The 1918 Flu Epidemic and You

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The 1918 Flu Epidemic and You

Nurses who get a flu shot protect the whole community

By Elizabeth Hanink, RN, BSN, PHN
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Should nurses be required to get a flu shot each year? Last October, the public health departments of Los Angeles and 11 other California counties sparked controversy by ordering that all nurses working in any facility providing direct patient care either be vaccinated against influenza or wear a facemask. However, a new study confirms that these measures not only protect nurses and their patients, but the larger community as well.  Flu shots really are a public health issue.

A Direct Correlation

The study, an abstract of which was presented on June 7 at the 41st Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC), examined California public health data from the years 2009 through 2012.

Researchers found that for every 15 healthcare providers who received a flu shot, there was one fewer case of influenza in the local community.

“This study suggests that there is a strong connection between how many healthcare personnel are vaccinated against the flu and how many cases of influenza-like illnesses are reported in the community,” says investigator James F. Marx, RN, Ph.D. CIC, founder of Broad Street Solutions, an infection prevention consultancy.

90 Percent by 2020

California law requires acute care facilities to provide influenza vaccinations for employees, but present law allows an employee to opt out by signing a written declaration. As a result, the vaccination rate of California hospital workers during the 2011–12 flu season was only 68 percent.

Marx says that if California were to achieve the 90 percent vaccination rate for healthcare personnel recommended by the federal Healthy People 2020 initiative (which L.A. County officials have set as their 2020 goal), there would be about 30,000 fewer cases of influenza-like illness in California.

Public Health

While many of us consider the flu to be an annoying but minor ailment, the CDC says influenza-like illnesses cause more than 200,000 hospitalizations and an average of 24,000 deaths each year.  

“Efforts to promote influenza vaccination of healthcare personnel have traditionally focused on protecting patients inside healthcare facilities,” says APIC 2014 President Jennie Mayfield, BSN, MPH, CIC. “Now, we have evidence that through enhanced healthcare worker vaccination, we can protect the broader community. This represents a tremendous public health opportunity.” 


The 1918 Flu Pandemic

Life before vaccines

Imagine a pandemic that infects almost 20 percent of the world’s population, leads whole neighborhoods to be quarantined, defies all attempts at creating a vaccine and ultimately kills more people than a world war. It sounds like the premise of some overblown Hollywood disaster movie, but that’s exactly what happened during the influenza pandemic that swept the globe in 1918–1919.

Since World War I was still raging in Europe when the first outbreaks of the so-called “Spanish Flu” began in 1918, some people assumed the disease was a biological weapon. Scientists now believe the pandemic may have originated in China and developed when a milder form of human H1 influenza mixed with an avian flu virus, creating a lethal new strain for which many people had no antibodies.

Dead by Tomorrow

Just how lethal was it? The overall mortality rate of the 1918 pandemic was about 2.5 percent — 25 times as high as the typical modern flu season — and was much higher in close quarters like military bases, where the virus could spread rapidly.

Unlike most influenza outbreaks, which are deadliest to very young and very elderly patients, the majority of the 1918–19 fatalities were otherwise healthy adults in their 20s and 30s, some of whom died within 24 hours of the onset of symptoms.

The pandemic’s exact death toll will never be known, but estimates run as high as 50 million worldwide and 675,000 in the U.S. alone, at a time when the U.S. population was only 105 million. The pandemic remains one of the largest public health disasters in recorded history, rivaling even the bubonic plague.

The Good News

The CDC says the deadly 1918 influenza strain would have been stopped in its tracks by modern flu shots. 

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