Contrarian Posted February 18, 2013 Share Posted February 18, 2013 Not taking the very, very small risk that the flu vaccine represents IS SELFISH as a health provider dealing with patients that may be immunocompromised and in no shape to survive a bout of the flu. Again... This is a REALLY cavalier and unipolar super simplistic perspective. Being "a healthcare provider" doesn't occur in a vacum... and therefore automatically mean you aren't or can't be a patient. Being "a healthcare provider" doesn't or atleast shouldn't mean that you surrender your rights to be treated under the same ethical principles as any other autonomous being. Therefore regardless of how large or small the "risk"... it should be at the sole discretion of the patient as to whether or not the risk is acceptable to THAT PERSON/Patient. You acknowledge that there IS RISK involved... but think it is ok for YOU to decide how much risk OTHERS should be willing to take... and its OK to bully them into accepting YOUR level of comfortable risk...??? So do you also daily minimize and belittle your patient's individual levels of risk aversion..??? Or simply omit facts about what YOU consider should be within THEIR level of acceptable risk. What YOU consider acceptable risk may not be acceptable for others. That SHOULD be ok with you and you should respect that since paternalism... ethically has no place in the practice of medicine. As for the "immunocompromised and in no shape to survive a bout of the flu" argument... its NONSENSE...!!! Why...??? Because that patient interacted with tens-> hundreds of non-vaccinated people BEFORE they sat with you for 7-20 mins in the clinic and will leave that visit to interact with tens-> hundreds more non-vaccinated people after the visit. This is no different than the other immunization requirements and PPD tests required to work in the health profession. This is not the government forcing you do anything. You have the choice to work where you don't have to take the "risk". So sounds like you (the student) are ok with patients compelled into invasive healthcare procedures under duress...??? Cause most of the problem does NOT stem from people showing up to a NEW job not willing to acccept the requirements of the job (risk of vaccines). If this was the case, I agree that if you apply for a job and vaccines are a requirement, then either get them or apply elsewhere. This isn't where most of the problem lies. Its when YOu have been working satisfactorily and/or exceptionally in a healthcare position for a while... then administration sends out the memo that 'to remain employed, you have to inject something else into your body'... basically YOU have to accept a healthcare "risk" THEY are comfortable with YOUR body accepting. Or simply quit a job that you have been in succesfully, sell your house, up-root your kids and move... cause you don't think Guillain-barre syndrome or any other possibility of healthcare risk is worth the gamble. The "risk" is more than acceptable to protect the people I serve. GREAT... for YOU...!!! Deciding this for any other person is heading down a potentially dangerous slope... Contrarian P.S... For Clarity... I have NO problems with vaccination programs. I have had LOTS of them in the military and continue to get them yrly since I'm asplenic. But it seems LOTs of folks simply ignored those Medical Ethics classes or simply skipped out to study for a test on the days these principles were being discussed. Link to comment Share on other sites More sharing options...
taotaox1 Posted February 18, 2013 Share Posted February 18, 2013 My viewpoint is not "cavalier" or "Simplistic" and I did not "skip out on ethics lectures" just because my opinion on the matter differs from yours. Yes. I am fine with healthcare providers being required to vaccinate against diseases that they will regularly encounter and could easily pass on to patients (I agree it is silly for an outpatient FP clinic to require it, but if you work in the ICU /etc it does matter). People can feel however you want about it, but the danger of vaccination is statistically, irrefutably less risky than not getting vaccinated. Sometimes public health needs outweigh our desire for personal autonomy in the matter. The non-compliant TB patient is a great example of this. They basically get force fed their meds, and for good reason. The flu is a less serious disease obviously, but no one is advocating forced mass inoculations. You CAN leave, even if it is hard. Also, most places offer an alternative (mask during flu season). On top of all of this, my point is that people that make the decision not to get vaccinated (at least in the inpatient setting) are selfish, requirements or no. Obviously this is a sensitive matter and a lot of thought needs to go into decisions that lessen people's autonomy, but my opinion is that it is (situationally) warranted. Link to comment Share on other sites More sharing options...
Guest JMPA Posted February 18, 2013 Share Posted February 18, 2013 Again...This is a REALLY cavalier and unipolar super simplistic perspective. Being "a healthcare provider" doesn't occur in a vacum... and therefore automatically mean you aren't or can't be a patient. Being "a healthcare provider" doesn't or atleast shouldn't mean that you surrender your rights to be treated under the same ethical principles as any other autonomous being. Therefore regardless of how large or small the "risk"... it should be at the sole discretion of the patient as to whether or not the risk is acceptable to THAT PERSON/Patient. You acknowledge that there IS RISK involved... but think it is ok for YOU to decide how much risk OTHERS should be willing to take... and its OK to bully them into accepting YOUR level of comfortable risk...??? So do you also daily minimize and belittle your patient's individual levels of risk aversion..??? Or simply omit facts about what YOU consider should be within THEIR level of acceptable risk. What YOU consider acceptable risk may not be acceptable for others. That SHOULD be ok with you and you should respect that since paternalism... ethically has no place in the practice of medicine. As for the "immunocompromised and in no shape to survive a bout of the flu" argument... its NONSENSE...!!! Why...??? Because that patient interacted with tens-> hundreds of non-vaccinated people BEFORE they sat with you for 7-20 mins in the clinic and will leave that visit to interact with tens-> hundreds more non-vaccinated people after the visit. So sounds like you (the student) are ok with patients compelled into invasive healthcare procedures under duress...??? Cause most of the problem does NOT stem from people showing up to a NEW job not willing to acccept the requirements of the job (risk of vaccines). If this was the case, I agree that if you apply for a job and vaccines are a requirement, then either get them or apply elsewhere. This isn't where most of the problem lies. Its when YOu have been working satisfactorily and/or exceptionally in a healthcare position for a while... then administration sends out the memo that 'to remain employed, you have to inject something else into your body'... basically YOU have to accept a healthcare "risk" THEY are comfortable with YOUR body accepting. Or simply quit a job that you have been in succesfully, sell your house, up-root your kids and move... cause you don't think Guillain-barre syndrome or any other possibility of healthcare risk is worth the gamble. GREAT... for YOU...!!! Deciding this for any other person is heading down a potentially dangerous slope... Contrarian P.S... For Clarity... I have NO problems with vaccination programs. I have had LOTS of them in the military and continue to get them yrly since I'm asplenic. But it seems LOTs of folks simply ignored those Medical Ethics classes or simply skipped out to study for a test on the days these principles were being discussed. I totally agree and it could not be said better, dont mind this tao toa whatever the @#$%idiot looking to rob the freedoms of american people, hopefully he wont graduate Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 18, 2013 Administrator Share Posted February 18, 2013 Sure, there's risk involved, but aside from specific contraindications (allergies, etc.) the risk/benefit equation is so far in favor of getting the flu shot that any practitioner who legitimately claims the risk/benefit argument favors anyone NOT being vaccinated is simply not competent to be a patient adviser. Don't feel bad about it--there are plenty of healthcare providers who buy lottery tickets or are more afraid of commercial air travel than driving POV--but healthcare providers should be better at dealing with the risks surrounding high impact, low frequency events than the average person. Link to comment Share on other sites More sharing options...
Contrarian Posted February 18, 2013 Share Posted February 18, 2013 Sure, there's risk involved, but aside from specific contraindications (allergies, etc.) the risk/benefit equation is so far in favor of getting the flu shot that any practitioner who legitimately claims the risk/benefit argument favors anyone NOT being vaccinated is simply not competent to be a patient adviser. This I agree with wholeheartedly... Its the compulsion I have a problem with because generally we DO NOT compel patients to do things, but since this hypothetical patient happens to be a healthcare provider... it seems that somehow compulsion is now ok. I have a serious problem with that notion. What's next...?? Healthcare providers can't own firearms, fast cars/motorcycles or be recommended medical marijuana simply because they are healthcare providers...??? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 18, 2013 Administrator Share Posted February 18, 2013 It's the golden rule, Contrarian: He who has the gold, makes the rules. Workplaces don't force anyone to do anything, they just make a very compelling economic argument that following the rules is much more profitable than unemployment. Consent-based rules have been farcical for decades--do you really agree to the licensing terms for whichever computer program you buy? Virtually everything these days is a contract of adhesion: you have no choice but to either accept it or walk away, and the courts have turned a blind eye to the disconnect for too long, pretending that a sale is a "license", and so forth, that it should come as no surprise at all that all the theoretical rights we have over e.g. our bodies are all economically impractical to exercise. Link to comment Share on other sites More sharing options...
Contrarian Posted February 28, 2013 Share Posted February 28, 2013 Ummm... Its a ethical quandry because innoculations/immunizations are NOT totally benign... The vaccine, more than 30 million doses of which were given during the H1N1 flu pandemic in 2009-2010, contains a booster, or adjuvant, and may have triggered an adverse immune reaction in some children at higher genetic risk of narcolepsy, scientists said in new research published on Wednesday. Researchers at Britain's Health Protection Agency (HPA) who published the study in the British Medical Journal said the at least 14-fold increased risk they found had "implications for the future licensing and use of adjuvanted pandemic vaccines". Narcolepsy is a life-long disorder and thought to be an autoimmune disease in which patient's immune system attacks the body's own cells. Its symptoms include frequent bouts of daytime sleepiness and in its severe forms it also causes night terrors, hallucinations and cataplexies - when strong emotions trigger a sudden loss of muscle strength. Studies in Finland, Sweden and Ireland have also found a Pandemrix link to narcolepsy, and GSK says more than 800 cases linked to the shot have been reported in Europe. H1N1 vaccine linke to Narcolepsy Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 28, 2013 Moderator Share Posted February 28, 2013 as i look to hire my first employee Vaccine for Flu will be MANDATORY no flu vaccine, no job - just not willing to have an employee out for 1-2 weeks with the flu and or spreading the flu to my geri home bound patients Someone can decline the shot, but then I can decline hiring them....... Link to comment Share on other sites More sharing options...
discogenic Posted February 28, 2013 Share Posted February 28, 2013 as i look to hire my first employee Vaccine for Flu will be MANDATORY no flu vaccine, no job - just not willing to have an employee out for 1-2 weeks with the flu and or spreading the flu to my geri home bound patients Someone can decline the shot, but then I can decline hiring them....... With the caveat that the flu shot is clearly no guarantee against either of these things. Link to comment Share on other sites More sharing options...
Contrarian Posted February 28, 2013 Share Posted February 28, 2013 Vaccine for Flu will be MANDATORY - just not willing to have an employee out for 1-2 weeks with the flu and or spreading the flu to my geri home bound patients...... Since this is your stated goal... Then you are going to REQUIRE EACH AND EVERY ONE of those fragile Geri Patients to get a Flu vac also right...???? Someone can decline the shot, but then You can decline serving as their provider... because you are "just not willing to have an employee out for 1-2 weeks with the flu" after one of those un-vaccinated Geri Patients sneeze on them or 'one of those un-vaccinated Geri patients spreading the flu to your other Geri home bound patients'... Link to comment Share on other sites More sharing options...
thinkertdm Posted February 28, 2013 Share Posted February 28, 2013 With the caveat that the flu shot is clearly no guarantee against either of these things. I have no interest in any of this discussion, and only wanted to make a statement about the "guarantee". We, as medical professionals, do not guarantee anything. A statin is no guarantee that your chances of heart disease will decrease. Lowering your cholesterol numbers will not guarantee your chances of heart disease. Quitting smoking will not guarantee not getting lung cancer. We deal in probabilities, not absolutes. Link to comment Share on other sites More sharing options...
Joelseff Posted February 28, 2013 Share Posted February 28, 2013 I have no interest in any of this discussion, and only wanted to make a statement about the "guarantee".We, as medical professionals, do not guarantee anything. A statin is no guarantee that your chances of heart disease will decrease. Lowering your cholesterol numbers will not guarantee your chances of heart disease. Quitting smoking will not guarantee not getting lung cancer. We deal in probabilities, not absolutes. That's because only a Sith Lord deals in absolutes! (i am ABSOLUTELY certain of that) LOL Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
discogenic Posted February 28, 2013 Share Posted February 28, 2013 I have no interest in any of this discussion, and only wanted to make a statement about the "guarantee".We, as medical professionals, do not guarantee anything. A statin is no guarantee that your chances of heart disease will decrease. Lowering your cholesterol numbers will not guarantee your chances of heart disease. Quitting smoking will not guarantee not getting lung cancer. We deal in probabilities, not absolutes. Agreed. However we also deal in evidence as much as we can, and the evidence that flu shots are as effective as we'd like to think (e.g., keeping an employee from missing 1-2 weeks of work, or preventing an employee from infecting an elderly person) just isn't there. Bottom line for me: if getting the flu shot allows you to acquire/retain your job without having to hire a team of lawyers to fight the policy, then get the darn shot. Link to comment Share on other sites More sharing options...
WanderlustPA Posted March 1, 2013 Share Posted March 1, 2013 You may find this interesting: http://articles.mercola.com/sites/articles/archive/2013/02/04/zinc-garlic-vitamin-d.aspx?e_cid=20130204_DNL_art_1&utm_source=dnl&utm_medium=email&utm_campaign=20130204 Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 1, 2013 Moderator Share Posted March 1, 2013 You may find this interesting: http://articles.mercola.com/sites/articles/archive/2013/02/04/zinc-garlic-vitamin-d.aspx?e_cid=20130204_DNL_art_1&utm_source=dnl&utm_medium=email&utm_campaign=20130204 While not everything he says is completely wrong (broken watch right twice a day), mercola is a quack and has been the center of much controversy for making unsubstantiated claims and using slick tactics to sell his products. No different than a snake oil salesman. And either we tell business owners they can't require anything of even slight danger (working on a ladder, driving, work around animals for fear of infectious disease) at their place of business or they can require vaccination for employment. Considering employment at someone else's business is a privilege and not a right, I'm inclined to side with the business owner. Link to comment Share on other sites More sharing options...
Contrarian Posted March 1, 2013 Share Posted March 1, 2013 And either we tell business owners they can't require anything of even slight danger (working on a ladder, driving, work around animals for fear of infectious disease) at their place of business or they can require vaccination for employment. Considering employment at someone else's business is a privilege and not a right, I'm inclined to side with the business owner. Logical Fallacy- "False Dichotomy"....!!!! A false dilemma (also called false dichotomy, the either-or fallacy, fallacy of false choice, black-and/or-white thinking, or the fallacy of exhaustive hypotheses) is a type of informal fallacy that involves a situation in which limited alternatives are considered, when in fact there is at least one additional option. The options may be a position that is between two extremes (such as when there are shades of grey) or may be completely different alternatives. The opposite of this fallacy is argument to moderation. False dilemma can arise intentionally, when fallacy is used in an attempt to force a choice (such as, in some contexts, the assertion that "if you are not with us, you are against us"). But the fallacy can also arise simply by accidental omission of additional options rather than by deliberate deception. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 1, 2013 Moderator Share Posted March 1, 2013 Logical Fallacy- "False Dichotomy"....!!!! I thought you were saying we can't mandate something that has proven benefit because it is not entirely benign. By that logic, we can not require them to do anything that isn't completely benign to their health. I'm missing the fallacy. What are the other options? Pick and chose what can and can't be forced? On what criteria? Who gets to pick what? What if I have active TB? Can you not force me to take treatment? cause the stuff sucks. I know. Are you basing your opposition on Freedom of choice? I'm all with you on personal liberties, but everyone has the liberty to not work somewhere. I thought I looked like an idiot working at a restaurant wearing required suspenders, but dem were da rules. Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 1, 2013 Moderator Share Posted March 1, 2013 Agreed. However we also deal in evidence as much as we can, and the evidence that flu shots are as effective as we'd like to think (e.g., keeping an employee from missing 1-2 weeks of work, or preventing an employee from infecting an elderly person) just isn't there. . http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm lots of information says it is not 100% effective, nor 100% safe but it works - and as a business owner trying to make a go of it in a crappy economy with the barriers TNTC to success this is a no brainer to try to keep the place running - it is different when you have to make money to pay the bills, ie payroll, and not just burn your own sick time or vacation - different level of stress that I have not felt before (and not to fond of it) so if someone doesn't want to get vaccinated they can get a job somewhere else because even though the shot is not 100% it is better then nothing..... [h=1]Flu Vaccine Effectiveness: Questions and Answers for Health Professionals[/h][h=4]On this Page[/h] How do we measure how well influenza vaccines work? What is vaccine effectiveness? How do vaccine effectiveness studies differ from vaccine efficacy studies? When can vaccine effectiveness studies be conducted? What factors can affect the results of influenza vaccine effectiveness studies? What outcomes are measured in influenza vaccine effectiveness studies? Which outcomes provide the best estimates of vaccine effectiveness? How can vaccine effectiveness against non-laboratory-confirmed outcomes be interpreted? Why do estimates of influenza vaccine effectiveness vary widely? How well do inactivated influenza vaccines work in randomized control trials? How well do influenza vaccines work during seasons in which the vaccine strains are not wellmatched to circulating influenza viruses? How well do influenza vaccines work in people with chronic high-risk medical conditions? How effective is the live attenuated influenza vaccine (LAIV)? How do live attenuated vaccine and inactivated vaccines compare in vaccine efficacy and effectiveness studies? What information is necessary to make assessments of vaccine effectiveness? References [h=3]How do we measure how well influenza vaccines work?[/h]Two types of studies are used to determine how well influenza vaccines work. The first type of study is called a randomized control trial (RCT). In a RCT, volunteers are assigned randomly to either a group that receives vaccine or a group that receives a placebo (e.g., a shot of saline), and vaccine efficacy is measured by comparing the frequency of influenza illness in the vaccinated and the unvaccinated groups. RCTs are required before a new vaccine is licensed for routine use by a national regulatory authority, such as the Food and Drug Administration (FDA) in the United States. The second type of study is called an observational study. In observational studies the study participants make their own decisions about whether or not to be vaccinated. In this type of study, vaccine effectiveness is measured by comparing the frequency of influenza illness in the vaccinated and unvaccinated groups, usually with adjustment for factors (like presence of chronic medical conditions) that may vary between the groups. (See below for further details.) [h=3]What is ‘vaccine effectiveness’?[/h]Vaccine effectiveness is a measure of how well influenza vaccines work to protect against influenza infection and illness when they are used in routine circumstances in the community, and not specifically in a RCT. Effectiveness represents the percentage reduction in the frequency of influenza infections among people vaccinated compared with the frequency among those who were not vaccinated, assuming that the vaccine is the cause of this reduction. These studies are conducted in community settings, and researchers have no control over those who choose to be vaccinated or not. [h=3]How do vaccine effectiveness studies differ from vaccine efficacy studies?[/h]Vaccine efficacy refers to studies of vaccine effects that occur under randomized, controlled conditions, where individuals are randomly assigned to either a group that is given influenza vaccine or to a second group that is not given influenza vaccine, but instead, given a placebo. A RCT is a study designed by researchers to minimize factors that could lead to invalid study results. For example, vaccine allocation is usually double-blinded, which means neither the study volunteers nor the researchers know if a given person has received vaccine or placebo. This methodology reduces bias that can occur if the researchers or the individuals receiving the intervention know which study volunteers have received placebo versus vaccine. Bias is an unintended systematic error in the way researchers select study participants, measure outcomes, or analyze data that can lead to inaccurate results.) Top [h=3]When can vaccine effectiveness studies be conducted?[/h]The most common approach now used to evaluate how well licensed influenza vaccines work is an observational or vaccine effectiveness study. Once an influenza vaccine has been licensed by FDA, recommendations are typically made by CDC's Advisory Committee for Immunization Practices (ACIP) for its routine use. For example, ACIP now recommends annual influenza vaccination for all U.S. residents aged 6 months and older. These universal vaccine recommendations make it unethical to perform efficacy (i.e., experimental randomized) studies with persons who are explicitly recommended to receive vaccine, especially because assigning people to a placebo group could place them at risk for serious complications from influenza. [h=3]What factors can affect the results of influenza vaccine effectiveness studies?[/h]Effectiveness studies are subject to various forms of bias (see above for definition), more so than are efficacy studies. Therefore, it is important when evaluating the results of an influenza vaccine effectiveness study that researchers identify the potential biases and introduce methods to minimize them. There are at least three forms of bias that are especially important in interpreting the results of influenza vaccine effectiveness studies: confounding bias, selection bias, and information bias. Confounding bias occurs when the effect of vaccination on the risk of the outcome of interest (e.g., RT-PCR-confirmed influenza infection) is distorted by other factors associated both with vaccination and influenza infection. For example, confounding bias would occur if the majority of influenza cases in a case-control study have a chronic medical condition that places them at a greater risk of influenza hospitalization and makes them more likely to receive an influenza vaccine than non-cases. Not taking these associations into account for this study population would lead to an estimate of effectiveness that is too low due to confounding bias caused by cases having more chronic medical conditions than controls. Selection bias refers to errors introduced into a study because of differences between people who are enrolled in a study compared with people who are not enrolled. For example, people who are willing to participate in vaccine effectiveness studies might seek health care sooner, exercise more, or live healthier lifestyles than people who don't participate in such studies. As a result of this bias, study participants may not be representative of the general population, and the study results may be biased towards finding higher vaccine effectiveness, if vaccination worked better in such persons. Taking into account "health seeking behaviors" is especially important in vaccine effectiveness studies conducted among the elderly. Finally, information bias occurs when there are differences in the quality or accuracy of measuring vaccination status or influenza illness in the groups of people being compared in a study. For example, if researchers obtain information on vaccination for influenza cases from medical records but use verbal interviews to get this information from non-cases, this difference in data collection procedures could bias the results of the study. The methods used to conduct observational studies of vaccine effectiveness must be reviewed carefully to see if these and other possible forms of bias have been described and addressed by adjustment for the factors that differ between groups. Top [h=3]What outcomes are measured in influenza vaccine effectiveness studies?[/h]The interpretation of vaccine effectiveness studies depends on the outcomes measured in a particular study. These outcomes may include prevention of laboratory-confirmed influenza illness or hospitalization, prevention of medically attended, acute respiratory illness (MAARI), prevention of influenza-like illness (or ILI, defined as an illness with fever and cough or sore throat), and prevention of pneumonia requiring hospitalization. In general, the more specific the outcome used (e.g., laboratory-confirmed influenza compared with ILI) the more accurate the measurement of the effect of vaccination. A recent study suggests that using serology (a laboratory test which measures the amount of antibody against a particular virus in a person's body) to determine whether or not study participants have been infected with influenza may potentially overestimate vaccine efficacy (Petrie et al, 2011). The reason for this is that following an influenza vaccination, a person's immune system may produce a significant amount of antibody against influenza. If that same person were to become infected with influenza despite being vaccinated (i.e., a "vaccine failure"), it is possible that enough additional antibody may not be produced to provide a positive result in a serology test. Diagnosis of influenza infection with serology tests requires two blood samples: one taken prior to infection, and the second taken after infection. Confirmation of influenza infection by serology tests requires a four-fold increase in antibody in the post-infection serum as compared to the level in the pre-infection serum. Because an influenza infection does not always produce a four-fold increase in antibody in people who have received the flu vaccine, vaccine failures can be missed, thus increasing estimates of vaccine efficacy. Despite this potential for bias, studies using serology-confirmed outcomes can still provide valid estimates of vaccine efficacy when considered with other disease endpoints. [h=3]Which outcomes provide the best estimates of vaccine effectiveness?[/h]Studies that use more specific outcomes, such as laboratory-confirmed influenza outcomes (e.g., culture positive or reverse-transcriptase polymerase chain reaction (RT-PCR) positive results), provide the best and most specific estimates of the impact of influenza vaccines in preventing influenza. In general, when non-laboratory-confirmed outcomes are used (e.g., all pneumonia hospitalizations or influenza-like illness, which include many non-influenza illnesses), vaccine effectiveness estimates are lower. For example, a study by Bridges et al (2000) among healthy adults found that the inactivated influenza vaccine was 86% effective against laboratory-confirmed influenza, but only 10% effective against all respiratory illnesses in the same population and season. [h=3]How can vaccine effectiveness against non-laboratory-confirmed outcomes be interpreted?[/h]The interpretation of vaccine effectiveness against less specific, non-laboratory-confirmed outcomes is influenced by the proportion of the outcome used that is actually caused by influenza virus infections compared with other pathogens. One non-laboratory-confirmed outcome that is often used is influenza like illness (ILI). The proportion of ILI caused by influenza viruses varies by year, and even varies within a specific year over the course of the winter. For example, in the results of a theoretical study graphed below, vaccine was 75% effective against laboratory-confirmed influenza, but it was only 30% effective against ILI when influenza caused 40% of ILI in unvaccinated people (Figure). Influenza vaccine would be estimated to be only 15% effective, however, if influenza viruses were responsible for only 20% of ILI at a particular point during the winter. This relationship is important because the percentage of ILI caused by influenza varies widely over time and geography. [h=5]Figure: The effect of non-influenza illnesses on an estimate of influenza vaccine effectiveness.[/h] Top [h=3]Why do estimates of influenza vaccine effectiveness vary widely?[/h]Estimates of influenza vaccine effectiveness are affected by several factors, including the specific study biases discussed above, the match between the vaccine influenza strains and the circulating strains, host factors and the sample size of a specific study. As noted above, the specificity of the outcome measured in a study has an important influence on the observed effectiveness. As more data are collected globally from annual studies that estimate effectiveness for RT-PCR confirmed influenza, it is expected that our estimates will become more refined. However, vaccine effectiveness will always vary from season to season, based upon the degree of similarity between the viruses in the vaccine and those in circulation, as well as other factors. In years when the vaccine strains are not well-matched to circulating strains, vaccine effectiveness is generally lower. In addition, host factors also affect vaccine effectiveness. In general, influenza vaccines are less effective among people with chronic medical conditions and among people age 65 and older, as compared to healthy young adults and older children. [h=3]How well do inactivated influenza vaccines work in randomized control trials?[/h]As noted above, effectiveness varies with vaccine match and the age and immune function of the recipient. In general, the greatest benefits of influenza vaccines have been reported in randomized controlled trials (RCTs) conducted among healthy adults. For example, recent RCTs of inactivated influenza vaccine among adults under 65 years of age have estimated 50-70% vaccine efficacy during seasons in which the vaccines' influenza A components were well matched to circulating influenza A viruses (Beran et al., 2009, 2006-2007 season; Jackson et al., 2010, 2005-2006 season; Monto et al., 2009, 2007-2008 season). As vaccine efficacy from a randomized clinical trial is the gold standard for how well a vaccine actually works, vaccine effectiveness estimates obtained from observational studies can equal, but not exceed, estimates of efficacy. Many factors that can result in substantial bias in effectiveness studies tend to bias the vaccine effect downwards. [h=3]How well do influenza vaccines work during seasons in which the vaccine strains are not well matched to circulating influenza viruses?[/h]When vaccine strains are not well matched with circulating influenza viruses, the benefits of vaccination may be reduced. For example, inactivated influenza vaccine effectiveness against laboratory-confirmed influenza was 60% among healthy persons and 48% among those with high-risk medical conditions in a case-control study among people 50–64 years old during the 2003-2004 influenza season, when the vaccine strains were not optimally matched to viruses in circulation (Herrera et al., 2007). However, in a year when the influenza vaccine and predominant circulating influenza viruses were poorly matched, researchers were not able to measure an effect of influenza vaccination against the respective vaccine component (Bridges et al., 2000). It is not possible to predict how well the vaccine and circulating strains will be matched in advance of the influenza season, and how this match may affect vaccine effectiveness. Top [h=3]How well do influenza vaccines work in people with chronic high-risk medical conditions?[/h]The presence of chronic medical conditions may also affect the effectiveness of influenza vaccines. For example, in an observational study of people 50–64 years of age, the vaccine was 60% effective in preventing laboratory-confirmed influenza among otherwise healthy adults 50–64 years of age, but only 48% effective among those who had high-risk medical conditions (Herrera et al., 2006). In general, vaccine efficacy and effectiveness estimates among people with high-risk conditions may be somewhat lower than among people of similar age without high-risk conditions. However, because the risk of influenza-related complications among this group is much higher, vaccination still provides important benefits. [h=5]Adults 65 years or older[/h]Only one large randomized, controlled trial of influenza vaccine has been conducted among an elderly population. During the 1991-1992 influenza season, a group of Dutch people 60 years of age and older not living in long-term care facilities (e.g., nursing homes) was studied (Govaert et al., 1994). In this study, vaccine efficacy was 58% in preventing clinically-defined influenza with serologic confirmation of infection. There are no published studies of the efficacy or effectiveness of influenza vaccines in preventing laboratory-confirmed, serious outcomes of influenza such as hospitalization, primarily because the size of the study would be large, and therefore, such a study is very expensive to conduct. Published observational studies conducted among people 65 and older not living in long-term care facilities have used non-specific outcomes, such as pneumonia hospitalizations or all-cause mortality. These studies may be subject to substantial confounding and selection bias, and they use outcomes in which the proportion of illness associated with influenza virus infections vary by season (as other respiratory viruses can cocirculate). As a result, it is difficult to interpret the results of these studies. [h=5]Adults 65 years or older in long-term care facilities[/h]All residents of long-term care facilities s (e.g., nursing homes) should receive annual influenza vaccination, as outbreaks of influenza can be explosive and result in substantial morbidity and mortality among residents of such facilities. There is evidence that vaccination prevents respiratory illnesses during periods of influenza circulation for elderly nursing home residents. For example, one study conducted during the 1991-1992 influenza season found that vaccination was associated with a 34% reduction in total respiratory illnesses and a 55% reduction in pneumonia during the two-week peak of influenza activity (Monto, 2001). In addition, one study conducted in UK nursing homes found that vaccinating health care workers decreased deaths during periods of influenza activity during one season with substantial influenza circulation, but not during the next year, when influenza activity was low throughout the winter (Hayward, 2006). [h=5]Children[/h]In a four-year randomized, placebo-controlled study of inactivated and live influenza vaccines among children aged 1–15 years, vaccine efficacy was estimated at 77% against influenza A (H3N2) and 91% against influenza A (H1N1) virus infection (Neuzil et al., 2001). A two-year study of children aged 6–24 months found that the vaccine was 66% effective in preventing laboratory-confirmed influenza in one year of the study (Hoberman et al., 2003). Only children who were fully vaccinated (i.e., had either two doses if not previously vaccinated, or one dose if previously vaccinated) versus unvaccinated children were included in the analysis. In the other year of this study, few cases of influenza occurred, making it difficult to assess the vaccine's efficacy (Hoberman et al., 2003). Children younger than 9 years of age who have not been vaccinated previously are recommended to receive two doses of vaccine the first year they get vaccinated. In subsequent years, they need only one dose. This recommendation was made because many children younger than 9 years of age have not been infected with influenza viruses previously, and a booster dose is needed for them to produce a protective immune response. Top [h=3]How effective is the live attenuated influenza vaccine (LAIV)?[/h]This vaccine currently is licensed only for healthy, non-pregnant people between 2 and 49 years of age. [h=5]Healthy Children[/h]Because LAIV (nasal spray) vaccine was licensed more recently than inactivated vaccines, there are more data available on its effects from large randomized trials. For example, a RCT conducted among 1,602 healthy children initially aged 15–71 months assessed the efficacy of trivalent LAIV against culture-confirmed influenza during two seasons (Belshe et al., 1998; 2000). In season one, when vaccine and circulating virus strains were well-matched, efficacy in preventing laboratory-confirmed illness from influenza was 93% for participants who received two doses of LAIV. In season two, when the A (H3N2) component was not well-matched between vaccine and circulating virus strains, efficacy was 86% overall. [h=5]Healthy Adults[/h]A randomized, double-blind, placebo-controlled trial among 4,561 healthy working adults aged 18–64 years assessed multiple endpoints (i.e., targeted outcome measures), including reductions in self-reported respiratory tract illness without laboratory confirmation, absenteeism, health care visits, use of antibiotics, and use of over-the-counter medications for illness symptoms during peak and total influenza outbreak periods (Nichol et al., 1999). The study was conducted during the 1997-1998 influenza season, when the influenza vaccine and circulating A (H3N2) viruses were poorly matched. Vaccination was associated with reductions in severe febrile illnesses of 19%, and febrile upper respiratory tract illnesses of 24%. Vaccination was also associated with fewer days of illness, fewer days of work lost, fewer days with health care provider visits, and reduced use of prescription antibiotics and over-the-counter medications. Among a subset of 3,637 healthy adults aged 18–49 years, LAIV recipients (n = 2,411) had 26% fewer febrile upper-respiratory illness episodes; 27% fewer lost work days as a result of febrile upper respiratory illness; and 18%–37% fewer days of health care provider visits caused by febrile illness, compared with placebo recipients (n = 1,226). Days of antibiotic use were reduced by 41%–45% in this age subset. A randomized, double-blind, placebo-controlled influenza virus challenge study among 92 healthy adults (LAIV, n = 29; placebo, n = 31; inactivated influenza vaccine, n = 32) aged 18–41 years assessed the efficacy of both LAIV and inactivated vaccine (Treanor et al., 1999). The overall efficacy of LAIV and inactivated influenza vaccine in preventing laboratory-documented influenza from all three influenza strains combined was 85% and 71%, respectively. These results were obtained after study participants, all of whom were susceptible to recently circulating influenza viruses before vaccination, were experimentally exposed to viruses. The difference in efficacy between the two vaccines was not statistically significant. [h=3]How do live attenuated vaccine and inactivated vaccines compare in vaccine efficacy and effectiveness studies?[/h]Few studies that directly compare live attenuated influenza vaccine (LAIV) and trivalent inactivated influenza vaccine (TIV) have been conducted, and results appear to differ for adults and children. More data are available for children than for adults. Among children, each of three RCTs comparing inactivated and live vaccines demonstrated that live vaccine offered better protection than inactivated vaccine. However, none of the studies included a placebo group, so the absolute efficacies of the two vaccines could not be assessed. One study included 2,187 children aged 6–71 months who had recurrent respiratory tract infections (Ashkenazi et al., 2006) and found overall influenza rates of 2.3% among live vaccine recipients and 4.8% for TIV, for a 52.7% decrease in children receiving live vaccine compared to those receiving inactivated vaccine. In a randomized study of 2,229 children aged 6–17 years with asthma, 4.1% of live vaccine recipients and 6.2% of TIV recipients developed influenza, for a relative reduction of 34.7% (Fleming et al., 2006). Finally, in 2004-2005 a multinational RCT was conducted among 8,352 children aged 6–59 months (Belshe et al., 2007). For the primary endpoint in this trial, culture-confirmed influenza-like illness, there were 45% fewer cases of influenza for well-matched influenza strains and 58% fewer for mismatched strains among live versus inactivated vaccine recipients. In contrast to the studies in young children described above, a RCT conducted among primarily college age healthy adults was conducted during three influenza seasons using three assignment groups, including a placebo group. Overall, the results suggested that inactivated vaccine may be more efficacious than live vaccine for this age group. For example, in the final season of the study, absolute efficacy against the influenza A virus was 72% for the inactivated vaccine and 29% (not significant) for the live attenuated vaccine. Therefore, the relative improvement in efficacy offered by the inactivated vaccine was 60% (Monto et al., 2009). The above studies taken together indicate that live and inactivated influenza viruses perform differently relative to each other in children and young adults. Top [h=3]What information is necessary to make assessments of vaccine effectiveness?[/h]Ideally, influenza vaccine effectiveness should be assessed on an annual basis, using a consistent methodology and similar populations. Use of a laboratory-confirmed outcome to assess vaccine effectiveness is important to provide the most specific results of the benefits of vaccination and to limit the impact of the co-circulation of non-influenza respiratory pathogens on estimates of vaccine effectiveness. Because the current recommendation for the United States is that all persons aged 6 months and older receive a vaccine each season, it is ideal if estimates of effectiveness can be made for children, adults and older adults. Because a proportion of older adults have chronic medical conditions and most in this age group seek vaccination, it is difficult to conduct and interpret influenza vaccine effectiveness in this population. CDC currently conducts annual vaccine effectiveness studies among people of all age groups recommended for annual vaccination (i.e., all aged 6 months and older). In addition, CDC conducts special studies targeted at answering more specific questions, such as estimating the effectiveness of inactivated vaccine in preventing laboratory-confirmed influenza hospitalizations among older U.S. residents. Link to comment Share on other sites More sharing options...
Contrarian Posted March 1, 2013 Share Posted March 1, 2013 I thought you were saying we can't mandate something that has proven benefit because it is not entirely benign. By that logic, we can not require them to do anything that isn't completely benign to their health. I'm missing the fallacy. What are the other options? Pick and chose what can and can't be forced? On what criteria? Who gets to pick what? What if I have active TB? Can you not force me to take treatment? cause the stuff sucks. I know. Are you basing your opposition on Freedom of choice? I'm all with you on personal liberties, but everyone has the liberty to not work somewhere. I thought I looked like an idiot working at a restaurant wearing required suspenders, but dem were da rules. A couple of problems with your response.... 1.) You couldn't possibly be equating something as serious as being compelled to INJECT something into your body with being required to wear a clothing item.... could you...??? Cause if you are... you should be expelled from PA school TODAY...!!! 2.) Nope...!!! Nowhere did I say... "we can't mandate something that has proven benefit because it is not entirely benign." What I said was MANDATING that people INJECT a substance with PROVEN risk into their bodies carries a lot of Ethical Quandries with it. 3.) Where were You taught that it was OK/Kosher to FORCE patients to do anything....???? (don't say the military because YOu haven't experienced THAT yet.... soon but not yet.) 4.) I have NO opposition to immunizations/vaccinations. As I stated, I think many of them are useful and took LOTS of them during my 8 yrs of military service with worldwide deployments. I've stood and functioned medically in OCONUS populations where the lack of a vaccination program caused significant problems that we rarely see here. So NO problem/opposition to vaccines. As stated above... if you were paying attention in college, Bioethics,has taught us that "compelling" folks to do things with their own bodies is BAD JuJu... As someone who recently signed up to protect "freedom"... I hope you under/overstand that "freedom starts cephal-caudally and then extends outward from there... Meaning: The "right" to vote, bear arms, etc... means Jack Schitt if you can be forced into having or NOT having a baby, a surgery, or a INJECTION. Said plainly... I tend to agree that if you don't like the rules work somewhere else... This agreement seriously conflicts with lots of Codified Ethics and Bioethics. I also think that this notion doesn't/shouldn't give employers carte blanche to usurp personal freedoms which are at the CORE of what YOU just joined the military to protect. I have a suspicion that many believe as I do because if they didn't... there wouldn't be a such thing as "EO/Sexual harrasement" Complaints cause a business owner could treat their employees as they please/ see fit and if the employee didn't like it, they coul just leave without any recompense. Fortunately, That's NOT how it works in civilized societies. Link to comment Share on other sites More sharing options...
Contrarian Posted March 1, 2013 Share Posted March 1, 2013 ... [your last post] ... Is really silly and completely avoids being called out on your ASSumption that MANDATING vaccination (requiring a patient to inject substances into their body) does anything to accomplish your stated goal... Link to comment Share on other sites More sharing options...
Corpsman2PA Posted March 1, 2013 Share Posted March 1, 2013 Ummm... Its a ethical quandry because innoculations/immunizations are NOT totally benign.."The vaccine, more than 30 million doses of which were given during the H1N1 flu pandemic in 2009-2010, contains a booster, or adjuvant, and may have triggered an adverse immune reaction in some children at higher genetic risk of narcolepsy, scientists said in new research published on Wednesday. Researchers at Britain's Health Protection Agency (HPA) who published the study in the British Medical Journal said the at least 14-fold increased risk they found had "implications for the future licensing and use of adjuvanted pandemic vaccines". Narcolepsy is a life-long disorder and thought to be an autoimmune disease in which patient's immune system attacks the body's own cells. Its symptoms include frequent bouts of daytime sleepiness and in its severe forms it also causes night terrors, hallucinations and cataplexies - when strong emotions trigger a sudden loss of muscle strength. Studies in Finland, Sweden and Ireland have also found a Pandemrix link to narcolepsy, and GSK says more than 800 cases linked to the shot have been reported in Europe.." Fallacy: --Misleading Vividness -- Misleading Vividness is a fallacy in which a very small number of particularly dramatic events are taken to outweigh a significant amount of statistical evidence. This sort of "reasoning" has the following form: Dramatic or vivid event X occurs (and is not in accord with the majority of the statistical evidence). Therefore events of type X are likely to occur. So according to this article, out of 30 million shots...and 800 reported cases...that's...carry the 1...about .000027% occurence? We'd all better buy lotto tickets and start wearing rubber suits to work to avoid the lightning strikes :) The hospitals and clinics make you wash your hands before entering each room with "chemicals" that can seap into your body and wreak havoc. AND they make you do it with warm hydrogen Oxide (Which, has been linked to causing death and has been the cause of numerous adverse events). What a bunch of sheep these providers are! How dare they require you to protect against your patient by handwashing with such dire and deadly chemicals!! I say we stop all handwashing in clinics/hospitals because it's just "Big Brother" controlling us from afar on his slippery slope. He can't tell me what to do! That's forced compliance at its best and I won't partake anymore! (<--- Borderline Straw Man :) Primum Non Nocere. If the flu shot helps my patients not become sick, or reduces their chance of infection when the encounter ME, then I'm willing to do it. I'm willing to wash my hands to prevent spread of disease. I'm willing to clean my stethoschope for the same reason. I'm willing to protect myself from other viruses out there. I choose not to eat fast food (look at ingredients in THAT next time you worry about a flu shot). Are patients exposed to hundreds of people each day that could transfer the virus to them? Yes. But those hundreds of people aren't putting their hands all over them, looking in their mouth, and examining them like a (good) HCP would be (unless said patient is the Japanese "spirit man"). Just a thought. Nobody has the "right" position on this debate. I think it's interesting how heated it gets though...especially when representatives of the profession say that they hope others "won't graduate from PA school" based off of a differing opinion. Heavy. Link to comment Share on other sites More sharing options...
Contrarian Posted March 1, 2013 Share Posted March 1, 2013 I'll repeat... You couldn't possibly be equating something as serious as being compelled to INJECT something into your body with being required to wear a clothing item.... could you...??? Cause if you are... you should be expelled from PA school TODAY...!!! Not even a close comparison.... those who don't understand this SHOULD NOT be responsible for caring for other folks health, well being and bodies... YEP .... that IS heavy...!!!! Contrarian P.S... if you are going to quote ME... do it correctly. A proper quote would be: Ummm...Its a ethical quandry because innoculations/immunizations are NOT totally benign... The rest was written by BMJ. Link to comment Share on other sites More sharing options...
Corpsman2PA Posted March 1, 2013 Share Posted March 1, 2013 I'll repeat... You couldn't possibly be equating something as serious as being compelled to INJECT something into your body with being required to wear a clothing item.... could you...??? Cause if you are... you should be expelled from PA school TODAY...!!! Not even a close comparison.... those who don't understand this SHOULD NOT be responsible for caring for other folks health, well being and bodies... YEP .... that IS heavy...!!!! Clothing item?? Nope. Transdermal chemical exposure. You couldn't possibly NOT KNOW what that is could you? Those who don't understand this SHOULD NOT be responsible for caring for other folks' health, well being and bodies... The bit about the "Expelled from PA school being heavy" was in reference to JMPA...not your clothing quote. I agree. Suspenders and injections don't mix. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted March 1, 2013 Moderator Share Posted March 1, 2013 Well, at least this is more interesting this time around compared to the fiasco last fall with that other guy Link to comment Share on other sites More sharing options...
Contrarian Posted March 1, 2013 Share Posted March 1, 2013 WTF are you moving your DSLs about...???? I was talking about him (Oneal) equating forced vaccination to wearing suspenders dumba$$... (see quote in post #44) Stand down until you actually KNOW WTF you are talking about....!!!!! Link to comment Share on other sites More sharing options...
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