NURSING AT McLEAN

To be vaccinated or not to be vaccinated,
that is the question

by Paula Bolton, RN/NP

Why do so many healthcare workers avoid getting the influenza vaccine despite recommendations to the contrary? That's the question being asked in healthcare institutions across the United States. Answers vary: "I got the flu vaccine once and got the flu anyway." "I never get sick, but the year I got the vaccine, I was sick all the time." "I'm afraid of needles." "I'm afraid of Guillain-Barré syndrome." "I'm healthy, so even if I get the flu, I won't get that sick." As someone who makes an effort to encourage healthcare providers to get the flu vaccine, I've heard all the excuses.

     Let me try to dispel some of the myths about the flu vaccine.

     Flu vaccine does not cause the flu. The injectable vaccine contains only inactivated (killed) viruses and cannot cause influenza disease. Fewer than 1% of people who are vaccinated develop symptoms of mild fever and muscle aches after vaccination. That is not the flu. The intra-nasal influenza vaccine contains attenuated viruses that are incapable of replicating in the lungs and therefore do not cause the flu. Common side-effects of this vaccine include runny nose or nasal congestion, headache, and mild sore throat. Again, not the flu.

     The risk of more serious side-effects is extremely low. In 1976, the swine flu vaccine was associated with Guillain-Barré syndrome (a nerve condition that can result in temporary paralysis). Since that time, no influenza vaccine has been positively associated with this syndrome. If there is any risk at all, it's only one or two cases per million doses of flu vaccine. The risk of getting severe flu with complications is much higher.

     Flu vaccine varies in its protection against flu viruses because of the way vaccine strains are determined. Usually, in the spring before flu season, infectious disease experts determine what flu viruses are circulating in the world and which ones are likely to affect our area. Flu vaccines are then produced based on the best estimates of these experts. That's why some years (such as last year) the flu vaccine does not exactly match the flu viruses in circulation. Usually, flu vaccine gives some measure of protection even when it isn't a perfect match.

     Healthy people do get the flu, which is characterized by malaise, upper-respiratory symptoms, fever, and cough. Serious sequelae can occur even in young, healthy people, although the elderly, the very young, and those with chronic medical conditions are at higher risk for serious complications from flu infections. Unfortunately people who become sick with the flu are infectious a day or two before symptoms occur. This means they can spread the flu even before they know they're sick. Every year in the United States 5-20% of the population get the flu, approximately 200,000 people are hospitalized with complications from the flu, and about 36,000 people die from those complications.

     So, my recommendation? Get vaccinated to keep yourself healthy-especially if you're exposed to someone with the flu. Get vaccinated to keep your patients, clients, and family healthy, as well. The Centers for Disease Control and Prevention and the Massachusetts Department of Public Health urge all healthcare workers to step up and be vaccinated.