"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 597.6 Pt. 2

Guest: Dr. Gregory Poland, Prof. Med, Mayo Medical School. Chief, Mayo Vaccine Research Group

Topic: Flu vaccines for health workers

Host/Producer: Steve Girard 

NEMA: Thanks for staying with us. Tens of thousands of people die from the flu and pneumonia each year, but a majority of those people...mainly the elderly...don't have to succumb to the diseases...because there are safe vaccines for them. Today, our guest is Dr. Gregory Poland, a professor of medicine at the Mayo Medical School in Minnesota, and chief of the Mayo Vaccine Research Group. Dr. Poland, you spoke at a recent press conference about this issue...why? 

POLAND: Well, first of all, it was just the timeliness of it. This is the start of the influenza immunization season, and it is an appropriate time for people that should get the vaccine to also consider getting the pneumococcal vaccine. So, our purpose was to, number one: call attention to the fact that now's the time to get the vaccine. Number two: to make people aware of the increasing resistance to all the antibiotics we have, with certain strains of that pneumococcal bacteria...and thirdly: to kind of give some press and some notice to more recent findings that have finally shown...we never have had really great data on this...but now have shown, that if health care workers who are employed in long term care facilities, get flu vaccine...there's as much as a 60% decrease in the death rate among the residents. That is, the elderly, frail people who live in long term care facilities, and we thought it was important to get that message out. 

NEMA: Who should get which vaccine?...and how many health care workers actually get vaccinated? 

POLAND: The pneumococcal vaccine is really meant only for people aged two and older who have some kind of chronic, serious medical problem...and for everybody aged 65 and older. So, few health care workers actually get the pneumococcal vaccine. They should, however, get the influenza vaccine, and past surveys have shown that only about 25 -30% of health care workers who work in long term care facilities actually get the vaccine. The number, interestingly enough, tends to be much higher in acute care settings, like hospitals. However, I will say there's not been a recent survey, in the last one, two or three years, and like all groups that are recommending to get the vaccine, we have seen an increase in the number of people who get the flu vaccine. 

NEMA: that's good....because the health care worker doesn't want to be the one to carry the bug through the door... 

POLAND: Absolutely. They are bringing the flu into the facility. They have patients get infected with it, or if a patient gets infected through some other route, they are carrying the virus, patient to patient. And by health care workers in long term care facility, we're talking about the receptionist, the dietary worker, the physical therapist...not so much just doctors and nurses.  

NEMA: One of the great dangers to the elderly is that flu can turn into pneumonia... 

POLAND: Of course, this is right to the heart of the matter. When an elderly, frail person gets influenza, they are at very high risk of complications or death. And by complications, what we primarily mean is either an exacerbation...a worsening of their underlying problem. So, for example if they have diabetes, their diabetes may go out of control. Or developing pneumonia...even a bacterial pneumonia, as a result. A proportion of those people who get influenza will end up being hospitalized, and between one and ten percent of them will die as a result of getting influenza.  

NEMA: Some people don't get a vaccine because they've heard that they might get a bit ill as a result of the shot. Is that true? 

POLAND: Well, no...it's not. In fact, in 1990 or '91, we published a very large study, where we gave half the people a flu shot, and half the people a placebo...but it was double blind, so we didn't know what we were giving them...they didn't know what they got. Only the pharmacist who worked with us knew. And what that study showed was that all of the symptoms that people attribute to the flu shot also happen with placebo. It has nothing to do with having the flu shot. It has to do with the time of year and the thousands of respiratory viruses and illnesses that are spread this time of year. And the point I would make is that the flu vaccine is safe, and effective. What many health care professionals don't even realize is that each year in the United States, between 20 thousand and 40 thousand Americans die of this vaccine-preventable disease. We lose another 40 thousand people a year due to pneumococcal, so together, influenza and pneumococcal infection, both of which are vaccine-preventable, cause as many, or more deaths as breast cancer and AIDS...combined! And can you imagine, if we were announcing that we had a safe and effective vaccine against breast cancer, or against AIDS, I think people would be beating our doors down trying to get that vaccine. Yet, there's not the same weight, even though there are the same, or more deaths given to influenza and pneumococcal disease. it's a paradox. 

NEMA: What can we do for those in our family that are susceptible to the flu...at home or in a long term care facility...to be more proactive...? 

POLAND: that's a very good question. What I would recommend to anybody who's aged 65 or older, anybody with a serious medical condition, anybody living in a nursing home or long term care facility...they should get influenza vaccine and pneumococcal vaccine. The family, even the health young family members who are going to visit....or perhaps that person is living in their home...those people should also get the influenza vaccine, to help protect not only themselves against influenza, but also to protect that elderly person who, as we mentioned, if they get influenza, it just won't be feeling bad for a day or two...it could mean being hospitalized or dying. 

NEMA: The bottom line is that we may be able to save as many as 60 thousand people from succumbing to flu and pneumonia. Get the vaccine if its appropriate. Our thanks to Dr. Gregory Poland of the Mayo Medical School in Minnesota.