Flu vaccines should be compulsory for all health-care workers because their patients' lives are at risk, a Canadian medical journal editor says.

In Monday's issue of the Canadian Medical Association Journal, senior associate editor Dr. Ken Flegel argues for mandatory seasonal influenza vaccination, urging that the "time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change."

More than half of doctors don't get a flu shot, a journal editorial says. (I.Lopez/Associated Press)

Flegel points to a 2010 study published in the same journal that concluded 55 per cent to 65 per cent of doctors don't get an annual flu shot.

But each season, 20 per cent of health workers get the flu, he said. A 2006 review on flu vaccination in health-care workers published in a Cochrane database suggested that some may shed the flu virus up to a day before symptoms begin, which can expose vulnerable hospitalized patients to the virus when they're less able to resist infection, he added.

Flegel cited a 2010 research report, which found that voluntary campaigns increased vaccination rates by 22 per cent to 52 per cent, compared with more than 95 per cent at teaching hospitals in Philadelphia that required flu vaccines. With such figures in mind, he said compulsory vaccination against flu in health-care workers is justified.

"Why would you want people in the hospital who could shed the virus that causes the disease when we have a way of drastically reducing the number of people in the hospital who can do that?" Flegel said.

Hospitals have tried to entice workers to get a flu shot using prizes but vaccination rates remain low, said Dr. Todd Hatchette, director of virology and immunology at QEII Health Sciences Centre in Halifax.

Health workers' autonomy

Health authorities in British Columbia announced earlier this year that health-care workers who come into contact with patients will need to get the influenza vaccine. The B.C. Nurses' Union said it wasn't happy about the move, although nurses who aren't vaccinated may wear a mask during the flu season instead of getting vaccinated.

"I think that any time anything is put into a person's body, they should have sovereignty over their body and have the right to decide for themselves whether or not it’s an appropriate thing to do," said Debra McPherson, a cardiac care nurse in Vancouver and president of the BC Nurses' Union.

Anytime health care decisions are made mandatory, it also raises questions about the evidence and whether it's the best use of money, McPherson added.

In 2002, an Ontario labour board ruled that mandatory flu shots for health-care workers in Hamilton, Ont., invaded their rights.

Flegel acknowledges that the autonomy of health-care workers may conflict with patients' rights. But he argues that patients' rights take precedence in similar situations, such as policies that prevent a surgeon who is infected with HIV or hepatitis from operating on patients.

Flegel, a professor of medicine at McGill University in Montreal, said the adverse effects associated with flu vaccines tend to be mostly fevers and runny noses. Serious complications like Guillian Barré syndrome occur at a rate close to the background level of one in 100,000 annually, he said.

People who can't be vaccinated because of medical reasons, or for deeply held religious or philosophical convictions, could be granted exemptions, he said.

The 2006 Cochrane review concluded that, "there is no credible evidence that vaccination of healthy people under the age of 60, who are health care workers caring for the elderly, affects influenza complications in those cared for.

"However, as vaccinating the elderly in institutions reduces the complications of influenza and vaccinating healthy persons under 60 reduces cases of influenza, those with the responsibility of caring for the elderly in institutions may want to increase vaccine coverage and assess its effects in well-designed studies."

While the Cochrane reviewers concluded there was no specific effect from flu vaccines, there was a drop in all cause mortality, and that's what matters for those caring for sick, elderly patients suffering who are dying from influenza, Flegel said.

The Association of Medical Microbiology and Infectious Disease Canada, which represents professionals in the field, endorsed a mandatory flu vaccination policy, Hatchette said.