Connecticut legislators are preparing for next year’s flu season.
Public Health Committee members are meeting today to hear testimony on a proposed bill (GA-1182) to require flu shots for health care employees who have direct contact with patients or medical facility residents.
State Sen. Terry Gerratana, D-Connecticut, said today that she is reserving judgment for after the public hearing, but added, “it seemed as though most legislators are very interested in this issue and also indicated that they thought health care workers should receive the shots.” Sen. Gerratana is co-chair of the Public Health Committee overseeing the public hearing today. She represents Berlin, Farmington and New Britain. The deadline for public comments is April 5. The Public Health Committee would have to pass it, then the House and State Senate. The new law, if enacted, is set to be effective July 13, 2013.
Several letters are already on file from nurses opposing the proposed legislation, most from Danbury Hospital. Tracey Rullo, a registered nurse at Danbury Hospital, wrote:
“Many, if not, all of our patients admitted with the flu did have the flu vaccine and I am sure those numbers are available from Infectious Disease.”
The numbers are not available from Centers for Disease Control (CDC) website, and CDC staff says those numbers won’t be complete until October 2013 at the earliest. The CDC collects so many varying forms of data, and rates of participation by state vary. There were 99 pediatric deaths reported on the CDC website.
Those who are opposed to flu vaccination cite thimerosal and other preservatives as reasons to stay away from the shot. Many question the effectiveness of flu control in general.
Michele Lopez, another Danbury Hospital nurse, said she wore a surgical mask in lieu of vaccination. “After four weeks of extended surgical face mask wearing I developed an upper airway and esophageal reaction. It was so bad that I choked and needed an emergency endoscopy to save my life,” writes Ms. Lopez.
Ms. Lopez ultimately opted to take the thimerosal-free vaccine, and states in her opposition letter that she had a reaction. She claims that the flu vaccine is “one of the most dangerous vaccines available,” and urges Connecticut legislators to research vaccine effectiveness on their own. She quotes a response to her inquiries from Dr. Raymond Roberge of the CDC stating, “There are three ways that the virus can be spread by someone who has been vaccinated. If a person has been vaccinated, but the vaccine is ineffective,…. Also, vaccinated persons can spread the virus via contact. For example, a healthcare worker who has been effectively vaccinated, and is disease-free, can transmit to disease to others via hand contact if he/she comes in contact an infected individual….Lastly, a successfully vaccinated healthcare worker who comes in contact with an infected individual can spread the flu to an inanimate object…that may subsequently be touched by another individual and result in disease transmission.”
Dr. Carolyn Bridges, associate director for adult immunizations at the CDC, says this year is definitely not perfect, but many studies show that vaccinating those in contact with high risk patients will lower transmission rates. A live attenuated virus vaccine, recommended for ages 2 to 49, has been proven, she says, to significantly lower transmission in day care settings, where there is the lowest rate of hygiene.
According to Dr. Bridges, the vaccines this year weren’t as effective as they hoped. Vaccine effectiveness is different every year. The 2012-2013 vaccine effectiveness estimates were 62 percent for the general population, but around 55 percent for those over age 65.
This public hearing comes after a very active flu season, but also after many Connecticut hospitals fired employees for not complying with vaccination. Connecticut Children’s Medical Center, Waterbury Hospital and at least four other Connecticut hospitals required workers to submit or lose their jobs after the Connecticut Hospitals Association Board of Trustees adopted a statewide policy endorsing mandatory flu vaccination of hospital staff in late 2011 followed by 2012 presentations supporting such programs.
A recent Associated Press article by Lindsey Tanner quotes a 2011 CDC survey that “more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees. Several states have laws or regulations requiring flu vaccination for health care workers but only three – Arkansas, Maine and Rhode Island – spell out penalties for those who refuse.” New Jersey has also followed suit last January.
Hospital administrators, such as Dr. Steven I. Aronin, chief of infectious disease for Waterbury Hospital, is among those in favor of such a proposal for Connecticut. In his writing he states, “Extensive medical research has already shown that influenza vaccination is the single most effective preventive measure available against the flu. Since healthcare workers provide care to, and are in frequent contact with, patients at high risk for complications of the flu, it is logical that expanding influenza vaccine use among healthcare workers is a high national priority. There is abundant peer-reviewed and evidence-based research supporting this initiative, including research proving that vaccination of health care workers is correlated with decreased transmission and acquisition of influenza within the healthcare setting, decreased influenza-related morbidity and mortality, and decreased influenza-related illness and absenteeism among hospital employees.” Dr. Aronin writes that, unfortunately, many myths about the flu shot misconstrue risk versus the shot benefit.
Others in favor are those at nursing facilties such as Leading Age Connecticut in Berlin, CT. The Connecticut chapter of the American Association of Retired Persons (AARP) is also in favor. Their statement reads, “AARP supports the Committee work to improve preventative services that can help reduce unnecessary hospitalizations, particularly among vulnerable individuals residing in nursing home facilities. This should result in better health outcomes and a more cost-effective health care system.”
Cochrane Collaboration, a non-profit organization which reviews medical studies, summarized 51 studies that showed vaccinating health care workers did not show any effect on influenza or pneumonia rates or deaths. Dr. Bridges says there are many more studies that show when health care workers are vaccinated it can decrease the risk of mortality in nursing home residents. The CDC has recommended vaccination for health care workers for at least 10 years, she says.
Issues the legislators will have to consider is what to do about volunteers, vendors and other administrative staff that may have contact with patients. Dr. Bridges says ideally all of these would be vaccinated as well.
Others, such as the National Vaccine Information Center (NVIC), warn that teachers, flight attendants and child-care workers will be next. The NVIC is a national, non-profit organization becoming more widely known.
"It's a slippery slope," says State Sen. Joseph Markley, R-Connecticut. State Sen. Markley was trying to get a bill passed preventing health care organizations from mandating vaccinations. This is the other direction, he says, and doesn't know where it would end. Certainly a good case could be made for day care workers and teachers, he warns.