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Flu season severe: FluMist may pose little risk
With this year’s flu season shaping up to be the worst in years, encouraging your own staff to get vaccinated is one of the best things you can do to prepare for the onslaught. The new intranasal flu vaccine may be fine for emergency department staff, contrary to some initial fears about shedding the virus to patients, say some experts.
There are discussions between the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and MedImmune Vaccines, but at press time, the CDC did not have an official recommendation on whether health care workers vaccinated with the new FluMist intranasal vaccine (MedImmune Vaccines, Gaithersburg, MD) should avoid close contact with immunocompromised individuals and for how long. In the interim, the CDC has referred clinicians back to a statement from its Advisory Committee on Immunization Practices that essentially discourages health care workers from taking the live vaccine in the first place.1
It always is important to remind staff that they put patients at risk when they are febrile from a natural exposure to the flu, and now because FluMist uses a live virus, there has been some talk in the health care community about the risk of shedding the virus to patients after vaccination. But the risk is very low and there is no need to prohibit ED staff from seeking the intranasal vaccine, says David Wilcox, MD, FACEP, spokesman for the American College of Emergency Physicians and an emergency physician at St. Francis Medical Center in Hartford, CT.
"It is possible to shed virus to immunocompromised people for a short time period, but that risk is so low that I don’t think emergency department staff have to avoid the live virus vaccine," he says. "Maybe if they worked all day with cancer patients or severely immunocompromised patients, that would be an issue, but I don’t see a concern in the ED."
That advice is seconded by Jeffrey Stoddard, MD, FAAP, senior director of medical affairs with MedImmune. The drug label approved by the FDA includes a caution regarding the theoretical transmission of the virus after FluMist vaccination, but there is no contraindication for health care workers, he says.
"Nationally, only about 36% of health care workers get vaccinated against the flu, and that’s a national disgrace," he says. "With respect to emergency room personnel, there is nothing in the label that would preclude use. There is some language that states a preference for the inactivated vaccine for those health care workers in close contact with immunocompromised patients, but the mention is made there only in regard to very close contact like household contact."
There has been no documented case of the virus being transmitted to anyone by someone vaccinated with FluMist, Stoddard says. The risk is "purely hypothetical," he says. It would be a mistake for ED staff to avoid the flu vaccination, especially this year, he says. By mid-December, the flu had spread to 24 states, and the CDC reported that the weekly percentages of patient visits for influenzalike illnesses jumped from 0.9% to 5.1% from Oct. 4 through Dec. 6. (For more information, go to www.cdc.gov/flu/.)
"ED managers are going to see some very sick people in very large numbers," he says. "Whether you use the intranasal vaccine or the shot, your personnel need to be vaccinated, or they’re going to be hit by the flu just when you need them the most."
No benefit to FluMist?
Despite his lack of concern about the intranasal vaccine, Wilcox says that the old-fashioned flu shot may be the better way to go. He advocates the standard flu shot because it is less expensive, typically about $20 compared to about $60 for FluMist.
"There’s really no benefit to getting the FluMist vaccine unless you’re severely phobic about shots," he says. "It’s more expensive, and I don’t think that’s a good way to spend our health care dollars. If the nasal vaccine makes the difference between someone on your staff getting vaccinated for the flu and not getting anything, then FluMist is fine. But I don’t think that many people have trouble with the flu shot."
Wilcox says ED managers should strongly encourage their staff to be vaccinated against the flu, not only for their own good, but to ensure full staffing for the department when the flu hits your community hard. The sooner they get vaccinated, the better, he says, because it typically takes about two weeks to build immunity.
1. Centers for Disease Control and Prevention. Advisory committee on Immunization Practices. Using live, attenuated influenza vaccine for prevention and control of influenza. MMWR 2003; 52 (RR13):1-8.
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