Getting the flu shot: Protecting ourselves and our patients

The doctrine of “do no harm” is a central theme in a physician’s duty to care for patients. Typically it refers to situations where doctors might hurt patients with inappropriate treatments, but it also ap­plies to situations where physicians fail to protect patients from foreseeable dangers inherent in the practice of our craft. We readily understand the need to wash our hands between pa­tients and to employ sterile technique in the operating room, and we do these things to prevent the transmission of infection to those in our charge.

The 1918 flu epidemic killed 50 million people worldwide—more than the number of deaths in the First World War.[1]  There have been a number of flu pandemics since, the most recent be­ing the 2009–2010 pandemic, during which there were 1059 documented severe cases and 56 fatalities in BC.[2

Pandemics aside, the seasonal in­flu­enza outbreak kills an estimated 2000 to 6000 Canadians yearly[3] and is responsible for a considerable amount of lost productivity and workplace absenteeism. 

In our work we often care for those who are unable to help themselves, especially those at the extremes of age. The elderly commonly have co­morbidities that make influenza all the more deadly. Clearly we need to stay away from vulnerable patients when we are sick, but influenza is contagious at least 24 hours prior to the onset of symptoms, making it difficult to know when we are at increased risk of transmitting the virus to our pa­tients. It is truly indefensible if we, as physicians, find ourselves doing more harm than good by going to work and passing the flu to our patients because we have not taken every available preventive measure.

In addition to good hand washing and the use of respiratory precautions around sick contacts, the annual flu vaccination is an important part of protecting ourselves and our patients. 

No preventive measure is perfect, and it is especially difficult to create vaccines against influenza due to its frequent mutations. The annual vaccine is made in a way that attempts to anticipate the antigenic mix of the upcoming influenza, and the match be­tween vaccine and virus is not always optimal. A recent Cochrane review has highlighted these limitations,[4] pointing out that in a good year it takes 33 vaccine doses to prevent one case of the flu, and 100 in a more typical year. However, in healthy adults this translates into a 50% risk of getting the flu in a “bad match” year and a 25% chance in a “good match” year.[4

Serious adverse events from the vaccine are rare, and are less common than in unvaccinated persons who become ill.[3] Knowing that influenza is a serious—sometimes deadly—disease, that simple hygiene measures are only partially effective at prevention, and that the flu vaccine is extremely safe, we owe it to our patients (and ourselves) to get the flu shot. 
First, do no harm.
—Lloyd Oppel, MD, Chair, Council on Health Promotion


References

1.    Flu.gov. Pandemic Flu History. Accessed 14 November 2012. www.flu.gov/pandemic/history/index.html.
2.    Wikipedia. 2009 flu pandemic in Canada. Accessed 14 November 2012. en.wikipedia.org/wiki/2009_flu_pandemic_in_Canada.
3.    Kendall P. BC’s Provincial Officer of Health responds to last month’s Focus article. FOCUSonline. Accessed 14 November 2012. http://focusonline.ca/?q=node/458.
4.    Jefferson T, Di Pietrantonj C, Rivetti A, et al. Vaccines for preventing influenza in healthy adults. The Cochrane Library. Accessed 14 November 2012. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001269.pub4/full.

Lloyd Oppel, MD, MHSc, FCFP(Em). Getting the flu shot: Protecting ourselves and our patients. BCMJ, Vol. 54, No. 10, December, 2012, Page(s) 532 - COHP.



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