Friday, 7 October 2016

Metal Nurse: The importance of the flu vaccine

In my second year as a student nurse I decided to write a blog that pretty much transformed my musings from music to health care related stuff. It was about the flu vaccine. I think it was pretty good and so did others, to the point where one of my favourite internet pages, Skeptical Raptor, reblogged it. So here I am, nearly 2 years later having been qualified for over 18 months. Still having to refute myths about this vaccine. If you work in health care there is no good excuse to refuse the vaccine. You do not have an excuse. Lets begin with a few quotes from the NMC Code of Conduct from 2015:

  • "Always practise in line with the best available evidence."
  • "Act without delay if you believe that there is a risk to patient safety or public protection."
  • "Be aware of, and reduce as far as possible, any potential for harm associated with your practice."
  • "Take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public."
Those are the points that I feel are the most important. 
And of course according to the GMC Good Medical Practice:

  •  If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients
  • You should be immunised against common serious communicable diseases (unless otherwise contraindicated).

Swine Flu plush toy.
I would like to introduce the concept "Post hoc, ergo propter hoc.". Translates as "after this, therefore, because of this.". Basically it is when you want to connect one event to another because of reasons to make the world seem like a logical place. You see a butterfly, then a thunderstorm happens. That kind of thing. It's not a very rational thinking process. Okay, why am I talking about it here? One of the many many excuses I hear regarding the flu vaccine has been "My relative had the vaccine, then they ended up with a cold."
One thing does not have to correlate with the other. Especially when the common cold is caused by
coronaviruses and rhinoviruses. The flu is only caused by the influenza virus. And the flu kills. On a regular basis. According to WHO, the flu kills between 250.000 and 500.000, every year. In England in 2013-2014 the Public Health England recieved 904 reports of patients being admitted to ICU, out of those 98 died. That's a whopping 11% mortality rate. According to the European Centre For Disease Prevention and Control, the season between 2014 and 2015:

  • "In 15 European countries that report mortality data to the EuroMOMO project, an excess winter mortality rate of 231.3 per 100 000 above the seasonal baseline was observed. This excess was noted for more than 11 consecutive weeks and was the highest of the last five winter seasons."

No, the flu is not just a bad cold. It's a killer. But not just deaths that we should be concerned about it's the complications that follow having the flu, the complications that arise for those who suffer from chronic illnesses, like COPD or diabetes. For those who have pre-existing lung conditions, the flu is even more deadly. Not just deadly it also exacerbates the disease and they rarely every recovered back to baseline. But it has been found that the vaccine reduces hospitalisations of diabetics by 72%, and up to 52% of those who suffer from chronic lung disease. It reduces mortality and ischaemic episodes in those who are recovering from angioplasty. It also prevents cardiacvascular events. Some of the rarer but also dangerous complications from the flu include:
Influenza associated encephalopathy is a rare complications. But it does have up 30% fatality rate. It is most likely to affect babies from 6 to 18 months old. With one third of those affected will suffer from neurodisabilites. 

Meningitis is a complication that occurs due to a viral infection. The influenza virus being one of the more common virus that can cause it. 

Guillan-Barré syndrome, has long been associated with the flu vaccine. But there is a story behind that. All in all it's the story that sort of defines everything about science, how science develops knowledge and improves on what it knows and continues to define how we as healthcare professionals should follow the evidence. In 1976 there was a case of where it was linked to the flu vaccine, so researchers concluded that there might be a casual link between then the swine flu vaccine and GBS. The most current research fails to find any link between them. If you get infected by the flu you are at an increased risk of developing Guillan-Barré Syndrome, 17 times more likely to develop it in fact.

But why do I rail against health care staff who refuse to be vaccinated. Simple. We take care of acutely ill patients. We are around them all the time. We take care of people who are infected with some nasty nasty illnesses. One in three people who get infected by this virus are asymptomatic carriers. So the danger of infecting those who are vulnerable increases. Because you can pass on the virus without ever showing symptoms yourself. It is infectious for at least 24 hours prior to any symptoms developing and is infectious 5-7 days during the infection. Which is why herd immunity is so important, or community immunity for those who like concepts that rhyme. In a nutshell herd immunity is where there is enough people vaccinated against a contagious diseases to protect those who cannot be vaccinated and/or are vulnerable to disease that are easily spreadable. And (I will be repeating this point) healthcare professionals are a big part of that herd (or community) in hospitals. This is important to remember, there are people who rely on this. And all of them will be in our care. The list includes:

The list is of course not exhaustive.

Most healthcare workers seem to have no objections to vaccinating against other illnesses, like measles or hepatitis B. But somehow they seemed to have this blind spot when it comes to the flu vaccine.

The "I've never had the flu, so I don't need the vaccine" excuse doesn't work. For the same reason as "I never got pregnant, so I don't need contraceptives." Or  "I've never been in a car crash, so I don't need a seat belt." Don't work. I've never had hepatitis B, you can be sure that I'd have that vaccine again. Same goes for all of them. I've never had Tetanus, but you can bet your bloody arse that I'd get the Tdap if I've had a serious cut when walking around mother nature. I've never had Yellow Fever, Typhoid, Cholera, Japanese Encephalitis or Hepatitis A but yes I'd have that vaccine if I was travelling to those countries where they are prevalent.

And honestly I struggle to understand why, most of the time I think it is purely out of sheer bloody mindedness rather than actual facts. Some people see it as a form or rebellion against a higher authority. It's one small needle. Once a year. And it's there to protect us, our loved ones and those who we are taking care of. There is not beating around the bush about this. At worst we will get a sore arm, 24 hours sniffles and an immune system that will know how to battle the flu. It's a myth that you get a cold after a vaccine and it's a myth that healthy people don't need a vaccine.

I have come across people who just flat our state "I don't agree with it." What is there not to agree with? It's a low risk thing to do. Even young health people have died from the flu. In fact if you look at the greatest epidemic in human history, the Spanish flu, majority of those who died were aged between 20-50. The more I listen to people who object to it, the more I get convinced that it should be mandated as a requirement to work in healthcare, like they do in America. Require those who don't vaccinate to wear masks if necessary. We are there to take care of the patient. Not our ego. Our egos will heal, some of our patients might not because of ill-thought out refusals.

"What about my right to refuse?" Well, what about it. Yeah, sure you do have the right to refuse it. But what about the right of the patient  to be taken care of by someone who works within evidence based practice? What about the right of the patient to be taken care of by someone who takes every step to make sure that THEIR health and well-being is the centre of their care?

Is the vaccine perfect? No, sadly it isn't. But it still offers the best protection available. Currently it offers between 50% and 60% protection, which is damn sight better than 0%. Though currently there are some great developments in terms of developing a universal flu vaccine. The issue is that there is more money for pharmaceutical companies in people getting ill with the flu, rather than the vaccine. But as an organisation like the NHS, we save money on people getting the vaccine. There is a reason why every medical organisation in the world recommends that their staff have the annual flu vaccine. And it's all about protection.

Are there complications with the vaccine? Certainly, but they are rare. Redness, soreness and localised swelling are most common. 1-2% of those who get the vaccine might get a fever. Rarer side effects include hives, urticaria, racing heart and high fever. Anaphylaxis might occur in 1 case per million doses given. But 
compared to the chances of getting the flu, I'd rather have the vaccine.

We are there to  take care of and protect our patients from harm. We barrier nurse them. We gown up and use face masks when needed. We use gloves, we wash our hands. We give intravenous antibiotics and anti-virals. But a small needle that will protect you from a dangerous disease is somehow a step too far? Really?