December 18, 2011
In a letter to Colorado public health officials, the Association of American Physicians and Surgeons (AAPS) opposes a rule requiring workers in health care facilities to have an annual influenza vaccination or lose their jobs. Workers who had a rare religious or medical exemption would be required to wear a mask in patient care areas from November through March.
The religious exemption is too narrowly drawn, AAPS writes, and should be a philosophical exemption, as accepted in many states, to “to avoid inquisitions into matters of faith.” The mask requirement “seems to be nothing more than a punitive retaliation against those who decline the vaccine” and should be dropped, the AAPS letter states, as both immunized and nonimmunized individuals can transmit influenza or other illnesses.
The New Mexico study cited in support of the policy shows a tiny effect: an adjusted odds ratio of only 0.97 for confirmed influenza “outbreaks” (at least one case) in residents of long-term care facilities where 60% of direct-care workers were immunized compared with facilities with a 51% immunization rate. This means that in facilities where more workers were immunized, residents were still 97% as likely to get influenza. “Many other factors could account for the small difference,” states AAPS executive director Jane Orient, M.D.
In the age of “evidence-based medicine,” AAPS notes that there is surprisingly little evidence supporting the efficacy of influenza vaccine, and evidence of safety is also scant. According to a 2006 article in the British Medical Journal by Tom Jefferson http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1626345/, the coordinator of the vaccines section of the Cochrane Collaboration, safety data are reported in only five randomized studies with 2,963 observations. Many repeated doses of similar vaccines likely increase the risk of allergic reactions, and no data exist on the safety of a large number of doses, states Dr. Orient, citing a 2006 article in the Journal of American Physicians and Surgeons. http://www.jpands.org/vol11no3/geier.pdf
Immunizations and pertinent information should be made conveniently available to all workers in medical facilities, states AAPS. But the judgment of medical professionals should be respected; more than half choose to decline the annual shot.
The letter to Colorado officials is available. http://www.aapsonline.org/index.php/site/article/colorado_influenza_letter/
AAPS, a national organization of physicians in all specialties, was founded in 1943 to preserve and promote the practice of private medicine and the sanctity of the patient-physician relationship.