer.

12. I will wait until I have symptoms and then stay home. Dangerous Fool. Despite often coming to work ill, especially second-year residents, about 1 in 5 cases of influenza are subclinical. Hospitalized patients are more susceptible to acquiring influenza from healthcare professionals than the general population, with 27% of nosocomial-acquired H1N1 patients dying. And you will never realize that you were the one responsible for killing that patient by passing on the flu.

13. The flu vaccine is not safe and has not been evaluated for safety. Computer-Illiterate Fool. There are 1812 references on PubMed on safety of the flu vaccine as I write this, and the vaccine usually causes—at most—only short-term, mild reactions. All healthcare requires weighing the risks of an intervention against the benefits. And if you are worried about toxins, good news: There are neither toxins nor gluten in the flu vaccine. For the flu vaccine, all of the data suggest huge benefit for negligible risk. And as a professional, it could be argued that we have a moral responsibility to maximize the safety of our patients.

14. The government puts tracking nanobots in the vaccine, as well as RFID chips as part of the mark of the beast, and the vaccine doesn't work because it is part of a big government-sponsored conspiracy to keep Americans ill, fill hospital beds, line the pockets of Big Pharma, and inject the American sheeple with exotic new infections in an attempt to control population growth and help usher in a New World Order. Well, that excuse is at least reasonable. Paranoid Fool.

So, get the vaccine. And pass this essay on to someone else instead of the flu. The life you may save may be your own. Or be a Dumb Fool.

One final thought. There is a tremendous amount of medical literature pointing to the safety and wide-ranging benefits of the influenza vaccine as well as the morbidity and mortality that influenza inflicts on humans every year. The preponderance of data is clear: When healthcare workers are vaccinated, patient mortality declines.

Here is my suggestion for patients: When you and yours are in the clinic or the hospital, request care only from practitioners who have had the flu vaccine. Put a sign on your hospital room door: "No entry unless you are influenza vaccinated," or put a copy of this essay on the door. You do have the right to refuse care, especially from a Fool.

I know this idea is a nonstarter. Sick, vulnerable people are in no condition to potentially antagonize their providers—even though sick, vulnerable people should be able to trust that their healthcare professional is maximally protecting them. No one wants to risk irritating their provider, especially if that person holds the key to the morphine.

I do not really expect that anyone will actually ask to be cared for by influenza-vaccinated providers only.

But I can dream.

Suggested Reading

My co-bloggers and I over at Science-Based Medicine have written at length about vaccines in general, influenza, the influenza vaccine, and the antivaccination movement. Here are links to some of my extensively referenced essays on influenza and vaccines.

Scam Stud

The Tamiflu Spin

Yes, But. The Annotated Atlantic.

Cochrane Reviews: The Food Babe of Medicine?

One Flu Into the Cuckoo's Nest*

Uneasy Lies the Head That Wears the Flu

What are words for?

I refute it thus

Protect Yourself

Drinking from the Fire Hose: Odds and Ends on the Gasping Oppression

Random Flu Thoughts

Ososillyococcinum and other Flu bits

Influenza Vaccine Mandates

Nine Questions, Nine Answers

Flu Vaccine Efficacy

More Flu Woo for You, Boo Boo

Herd Immunity

Flu Woo Hodge Podge

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