UPDATE, Dec. 12, 2012: This story updates to include the position of the California Association of Health Facilities.
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In an effort to prevent health care workers from spreading the flu to patients this winter, county health officials are mandating that medical staff around the Bay Area receive vaccinations or wear a surgical mask on the job.
Health officials say flu vaccination rates among health care workers are dangerously low – 60 percent [PDF] of those working in California hospitals received the vaccine in the 2010-11 flu season, according to the most recent data available from the California Department of Public Health.
Officials hope the requirements will help prevent the spread of the virus to patients most vulnerable to its life-threatening complications, particularly the elderly, whose weakening immune systems may render the flu vaccine less effective.
However, county health officers say they have few resources to enforce the new orders, leaving it up to the discretion of hospitals, nursing homes, dialysis centers and other health care facilities to make sure their staffs are vaccinated.
Nationally, this year’s flu season has started early and may be shaping up to be a bad one, according to the Centers for Disease Control and Prevention. Among those locally requiring vaccination or masks this year are health officials in San Francisco, Alameda, Contra Costa, Santa Clara and Sonoma counties. Scattered counties around the state are doing the same.
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“This is a way that health care workers can prevent transmitting a possibly deadly disease to their patients,” said Erika Jenssen, communicable disease programs manager for Contra Costa Health Services.
The CDC recommends that everyone at least 6 months old get an annual flu shot; because flu viruses are constantly changing, a new vaccine is needed every year. But it is a recommendation that even some health care workers don’t follow.
Vaccinating patients is, unfortunately, no substitute for their caregivers receiving the shot. Some patients who are most at risk from flu complications don’t receive as much immunity from the vaccination as healthier people do.
All hospitals in California are required to offer free flu shots to their workers. Personnel must either get vaccinated or sign a statement declining to do so. Some people may not get the shots for medical reasons, such as those who have a severe allergy to chicken eggs, according to the CDC.
Jenssen, the Contra Costa program manager, noted that it’s possible to spread the flu to others before exhibiting symptoms.
“You, as a health care worker, could be spreading the flu to patients you’re caring for, even if you’re vigilant about staying home when you’re sick,” she said. People with medical conditions such as asthma, heart disease and chronic lung disease are among those most at risk for serious complications from the flu.
Sonoma County [PDF] has seen several significant influenza outbreaks in residential health facilities in 2012 alone, said Dr. Lynn Silver Chalfin, the county’s health officer.
A deadly outbreak at a long-term care facility in Santa Clara County in the late 1990s illustrates the problem. Only 17 percent of staff at the facility, which the county’s health officer declined to name, had been vaccinated against the flu. Sick staff introduced the virus to the facility, spreading it to patients.
“They vaccinated all these very frail people and assumed that they would be protected, yet the staff had such low rates that they got infected and passed it on to the people who had been vaccinated,” said Dr. Marty Fenstersheib, health officer for the county.
The outbreak caused two deaths and four hospitalizations, even though the vaccination rate among patients at the facility was nearly 100 percent. As people age, their immune systems begin to weaken, making the vaccination less effective, Fenstersheib said.
“Just because we give them the shot doesn’t mean that they will necessarily be protected,” he said.
In September, Gov. Jerry Brown vetoed a bill [PDF] that would have required California clinics and health facilities to achieve a 90 percent or higher flu vaccination rate by mid-2015. In his veto message, Brown professed confidence that local governments and health facilities could raise the rates without a new state law.
Some employers, such as Kaiser Permanente, have taken a strict approach in enforcing the requirements.
“As with other job requirements, especially those related to patient safety, failure to fulfill this job requirement can result in discipline up to and including termination,” Nathaniel Oubre, senior vice president and East Bay manager for Kaiser in Northern California, said in an email.
The California Nurses Association recommends that its members get the vaccine, but objects to mandating masks for those who refuse to do so or firing those who refuse to comply.
The California Association of Health Facilities, which represents most nursing homes in the state, encourages its members to comply with the mandates. Some nursing homes, though, oppose the mask requirement for unvaccinated staff.
“We’re trying to create a homelike environment, and then you’ve got someone with a mask coming to take care of you,” said Deborah Pacyna, spokeswoman for the association. “That could be disconcerting to a vulnerable elder.”
Some hospitals say the new requirements are boosting vaccination rates. At Sutter Delta Medical Center in Antioch, 67 percent of employees received the vaccine two years ago, the state Department of Public Health found. This year, 96 percent of the staff had been vaccinated by Nov. 28, said Dr. Brion Pearson, the hospital’s vice president of medical affairs.
“The mandate is helping,” he said. “We just want to encourage people to do the right thing.”