ECDC: Influenza Virus Characterization – Sept 2012

 

 

# 6621

 

The only thing truly constant with influenza viruses is that they are continually changing. As flu viruses leave behind varying levels of immunity in those they infect - were they not to change over time - they would soon die out due to a lack of susceptible hosts.

 

Influenza viruses evolve via two well established routes; Antigenic drift and Antigenic Shift (reassortment).

 

Antigenic drift causes small, incremental changes in the virus over time. Drift is the standard evolutionary process of influenza viruses, and often come about due to replication errors that are common with single-strand RNA viruses.

 

Shift occurs when one virus swap out chunks of their genetic code with gene segments from another virus.  This is known as reassortment. While far less common than drift, shift can produce abrupt, dramatic, and sometimes pandemic inducing changes to the virus.

 

For shift to happen, a host (human, swine, bird) must be infected by two influenza different viruses at the same time. 

Reassortment of two Flu viruses

 

While successful reassortment is relatively rare, as any virologist will tell you . . . Shift happens.

 

While we talk about four main strains of influenza that currently circulate in humans (A/H1N1(pdm), A/H3N2, B Victoria, B Yamagata), in reality – within each strain - you will find a good deal of diversity.

 

New `prototypes’ from  these strains are constantly being generated and are then immediately`field tested’ for biological fitness and transmissibility. 

 

Most fail miserably.

 

But occasionally, a new, biologically fit virus will emerge that can outcompete its parental strains, and it begins to spread rapidly.

 

Since flu vaccine formulations must be decided upon six months before they can be deployed, public health agencies like the CDC, ECDC, Hong Kong’s CHP  (and others) spend considerable resources on influenza surveillance, looking for signs of any up-and-coming viral strains.

 

Once each month the ECDC issues an influenza characterization report, showing what changes have been detected in the influenza viruses circulating in Europe. 

 

Below you’ll find a link to their recent report, and a brief summary of the highlights.

 

Influenza virus characterisation - Summary Europe, September 2012

 

 

ABSTRACT

Since 01 January 2012, influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B/Victoria and B/Yamagata lineage viruses have been detected in ECDC-affiliated countries.

• Type A viruses have predominated over type B.
• A(H3N2) viruses have predominated over A(H1N1)pdm09 viruses.
• A(H1N1)pdm09 viruses continue to show genetic drift from the vaccine virus, A/California/07/2009, but the vast majority remain antigenically similar to it.
• During the last nine months, all European A(H3N2) viruses sequenced fell within five genetic clusters. Test viruses isolated in mammalian cells show low titres with post-infection ferret antisera raised against egg-propagated viruses, including the new vaccine virus A/Victoria/361/2011. They react well with post-infection ferret antisera raised against A/Victoria/361/2011 and other current reference viruses propagated exclusively in tissue culture.
• Recent B/Victoria lineage viruses fell within the B/Brisbane/60/2008 genetic clade and were antigenically similar to reference cell-propagated viruses of the B/Brisbane/60/2008 genetic clade.
• Recent B/Yamagata-lineage viruses fell into two genetic clades, represented by the recommended vaccine component for the 2012/2013 influenza season, B/Wisconsin/1/2010 (clade 3), or B/Estonia/55669/2012 (clade 2); viruses in these clades are antigenically distinguishable.
• Antigenic analyses of A(H3N2)v viruses, the cause of zoonotic infections in the USA, indicate that these viruses are antigenically distinct from seasonal A(H3N2) viruses.

 

The best news in this report is that most of the newest iterations of the (now seasonal) 2009 pandemic H1N1 virus continue to be antigenically similar to the original virus, and this year’s vaccine should be reasonably effective against it.

As for the growing diversity and antigenic drift among the A/H3N2 viruses (now 5 distinct subtypes), we’ll have to wait to see how much of an impact they will have on the overall VE (Vaccine Effectiveness) of this year’s flu vaccine.

 

We are also seeing signs of divergence in the Yamagata lineage between this year’s vaccine component clade 3 virus (B/Wisconsin/1/2010) virus and a newer clade 2 virus (B/Estonia/55669/2012).

 

Despite the inevitable diversity being reported in flu viruses across Europe, the World Health Organization recently released their Southern Hemisphere 2013 Flu Vaccine Composition recommendations, which remain unchanged from this fall’s vaccine.

 

Which is a pretty good indication that their confidence in the makeup of this fall’s flu vaccine remains high.

Prof. Peter Doherty On The Challenge Of Developing A Universal Flu Shot

 

 

# 5957

 

Every few months the media barrages us with stories about the latest step forward towards the holy grail of influenza research; a one-time universal flu shot. 

One that would protect against all strains of influenza and last – if not a lifetime – many years.

 

Many of these `news’ reports are based on `forward looking statements’ or press releases by universities, research organizations, and other entities.

 

Often the media fails to mention in these reports that while progress is being made, there remain substantial obstacles to overcome, and any universal vaccine is still likely years away. 

 

After all, why complicate a perfectly good story with downer details like that?

 

In Part II of his series on the challenge of influenza, Australian Nobel Prize winning scientist Professor Peter Doherty outlines some of the approaches being used in the hunt for a universal flu jab, and some of the substantial difficulties that still lie ahead.

 

As Professor Doherty states in his article::

 

`The science of vaccine creation is complex, technical and incomplete and the road to a universal flu vaccine is long.’

 

11 November 2011, 2.33pm AEST

Search for the elusive universal flu vaccine

 

 

Yesterday, in Prof. Peter Doherty On Influenza’s Threat, we looked at Part 1 of this series.

Flu Shot Ethics

 

 

Photo Credit – CDC PHIL

# 5866

 

This week I’ll stop by my local pharmacy and get my seasonal flu shot. No, I don’t particularly like taking the time, or spending the $30 (my insurance doesn’t cover it), to do this every year.

 

And I usually end up with a sore arm for a couple of days.

 

But I get the shot not only to protect my own health, I do it to protect those around me; family, friends, and even casual contacts I might meet.

 

People like my Dad, who will be 87 in November.

 

Last year he contracted an ILI (influenza-like-illness) over the Christmas holidays which evolved into pneumonia, and we almost lost him. 

 

I don’t know for sure that his flu-cum-pneumonia was vaccine preventable (for reasons why, see BMC Study: A Crowded Viral Field), but when the stakes are this high, I consider it my duty to try to reduce the risks as much as I possibly can.

 

While I can’t do much (beyond practicing good flu hygiene) about catching the various adenoviruses, rhinoviruses, coronaviruses, Parainfluenzas, or Human metapneumoviruses out there, I can significantly reduce my odds of catching . . . and spreading the flu.

 

And yes, Dad got the flu vaccine last year.  But at the age of 86, his immune system doesn’t mount as robust of a response to the vaccine as would a younger person.

 

          *       *       *      *      *      *      *

Earlier this year, NFID - the National Foundation for Infectious Diseases - convened a panel of experts to address the issues of influenza and the elderly that included such familiar names in public health as Arnold Monto, MD; Kristin Nichol, MD, MPH; H. Keipp Talbot, MD, MPH; and William Schaffner, MD.

 

From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.

 

Although the elderly generally see less protection from the flu vaccine, older individuals may still mount a robust immune response. In populations 65 and older, the brief points out that:

 

• Hospitalization rates for influenza and pneumonia are lower in community-dwelling adults who received the seasonal influenza vaccine.
• Immunization is associated with reduced hospitalization of older patients for cardiac, respiratory, and cerebrovascular diseases.

 

While the goal of vaccinating the younger population is to prevent infection, the authors point out that:

 

. . . the goal in older adults is to prevent severe illness, including exacerbation of underlying conditions, hospitalization, and mortality.

 

In other words, even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.

          *       *       *      *      *      *      *

 

 

But it isn’t just the elderly (and myself) that my flu shot helps to protect. 

 

By denying the virus a susceptible host, I help limit its ability to spread in my community. And that means I’m helping to protect younger adults, children, and even infants (who, under 6 mos. of age can’t be vaccinated). 

 

Unfortunately, based on the most recent flu vaccination numbers published by the CDC’s MMWR (see FluVaxView Report ), last year only a little over 1/3rd of the residents in my state took it upon themselves to do the responsible thing and get vaccinated.

 

 

Even in the top five states (Maryland, Hawaii, Massachusetts, Rhode Island, and South Dakota) coverage was less than 60%.

 

And among healthcare workers (HCWs) – who have the opportunity to spread the flu to the most vulnerable members of our society – uptake of the vaccine in the United States last year was reported recently to have been just over 60%.

 

Despite resistance from some HCWs, calls for mandatory flu vaccination among health care workers have been coming from many directions. Earlier this year, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Numerous professional medical organizations, however, have adopted policies calling for mandatory vaccination of HCWs.  A few earlier blogs on that include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

Today, with another flu season approaching, Katherine Harmon writing for Scientific American asks a number of infectious disease experts:

 

Are Health Care Workers Who Decline Flu Shots Irresponsible?

More than a third of U.S. health care employees were not vaccinated last flu season. Research shows that the unvaccinated staff have a decent chance of getting sick--and passing that infection on to at-risk patients

 

 

While the answers vary in terms of diplomacy, the consensus is that HCWs who do not get vaccinated against influenza are putting their patients at unreasonable (and unnecessary) risk.

 

Which is why – despite protests from some employees – an increasing number of hospitals and medical offices are making flu vaccination mandatory this year. A few recent headlines illustrating this growing trend include:

 

Mandatory Flu Shots For Children's Medical Center Employees

Hospital's 'Cocoon Strategy' Aimed At Protecting Young Patients

 

Local health system mandates flu vaccine for upcoming season

 

Hospitals Making Flu Vaccine Mandatory for Employees

 

 

Increasingly, hospitals are looking at this as both a liability and an economic issue, on top of their concerns over patient welfare. 

 

But no matter your job description, unless you live alone in a cave somewhere, you have the potential to spread the serious – and sometimes life-threatening – influenza virus.

 

Getting a flu shot every year can significantly reduce (but not completely eliminate) that risk.

 

That, and practicing good flu hygiene (covering coughs, sneezes, washing hands, staying home when sick), can literally save lives.

 

Which makes getting the flu shot not only smart in terms of protecting your own health, but it also makes it, without a doubt, the ethical thing do do. 

Lancet: Progress Towards A Dengue Vaccine

 

 

 

# 5264

 

 

2010 was the year that Dengue Fever finally began to receive the public attention here in the United States (and in the rest of the developed world) that it truly deserves. 

 

As is too often the case, our newfound concern has been largely spurred – not by concerns over the huge burden the disease has placed in poorer tropical regions for decades – but by the recent influx of cases into more developed countries. 

 

The return of dengue fever to Florida after an absence of 60 years, and the worst epidemic of Dengue fever in Puerto Rico in decades, have both raised awareness.

 

Similarly, locally acquired dengue has been showing up in Australia and Hong Kong, and in travelers returning from areas where the virus is endemic.

 

As Maryn McKenna wrote yesterday in her blog (see Spreading cholera, maybe polio: Now will we care about Haiti?) - “infectious diseases do not respect borders”.

 

Unlike even a few decades ago, we cannot depend upon vast oceans and prolonged travel times to protect us against the encroachment of exotic diseases into previously immunologically naive regions.

 

Simply put, we neglect them at our own peril.

 

While our dengue awareness may be relatively new, the explosion in cases has been accelerating for decades. The World Health Organization now estimates there may be as many as 50 million dengue infections each year. 

 

 

Since the 1950s a rare, but far more serious form of the disease – DHF or (Dengue Hemorrhagic Fever) –  has emerged.  

 

PAHO recently released new numbers on dengue in the Americas for 2010, in this pdf file, dated December 10th.    So far, more than 1.5 million cases have been reported (many more are likely undiagnosed).

 

 

Over the past few months we’ve seen a number of reports on novel attempts to prevent dengue by controlling the mosquito vector, including:

 

The Cayman Island Mosquito Trials

Malaysia: `Terminator’ Mosquito Field Test On Hold

 

The introduction of GM (genetically modified) mosquitoes have exciting possibilities, but their effectiveness in the wild remains unproven.

 

The other big hope is to come up with a safe, effective, and affordable vaccine.  And a number of vaccine candidates have been under study for several years.

 

I’ve written in the past about the race to produce a safe and effective dengue vaccine by number of different companies and entities, including Sanofi, the NIAID vaccine trials, GlaxoSmithKline , Hawaii Biotech Inc (HBI), and an entry created by Inviragen and the CDC.

 

One of the major obstacles in developing a vaccine is that there are four strains of dengue; DEN1 – DEN4. Single strain live attenuated Dengue vaccines have been developed and tested, and seem effective.

 

They aren’t considered a good solution, however, because having antibodies to one strain of dengue can make an individual more likely to develop the more dangerous hemorrhagic form of dengue when exposed to a different strain.

 

Today, a correspondence appears in The Lancet (free registration required for access), outlining progress being made towards a viable dengue vaccine.

 

The Lancet, Volume 377, Issue 9763, Pages 381 - 382, 29 January 2011

doi:10.1016/S0140-6736(11)60128-

Dengue vaccine prospects: a step forward

 

Bruno Guy a, Jeffrey Almond a, Jean Lang a

PREVIEW

The worldwide expansion of dengue fever is a growing health problem. Crucial issues surround this global expansion and some of them present some challenges for vaccine development. Nevertheless, several promising approaches are being investigated in both academic and industrial laboratories.1 Vaccine candidates include live, attenuated vaccines obtained via cell passages or by recombinant DNA technology (such as those being developed by the US National Institutes of Allergy and Infectious Diseases, InViragen, Walter Reed Army Institute of Research/GlaxoSmithKline, and Sanofi Pasteur), and subunit vaccines (such as those developed by Merck/Hawaii Biotech).

 

 

While the authors state that - `a dengue vaccine is now within reach’  and `we can reasonably expect to address the crucial and urgent medical need for this vaccine in the near future’ -  human clinical trials are just starting, and a safe, effective, and available vaccine is still several years away.

 

But it is progress.

 

NPM10: Vaccination As Part Of Your Preparedness Plan

 

Note: National Preparedness Month continues, and today the focus is on vaccinations as part of your preparedness plan.

You can follow this month long awareness campaign on Twitter by searching for the #NPM10 hash tag.

# 4919

 

 

Having just gotten my yearly flu shot on Saturday (see Already Working On My Antibodies For The Fall), I started thinking about how long it has been since my last Tetanus booster shot. A little digging through my files provided the answer.

 

I found my vaccine history card which placed it as the fall of 1999. 

 

Meaning I’m due for another booster shot.

 

Most people think of vaccines as kids stuff.  Something you outgrow the need for.  But that isn’t true.  Adults need vaccines as well.

 

During a major disaster - such as an earthquake, hurricane, or flood -  thousands, perhaps tens of thousands of people may sustain injuries ranging from small cuts and scrapes to major trauma.

 

And any of those who have let their tetanus booster vaccination lapse are at risk of serious, even life threatening, infection.

 

Even if you can obtain a tetanus shot immediately after an injury (and that could be problematic in a mass casualty event), that may not prevent infection.  It can take up to two weeks to build antibodies after getting the shot.

 

 

Tetanus is relatively rare in the United States (see Tetanus Surveillance --- United States, 1998—2000) due to aggressive vaccination campaigns, but worldwide, this infection still claims hundreds of thousands of lives each year. 

 

And the Tetanus booster shot also protects against Diphtheria and Pertussis (Whooping Cough) – an old scourge that once was almost vanquished here in the United States, but has returned with a vengeance in recent years (see California Reports 9th Pertussis Fatality of 2010)

 

While many people avoid the flu vaccine each year, in the wake of a disaster thousands of people may find themselves temporarily crowded together in shelters, where an influenza virus could spread rapidly.

 

And of course, being down with the flu during a crisis isn’t exactly a good plan, either.  

 

Imagine trying to evacuate your home quickly with a couple of very sick kids, or the difficulties you might encounter finding a place to stay if your family were visibly ill with a communicable disease.

 

A simple flu vaccination each fall could go a long way towards preventing these scenarios.

 

If you have kids, talk to their pediatrician or your family doctor about what vaccinations they require.  

 

Adults can either ask their physicians, or refer to this handy vaccination schedule for adults provided by Immunize.org.

 

 

(Click to load)

 

 

Now . . .  where’s the number for my local health department?  

 

I need to schedule a booster shot.

Study: Vaccinating Kids Promotes Herd Immunity

 

 

# 4416

 

 

The recent push to vaccinate children against seasonal influenza every year is based, in part, on the idea that kids are very efficient spreaders of the virus – and that if you can reduce their susceptibility to infection – you can reduce the influenza burden on the entire community.

 

Today we’ve a new study out of Canada that seems to support this theory, suggesting that vaccinating kids helps protect the entire community.

 

Helen Branswell of the Canadian Press brings us the details, and I’ve included the NIAID press release as well.   Follow the link to read Helen’s article in its entirety.

 

 

Want to reduce amount of flu in adults? Vaccinate kids, study shows

By Helen Branswell Medical Reporter (CP) – 2 hours ago

TORONTO — A landmark study looking at how to limit the spread of influenza has shown what experts have long believed but hadn't until now proved: Giving flu shots to kids helps protect everyone in a community from the virus.

 

The study, led by Dr. Mark Loeb of McMaster University in Hamilton, Ont., showed the risk of catching the flu was lowered by nearly 60 per cent in communities where a substantial portion of kids aged three to 15 got flu shots.

 

That level of indirect protection is nearly as good as what healthy adults might expect from getting a flu shot themselves and is perhaps better than what a senior with a waning immune system might expect from a flu vaccination.

(continue . . .)

 

 

Vaccinating Children against Flu Helps Protect Wider Community

Trial Results in Rural Canadians Show Effect of Herd Immunity

WHAT:

Results of a clinical trial conducted in a largely self-contained religious community during the 2008-09 influenza season show that immunizing children against seasonal influenza can significantly protect unvaccinated community members against influenza as well. The study was conducted to determine if immunized children could act as a barrier to limit the spread of influenza to the wider, unvaccinated community, a concept known as herd immunity.

 

Researchers recruited volunteers from 46 Canadian Hutterite religious colonies that have limited contact with surrounding, non-Hutterite populations. A total of 947 children between 36 months to 15 years of age participated in the trial; 502 children in 22 colonies received 2008-09 seasonal influenza vaccine, while 445 youth in the other colonies received hepatitis A vaccine. The hepatitis A vaccine served as a control vaccine for comparison.

 

In the six months after the children were vaccinated, 119 of 2,326 unvaccinated community members (who were of all ages) developed laboratory confirmed cases of influenza. Of these, 80 of 1,055 were from colonies where children received hepatitis vaccine, while 39 of 1,271 were from colonies where children received the influenza vaccine.

 

The researchers found that influenza vaccination was 61 percent effective at indirectly preventing illness—that is, protecting via herd immunity—in unvaccinated individuals if they lived in a colony where approximately 80 percent of the children had received flu vaccine. The findings, they write, “...offer experimental proof to support selective influenza immunization of school aged children…to interrupt influenza transmission. Particularly, if there are constraints in quantity and delivery of vaccine, it may be advantageous to selectively immunize children in order to reduce community transmission of influenza.”

 

Mark Loeb, M.D., of McMaster University, Hamilton, Ontario, led the trial. The research was funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and by the Canadian Institutes for Health Research.

 

Visit the NIAID Web site to see an illustration showing how vaccination generates herd immunity. 

ARTICLE:

M Loeb et al. Effect of influenza vaccination of children on infection rates in Hutterite communities. JAMA 303:943-50 DOI: 10.1001/jama.303.10.943 (2010).

 

 

 

Credit NIAID

Compulsory HCW Vaccinations Revisited

 

 

# 4222

 

 

One of the most contentious pandemic issues to arise during the past six months has been the notion that HCW’s (Health Care Workers) should be required to get vaccinated against pandemic and seasonal influenza.

 

New York State attempted to require vaccination as a requirement to work as a HCW, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

While New York was the only state to try to mandate flu vaccination for HCWs,  the suspension of that ruling doesn’t mean the issue has gone away.

 

• Some hospitals around the nation have adopted mandatory vaccination – or require the wearing of masks by unvaccinated workers during flu season.
• APIC (Association for Professionals in Infection Control and Epidemiology) has been promoting the idea of mandatory flu shots for HCWs for over a year (see APIC Seeking Mandatory Flu Shot For HCWs)
• And the New York State Health Department indicates that they will pursue mandatory vaccination again in 2010, assuming adequate vaccine supplies are available.

 

I strongly support the idea that HCWs should get vaccinated, but I fell short of wanting to see that mandated with this year’s vaccine. (See Public Support For Mandatory HCW Vaccination).  

 

Forcing vaccinations during a time when a sizable portion of Health Care workers perceived the vaccine to be `untested and unsafe’ (it isn’t) seemed to me to be terrible timing and almost certain to backfire.  

 

Better to implement this sort of thing during a non-pandemic year, I should think, when the release of a `new’ vaccine isn’t clouding the issue. 

 

I do believe the day is coming when most states will require yearly flu vaccines for HCWs, and I am generally supportive of the idea.  

 

But before that can happen, better education of the workforce needs to be implemented, and steps must be taken to make getting the shot easy, free, and convenient.

 

Despite the vocal outcry in New York State against mandatory flu shots, at least one poll – highlighted in this month’s issue of Archives of Pediatrics & Adolescent Medicine - indicates broad support (70%)  for compulsory vaccination of HCWs.

 

This report from Medscape, followed by the study’s abstract.

 

 

Most Healthcare Workers Support Compulsory Influenza Vaccinations

Nancy Fowler Larson

January 5, 2010 — Most healthcare workers (HCWs) approve of mandatory influenza vaccines for hospital employees, and their numbers could be further boosted by giving opponents more information, according to a study released yesterday in the January 2010 issue of the Archives of Pediatrics & Adolescent Medicine.

 

"Influenza is responsible for an estimated 36,000 deaths and 226,000 hospitalizations every year in the United States," write John D. Lantos, MD, from Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri, and colleagues. "The Centers for Disease Control and Prevention recommend that all [HCWs] receive an annual influenza immunization to protect themselves and their patients. Nevertheless, only 40% of HCWs in the United States get immunized every year."

 

At greatest risk for influenza infection are children and the elderly. Although vaccination rates are greater at pediatric hospitals, some continue to have low rates even in high-risk units. With the eventual goal of protecting pediatric and other populations in hospital settings, the study sought to determine the level of support for mandated vaccinations among HCWs and to pinpoint differences in the beliefs and behavior of supporters vs opponents.

(Continue . . .)

 

 

Excerpts from the abstract which appears in this month’s Archives of Pediatrics & Adolescent Medicine.

 

Health Care Worker Knowledge, Attitudes, and Beliefs Regarding Mandatory Influenza Vaccination

Lauren E. Douville, BS; Angela Myers, MD, MPH; Mary Anne Jackson, MD; John D. Lantos, MD

Arch Pediatr Adolesc Med. 2010;164(1):33-37.

 

Objective To determine the attitudes, beliefs, and knowledge of children's hospital health care workers toward mandatory influenza vaccination.

<SNIP>

 

Results Many employees (70%) thought influenza vaccination should be mandatory for health care workers who did not have a medical contraindication. Nearly everyone, 363 of 391 (94%), who favored mandatory immunization had been immunized themselves. Of those who opposed mandatory immunization, 45 of 81 (55.6%) had been immunized (P < .001). Individuals who supported mandatory policies were more likely to believe that the vaccine is safe for both children and adults.

There was no significant difference between the percentages of promandate and antimandate employees who believed influenza was dangerous for the patients where they work (66.5% and 62%, respectively, P = .07). Only 29% of antimandate employees believed they were at high risk of contracting influenza, compared with 51% of promandate employees (P < .001).

Conclusions Approval of mandatory influenza vaccine policies was high; however, attitudes about the dangers of influenza for patients were not associated with acceptance of mandatory vaccination policies for health care workers. Educational efforts targeting health care workers' fears and misconceptions about influenza vaccines might help to decrease the reservoir of unimmunized health care workers.

 

 

 

A few blogs from the past year on this subject include:

 

Public Support For Mandatory HCW Vaccination

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

BJC: Mandatory Flu Shots For HCWs