Where's the evidence?

[Lavinia]

Believing in evidence based practice, I've been searching for studies concerning patient outcomes in relation to influenza vaccination of health care workers.

Any of the studies I have found are in long term care. Ironic that this regulation is not in effect for nursing homes as the regulatory body that adopted it does not have any jurisdiction over them. (This regulation applies to article 28 facilities only - acute care)

Seems to me that patient outcomes in relation to vaccination of HCW in acute care have not been studied adequately to provide the evidence such a mandate should require. Below is my evidence to back up that statement:

From the CDC MMWR: www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm

"Randomized trials assessing the impact of staff vaccination
on patient outcomes in acute care facilities have not
been conducted, but low staff vaccination coverage has been
correlated with influenza outbreaks in hospitals."

and a quote from the a 2009 MMWR- www.cdc.gov/mmwr/pdf/rr/rr5808.pdf

"Additional data on indirect effects of vaccination also are needed to quantify the benefits of influenza vaccination of HCP in protecting their patients (308)"

Could this be the reason that the CDC has not recommended mandatory vaccination? Perhaps they feel obliged to base such a recommendation on solid science.

It looks like NYS health care workers will be providing the needed data for further study- whether they want to or not! Normally research subjects must give their consent- but not in this case.

BTW- I get my flu shot every year- by choice.

[nursetoday]

Thank you for this information.
We are so helpless--who will be responsible if there is a bad batch of vaccine?
This whole thing is to calm the public's hysteria.
Instead of making hospitals safe places with adequate infection control standards, health workers become the issue.
The public is getting ripped off!

[Eitan Giat MD]

A Cochrane systematic review examined the efficacy of the influenza vaccine in children. (April 16, 2008, Cochrane Database of Systematic Reviews) Live, attenuated and inactivated influenza vaccines were 82% and 59% effective in reducing the incidence of laboratory-confirmed infection with influenza, but
the efficacy of both types of vaccine in preventing all influenza-like illness was markedly less (33% and 36%, respectively). The efficacy of the inactivated vaccine was negligible among children younger than 2 years, and the heterogeneity of data prevented a meta-analysis of the safety of the vaccines.

When this data is compared to prevention using mechanical means (by the same author, as published this month in the BMJ), vaccination are by far inferior to simple means such as hand washing or surgical masks.
www.bmj.com/cgi/content/full/339/sep21_1/b3675?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=jefferson&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

Now, if such alternatives are available that can prevent not only seasonal flu, but swine flu, and other flu-like respiratory illnesses (let alone other serious infectious diseases, such as TB, etc.), on what basis does the DOH have the right to violate personal human rights and forcing personnel to undergo vaccination? - even if the risk is not great, it definitely has its side effects, and the better, more cost-effective alternative should be offered.

Are there other interests involved?

[Outraged Concerned RN]

Dr Giat,
Thank you for your Cochrane citation. I spent the entire day yesterday at the NY State Assembly Hearing on H1N1. Are you a practicing MD and if so where is your practice? Nurses are so backed into a corner by this "emergency" - NO emergency exists, the regulation wasn't even voted upon by the legislature, the simple definition of Pandemic has even been changed.

I cannot understand why the public is buying this hook, line & sinker. The evidence in properly controlled studies does not exist. There is doubt and yet the mandate still stands.

The healthcare workers of NY State need MD's such as yourself to continue to support us with science based evidence - not to mention that the mandate is a violation of our basic human rights to decide what goes into our bodies or not.
Kind regards,