As healthcare providers in Tennessee ramp up to vaccinate the general populace against H1N1, industry leaders around the state still have a major question about the vaccine … namely, will colleagues lead by example or go through the season unprotected?

 

There has been a great deal of information and misinformation circulating around the H1N1 vaccine. Despite following the same protocol as seasonal vaccine testing and manufacturing, there has been a persistent buzz that the H1N1 nasal mist and injection were somehow created "too fast."

 

"This flu vaccine for H1N1 flu is made by the same manufacturers using the same process as the seasonal flu," said Tennessee Department of Health Commissioner Susan R. Cooper, MSN, RN. "If this new flu virus had popped up back in the fall, it's likely it would have been included in the seasonal flu vaccine."

 

She continued, "The second myth we hear is really more of a fear. Everybody remembers back to 1976 when there was a swine flu. There were links made, that I do not believe have ever been proven, to Guillian-Barré syndrome. That being said, the way vaccines are made today in 2009 is very different than the way they were made in 1976."

 

The vaccine is not appropriate for those with a history of Guillian-Barré, severe allergy to chicken eggs or for those under 6 months. The nasal vaccine is approved for most people aged 2 -49 who are healthy, not pregnant and not allergic to any of the nasal spray vaccine components.

 

Vanderbilt University Medical Center is one of 10 NIH-sponsored vaccine evaluation centers in the country. William Schaffner, MD, chair of the Department of Preventive Medicine at VUMC, said the National Institutes of Health deliberately chose those units with whom there was a long-standing, well-established relationship to evaluate the immunogenicity and safety of the H1N1 vaccine. If anything, said Schaffner, this vaccine has been under more scrutiny than normal.

 

Schaffner strongly urged healthcare workers to follow the recommended course of action and receive both the seasonal and H1N1 vaccines.

 

"Most people in the public are vaccinated in order to protect themselves," he pointed out. "The reason we're vaccinating healthcare workers is patient safety. It's not for personal protection. This is an important distinction because it becomes a professional obligation … and I like to say it's not just a professional obligation but an ethical one."

 

Mountain States Health Alliance (MSHA), which kicked off their team member vaccination campaign in early October, is appealing to workers along those same lines. The in-house campaign uses a graphic featuring a young, healthy woman and three children. The tag line reads, "If not for yourself, do it for them." The literature then goes on to provide facts and bust myths associated with H1N1.

 

The large system in northeast Tennessee and southwest Virginia includes 15 hospitals, 76 physician offices, 9,000 team members and 1,000 associated physicians. James Watson, MSHA spokesperson, said they have not yet seen the levels of H1N1 in their 29-county coverage area that have appeared in Nashville and Memphis. However, Watson said the number of cases of patients presenting with flu-like illness is "definitely growing."

 

To get ahead of the problem, the system launched a 'voluntary but strongly encouraged' vaccination drive utilizing a two-pronged strategy of free vaccines for all team members coupled with a fact-based information campaign. "There's a lot of bad information out there," said Watson. "We wanted to make sure our team members had the correct information. We're fighting that bad information with facts."

 

Watson said it was important to adequately inform healthcare workers since so many in the community turn to them for advice … both in the clinical setting and in social situations. "They are also dealing with the most vulnerable people in our community," he continued, noting H1N1 has proven to be very contagious.

 

Schaffner, an internist certified in both infectious disease and preventive medicine, has heard many reasons over the years why healthcare workers opt not to get a flu vaccine. He is quick to debunk the myths and counter the opposition.

 

One of the most often-used excuses healthcare providers offer for skipping a vaccine is, "Oh, I never get the flu." Schaffner said from prior studies of seasonal influenza, we know that 20-40 percent of healthcare workers will have evidence of having had flu after the season has ended, but only about half will recognize or realize they had it. However, he pointed out, a mild case for a healthy provider could turn into a major medical issue for patients with compromised immune systems.

 

"The second thing I'm told is, 'I'll stay home when I'm sick,'" he said. "My answer to that is two-fold. The first is a facetious 'sure.' Even more important, suppose everyone did stay home when they felt sick. The day before they get 'sick,' they are already excreting virus."

 

For those who argue they don't like inoculations, Schaffner countered with "nasal spray vaccine." While not everyone can take the live virus, most do qualify to skip a shot with this option. He also still hears healthcare professionals "who actually believe you can get flu from the flu vaccine, which is a total myth," he stated firmly.

 

Finally, for those who object on the basis of their personal rights … particularly to mandatory vaccination programs … he noted patients have rights, too. "I'm sorry, but you're a healthcare worker. This is a patient safety issue. You have to do what's best for your patient."

 

Schaffner said volunteer efforts to vaccinate healthcare workers (which is how Vanderbilt handles the issue) typically fall short. Nationally reported figures from voluntary vaccination programs show about half the staff gets vaccinated. In hospitals where there is a major push, Schaffner said the percentage might rise to the 60s and perhaps even touch 70 percent.

 

"Increasingly hospitals and healthcare systems have said that's not enough, and they are beginning to make it mandatory," he noted.

 

Of the backlash that followed passage of legislation that mandates influenza vaccinations for healthcare workers in New York, Schaffner said, "I'm disappointed by those protests and annoyed, frankly, because that means healthcare workers don't understand that patient safety must come first and supercedes the healthcare worker's personal inclination."

 

While there is no mandated vaccine for healthcare workers in Tennessee, Commissioner Cooper also strongly urged all those on the front line to make sure they get the facts and get protected. "It's really important to us to ensure if a Tennessean needs medical assistance, there is a full contingent of healthcare providers to care for your needs."