http://www.cbc.ca/news/features/flu.html

 

You and the flu
Martin O'Malley, Catherine Riddell and Owen Wood
CBC News Online | January 2002

The first controversy of the flu season involves a paramedic in northern Ontario who was suspended from work for refusing to get a flu shot. Because Bill Kotsopoulos of North Bay said no, he was suspended from his job on Dec. 22, 2001.

The Canadian Union of Public Employees, the union that represents paramedics, supports Kotsopoulos. The Ontario Ambulance Act says all paramedics must be vaccinated against the flu, but CUPE argues that enforcement of the Act rests with municipalities. The Ontario Paramedic Association says Kotsopoulos is the only paramedic in the province to be penalized. CUPE says fewer than eight per cent of Toronto’s 790 paramedics have been vaccinated against the flu.

A localized controversy, to be sure, but the issue of mandatory flu shots – and the efficacy of flu shots overall – will keep popping up during the rest of the flu season, which runs from early December to late March.

If flu shots are compulsory for paramedics in some jurisdictions, should they also be compulsory for doctors and nurses? And what about teachers and day-care workers? What if a health professional has a serious allergy to flu vaccines (such as people allergic to eggs, as the vaccine is grown in egg protein)? Should the vaccine be free to all, or only to high-risk people? Do flu shots have serious adverse effects? Are they effective? And are they cost-effective, in the sense of saving Canada’s health care service money?

So far this flu season there have been no alarms across Canada warning of a killer flu, or any flu at all. Health Canada’s “Flu Watch” – which monitors influenza activity across the country – says only Ontario and southeast British Columbia have reported “sporadic” influenza activity. The latest Flu Watch report (for the week ending Dec. 22) says, “…most influenza surveillance regions reported no influenza activity.”

The average fee for a flu shot is $10, though many jurisdictions provide free vaccinations for high-risk groups. Many companies also pay for employees’ vaccinations.

Among those considered high risk for the flu:

Influenza is a serious disease. The warnings are correct when they say it is much worse than the common cold (an entirely different malady). During most flu seasons, some 4,500 Canadians die of the flu, up to 6,000 if we include complications such as pneumonia. Five million Canadians get sick with the flu every year, resulting in 1.5 million workdays lost. The flu costs the Canadian health care system about $1 billion a year.

Ontario has the most intense flu vaccination program in Canada.

The Canadian Medical Association Journal published a series of commentaries on the Ontario flu vaccination program, beginning with a contribution from Dr. Vittorio Demicheli, an epidemiologist in Italy who questions whether the Ontario program is a worthwhile model for a global flu prevention program. He says only one in four vaccinated adults acquires protection against influenza.

In the same issue, Dr. Richard E. Schabas of Toronto responds to Demicheli, saying the Ontario program “will become the standard for influenza control in Canada.” Schabas says in a typical year the flu causes illness in 10 to 20 per cent of adults and up to 40 per cent of children. “Influenza is not just a nasty wintertime bug that causes misery and lost productivity, with a week-long illness of cough, fever, chills and myalgias,” Schabas says. “It is also the cause of serious illness and death for thousands.”

Schabas says the flu vaccine program works well, with few side effects and an efficacy rate among adults of between 70 and 90 per cent.

In a rebuttal, Demicheli argues that Schabas’s figures of a 70 to 90 per cent efficacy rate are “wrong and misleading.” Demicheli puts the efficacy rate at about 60 per cent. He calls the Ontario program a “let’s see what happens” approach to public health care and says it should not be emulated in other jurisdictions.

“The Ontario decision to implement mass influenza vaccination has little to do with influenza control,” Demicheli says. “As clearly stated by the Ontario government, the aim is to ease pressure on emergency services during the ‘influenza season.’ There is absolutely no evidence that universal vaccination has ever achieved such a goal.”

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.