Health workers under pressure to get flu shots

[Pathfinder]

Health workers under pressure to get flu shots
Written by Associated Press Tuesday, 08 September 2009 08:31AM

News Central National AP


ALBANY, N.Y. (AP) ? Tens of thousands of health care workers who typically avoid flu shots are under more pressure than ever to get vaccinated as hospitals and clinics prepare for a spike in swine flu cases this fall and winter.

Roughly half of health workers skip the immunizations, raising two concerns: If doctors and nurses get sick, who will treat what could be millions of Americans reeling from seasonal or swine flu? And could infected health workers make things worse by spreading flu to patients?

New York, the first state to be hard-hit by swine flu, is requiring all health workers to get immunized against both types of flu. Other states are weighing whether to follow suit.

But shots for all health workers may not be an easy sell.

Fewer than half of them got flu vaccinations last year, according to a Centers for Disease Control and Prevention survey of about 1,000 workers. That includes physicians in clinics, lab technicians, respiratory therapists and home health aides. Rates are highest among doctors and nurses in hospitals ? 70 to 80 percent, but the overall rate shows many still shun the shots.

Why? The reasons vary from safety concerns to skepticism over vaccine effectiveness.

Sandra Morales, a labor and delivery nurse in New York City, had her last flu shot 16 years ago. She says she got the flu anyway.

She objects to New York's new law, saying it infringes on free-choice rights. "It's crossing the line, and I'm opposed to that."

Hospital workers "are at risk for being exposed to many, many diseases," she said. "Imagine if we had to take a vaccine for everything that comes in the door."

Morales worries she might lose her job if she refuses ? it will be up to individual clinics and health centers to decide how to enforce the law. She has until Nov. 30 to get her shots. Both the seasonal flu vaccine (available this month) and swine flu vaccine (expected in October) are required for workers in hospitals, treatment centers and in home care.

That may mean three separate shots, if the swine flu vaccine requires two doses to be effective. Testing in the U.S. is still under way to determine the dose.

The uncertainty about the new swine flu vaccine has added to the challenge.

"If health care workers have concerns about the safety and efficacy of a vaccine that has been around for decades, I'm sure they're going to have those same concerns about a vaccine that we've never used before," said Dr. Gregory Poland, a Mayo Clinic vaccine specialist.

He says health workers are ethically obligated to get vaccinated for both kinds of flu. He supports requiring them. New York, which had the first big surge of swine flu cases in the spring, is the only state doing that, although some states are considering the issue.

The theory that health care workers could spread the infection is supported by only isolated evidence, but the fear persists.

Some large hospitals have adopted rules requiring employees to get flu shots. Loyola University Medical Center near Chicago and Charleston Area Medical Center in West Virginia recently joined a handful of hospitals that have made seasonal flu shots mandatory for all workers. Some also plan to include swine flu. Several infectious disease groups support required flu vaccination for health workers.

Federal health officials say health care workers are among the priority groups for flu shots, but the government is not ordering anyone to get shots.

In New York, Health Commissioner Dr. Richard Daines notes that health employees are already required to get other vaccinations, including rubella and measles shots.

Under the new flu shot law, workers can opt out only for certain health reasons, including an allergy to flu shots.

Bill Van Slyke of the Healthcare Association of New York state, which represents hospitals, said hospitals have concerns about what action they can legally take if staffers refuse vaccinations.

"We don't expect that to happen to any significant degree ? we think most recognize the value of doing this, but there are one or two challenging scenarios out there," he said.

Dr. Brian Currie, an infectious disease specialist at Montefiore Medical Center in the Bronx, supports the law but said including swine flu vaccinations could be a headache.

"It means twice as much time, tracking people to make sure they get a timely second vaccination" if required. "It's a lot more work," Currie said. "We'll do our best."

Though infectious disease specialists say they have seen no serious complications during the swine flu vaccine testing that began last month, some critics say it is being fast-tracked without adequate safety tests. Some also fear a repeat of a rare paralysis called Guillain-Barre syndrome that occurred during a 1976 swine flu vaccination effort, though there is no evidence the vaccine caused that condition.

Dr. William Schaffner has had two swine flu shots during testing at Vanderbilt University, with no ill effects. The current flu virus is molecularly different from the one circulating in 1976, so Schaffner, who has consulted for the swine flu vaccine makers, said similar problems are unlikely.

Deborah Burger, a president of the California Nurses Association/National Nurses Organizing Committee, said safety concerns persist. That union, with 86,000 members in 50 states, is weighing whether to support required flu shots for nurses.

She said the union believes patients should be protected but also wants to protect nurses from any potential vaccine-related problems, saying, "It's a difficult tightrope to walk right now."

More than 550 U.S. deaths have been attributed to the new H1N1 swine flu. So far it does not appear to be more deadly than regular seasonal flu. Projections for the upcoming season vary. A worst-case scenario from a scientific panel advising the White House said up to half the population might get sick and up to 90,000 might die.

An estimated 36,000 Americans die from regular influenza each year.

At Virginia Mason Medical Center in Seattle, the first U.S. hospital to require flu vaccination for staffers, employees who object must wear a face mask during flu season or possibly be fired. Only a handful of objectors have been fired, all in the first season, 2005-06, said hospital spokeswoman Alisha Mark.

Dr. Joyce Lammert, Virginia Mason's chief of medicine, said if testing shows the new vaccine is safe and effective, and if supplies are adequate, the hospital will make that mandatory, too.

"We feel that getting immunized is so important," Lammert said. "In some ways, I'm glad H1N1 is out there. It raises awareness of the seriousness of the disease."

___

Medical Writer Lindsey Tanner reported from Chicago.

___
http://www.neworleans.com/index.php?option=com_content&view=article&id=207275&Itemid=493

 

[Emily]

Re: Health workers under pressure to get flu shots

"We feel that getting immunized is so important," Lammert said. "In some ways, I'm glad H1N1 is out there. It raises awareness of the seriousness of the disease."

That's an outrageous statement. Dying children and pregnant women lying in comas for months are nothing to be glad about or used as support for an agenda.

 

[Commonground]

Re: Health workers under pressure to get flu shots

Earlier Article: August 19, 2009
State Requires Flu Vaccination for Caregivers
By ANEMONA HARTOCOLLIS

The State Health Department is requiring tens of thousands of health care workers across the state to be vaccinated for flu, amid fears that swine flu will return in the fall.

The new regulation, quietly adopted as an emergency on Thursday, affects workers at hospitals, in home health care agencies and in hospice care, but, because of a technicality in state law, not in nursing homes.

The regulation raised protest Tuesday from New York?s largest health care union, 1199 S.E.I.U. United Healthcare Workers East, whose president, George Gresham, said that the policy was ?completely unprecedented? and could become punitive if the religious or cultural beliefs of workers prevented them from being vaccinated.

?Health care workers on the front lines of providing care deserve the dignity and respect of thoughtful consideration before a regulation like this can just be rushed through and put into effect,? Mr. Gresham said.

Until now, flu vaccination has been voluntary, and fewer than half of health care workers have been vaccinated in a typical season, state health officials said.

The new regulation, which requires vaccination against seasonal flu and the H1N1 virus, would affect workers and volunteers who come into direct contact with patients, including nurses, doctors and aides, and even nonmedical staff members like food service workers if they enter a patient?s room, a Health Department spokeswoman, Diane Mathis, said.

Ms. Mathis declined to comment on Mr. Gresham?s criticism, but said that health officials had met with the union and other professional associations to discuss the proposal before it was adopted.

She said that vaccination was ?clearly a patient safety issue.?
http://www.nytimes.com/2009/08/19/health/policy/19swine.html?_r=1

 

[Commonground]

Re: Health workers under pressure to get flu shots

[Another earlier article]

First published in print: Saturday, August 29, 2009

Flu shot or get fired

About 25,000 Capital Region hospital workers need the state-mandated shield, and the area's top sites say comply or quit
ALBANY -- Workers at Capital Region hospitals are going to have to get a flu shot this year or face losing their jobs.

The requirement is part of a new emergency regulation adopted earlier this month by the State Hospital Review and Planning Council that requires that all hospital workers get the flu vaccine -- and that it be a requirement for employment.

Hospitals are quickly trying to assemble new workplace policies to comply with the regulation, and those that have been put in place threaten disciplinary action and even termination if workers, from janitors and food service workers to doctors and nurses, refuse to get the shots. The policy affects about 25,000 people in the region.

Albany Medical Center, the region's leading hospital, sent out announcements to workers earlier this week saying employees had to get flu shots by Oct. 16. Spokesman Gregory McGarry said the hospital may take "corrective action" against employees if they don't comply, although he declined to get into specifics about what type of penalties they would face.
The hospital, which will pay for the vaccine, is insisting that almost all of its 7,000 employees get the shots, even those who work at off-site buildings such as the finance center in Delmar. McGarry said that even those workers spend time at the main hospital buildings for meetings.

"It's anyone who has contact with patients or providers," McGarry said. "There may be rare exceptions."

St. Peter's Hospital in Albany is also developing a set of strict guidelines as it seeks to get all of its 4,500 employees shots by Dec. 1.

"There are very few exceptions," said spokesman Elmer Streeter. "We will be requiring it of all our employees as a condition of employment."

Workers will be suspended for five days initially if they do not get the shot. After that, they have another five days to comply before facing possible termination.

Public health officials across the world are gearing up for the flu season this year with special urgency, especially because of concerns over the H1N1 "swine" flu virus. The new state regulations do not cover the swine flu vaccine, only the seasonal flu vaccine.

The New York State Nurses Association, which represents 37,000 nurses in the state, has opposed mandatory policies, and still does, says spokesman Mark Genovese.

"We think it should not be mandatory," Genovese said. "But we of course urge them to protect themselves."

Northeast Health in Troy, the organization that owns Albany Memorial Hospital and Samaritan Hospital in Troy, is working toward new guidelines.
"We're still in the process of finalizing our policy on that," said spokeswoman Angela Yu. "Obviously, we are trying to comply with the health department rules."

Larry Rulison can be reached at 454-5504 or by e-mail at lrulison@timesunion.com.

http://www.timesunion.com/AspStories/story.asp?storyID=836256

 

[Cairelle RN]

Re: Health workers under pressure to get flu shots

I am opposed to mandatory policies... but if one group is forced, then everyone should be forced. I can only imagine the outcry if it became mandatory for children...

That comment by Joyce Lammert about being "glad H1N1 is out there" is just ridiculous... but I guess there's no better opportunity than a bunch of pregnant women and kids getting knocked off to push an agenda.

 

[Shiloh]

Re: Health workers under pressure to get flu shots

Source: http://www.nytimes.com/2009/09/21/nyregion/21vaccine.html

New York Health Care Workers Resist Flu Vaccine Rule

By DONALD G. McNEIL Jr. and KAREN ZRAICK
Published: September 20, 2009

When she cleans the rooms of patients with swine flu symptoms, Jana Newton, a housekeeper at Maimonides Medical Center in Brooklyn, has to suit up for her own protection in a mask, gloves, gown and hairnet.

But she still does not want the one thing that would give her a far better defense ? a flu shot.

?Some people?s immune system is good, like me,? Ms. Newton said. ?I?ve been here five years and never been sick. Why mess with something that?s not broken??

She is not alone. Across the country, federal health officials say, only about 42 percent of all health care workers get an annual flu shot. That is little better than the overall national average of 33 percent and far below the 65 to 70 percent rate for the elderly.

That?s why the emergency regulation adopted this summer by the State Health Department making all hospital, home health and hospice workers get seasonal and swine flu vaccinations was a startling and radical step.

No other state or city health department has such a rule. Local unions reacted angrily, saying they had not been consulted.

Joel Shufro, executive director of the New York Committee for Occupational Safety and Health, a coalition of 200 union locals, said the change was presented to them ?as a done deal? on Aug. 17. His coalition is still debating suing to stop it, he said.

The unions do not oppose vaccination ?but we oppose a mandatory program,? he said. ?This is: ?You don?t get the shot, you?re fired.? ?

Some prominent health experts, however, were delighted.

Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention, called New York?s move ?a big deal.?

She had pushed for years for mandatory vaccinations ? not just to protect health care workers, she explained, but to protect their patients, who are often aged, have weakened immune systems or are bedridden after surgery, which increases pneumonia risks.

?We tried to market the idea, to push people, to educate,? she said. ?But looking back, broadly speaking, we failed. It?s time to look at a more aggressive approach.?

By contrast, her successor, Dr. Thomas R. Frieden, said last month that even though he expected a surge in swine flu deaths this winter and even though C.D.C. guidelines give health care workers first priority for the new vaccine, he would not push to make vaccinations mandatory.

?This is just not the right flu season to take this on,? said Dr. Frieden, who previously was the New York City health commissioner.

C.D.C. experts said there was just too much confusion this year, with the logistical difficulties of getting both seasonal and swine flu vaccinations to workers and the fact that the swine flu vaccine is still being tested, to risk a fight over the issue now.

On Friday, federal health officials said more than three million doses of swine flu vaccine would be available by the first week of October. But they also reported ?widespread? swine flu activity in 21 states, with summer not even over.

Every state already requires health workers to be immunized against measles, mumps and polio, and the unions do not object. Also, federal law requires their employers to offer free hepatitis shots against needle-stick injuries, and California requires them to offer free flu shots too. While workers may decline, they must sign a form saying they accept the risk.

Immunologists generally agree that real protection against any disease requires vaccination rates over 90 percent. But because rumors always circulate and many people fear needles, voluntary acceptance never gets that high.

Only two hospital groups in the country, Virginia Mason in Seattle and BJC HealthCare in St. Louis, now make all their employees get flu shots or face dismissal, said Dr. Thomas R. Talbot, an epidemiologist at Vanderbilt University School of Medicine who studies the issue. Both groups reached vaccination rates of more than 98 percent and he knew of five more planning to follow suit, he said.

Many hospitals make voluntary vaccination easier by using roving ?shot carts,? drive-up shots and rewards like time off or a raffle for a Caribbean vacation. Tom Lowe, occupational health representative for the New York State Nurses Association, said he had heard some had reached 80 percent that way, though he could not name any.

Dr. Talbot said that, of the handful of hospitals he knew of that achieved more than 75 percent voluntarily, some used measures that were not entirely voluntary ? workers who refuse must wear masks at all times or are told notes will be put in their personnel files.

With volunteers, ?the best you can get is usually 50 to 60 percent,? said Dr. William Schaffner, president-elect of the National Foundation for Infectious Diseases and a longtime proponent of mandatory shots.

Complying with the new state rule, the New York City Health and Hospitals Corporation, which runs the city?s public hospitals, announced on Aug. 28 that seasonal and swine flu vaccinations would now be mandatory for all its workers. The corporation already requires an annual tuberculosis test, as well as evidence of measles and rubella vaccinations. Its previous flu shot program, which was voluntary, reached only 51 percent of workers last flu season.

Flu shots and attitudes toward them have changed slowly. The shots were invented in 1942 by the military, but became widespread only in the 1990s after Medicare began paying for them.

They have also been ?cleaned up? as viral parts replaced whole killed virus, and filtering to remove stray proteins from the eggs they are grown in improved.

?Older health care workers remember the days when it gave you a sore arm and made you feel crummy,? Dr. Schaffner said of the shot. ?That?s why some avoid it.?

Also, although the original intent was to protect the recipient and cut down on absenteeism, it slowly became clear that in hospitals, fewer flus in doctors and nurses meant fewer dead patients.

?I was an epidemiologist at San Francisco General in the early 1990s,? Dr. Gerberding said. ?Among bone marrow transplant patients and others who were profoundly immune-suppressed, outbreaks of flu and other viruses could be very deadly. That changed the paradigm.?

Still, many workers dislike them.

Anthony Montero, 55, a dietary aide at Lutheran Augustana Center for Extended Care and Rehabilitation in Brooklyn, said he was afraid of needles, but added: ?If it?s a must, it?s a must.?

Patrind Rungreang, 45, an X-ray technician at New York Methodist Hospital in Brooklyn, said he had no problem with being vaccinated if it was mandatory. But he felt the fear of swine flu was overblown.

?It?s just another flu,? he said. ?We deal with all kinds of diseases here.?

Many poorly educated workers still believe flu shots cause flu, Dr. Schaffner said. Though that is impossible, because it is only parts of a dead virus, the myth persists and is reinforced every time someone gets a shot and then catches a cold, which it does not prevent.

This year?s rushed testing has added to fears.

Surveys of 8,500 Hong Kong health-care workers published last month in BMJ, formerly The British Medical Journal, found that more than half planned to refuse the new vaccine if they could.

The unions also object because no flu shot protects perfectly. As the virus mutates, new vaccines must be made each year, and in some years, like 2005, the flu mutates so quickly ?that it?s really a crapshoot in terms of matching the strain,? said Jan S. Rodolfo, a nurse and a flu expert at the California Nurses Association, which represents 86,000 nurses in several states.

Over all, virologists say, of every 100 people who faithfully get flu shots, only about 70 are fully protected every year. But even the other 30 are partly protected by previous shots and by ?herd immunity? ? the fewer unprotected victims a virus finds, the faster it fades out.

David Welch, a cardiac unit nurse in Chico, Calif., who blogs about health issues for the California Nurses Association, said he got injected to protect himself and his patients, ?but I want to defend the rights of other people not to get it. It?s not an easy choice.?

 

[Pathfinder]

Re: Health workers under pressure to get flu shots

Mandatory flu vaccination splits workers

September 27, 2009
By DELTHIA RICKS

Despite a planned rally in Albany Tuesday to protest a state regulation requiring health care workers be vaccinated against influenza ? both seasonal and swine flu ? New York?s top public health official predicts dissenters will ultimately extinguish their anger and roll up their sleeves.

The regulation, which was approved in August, comes with a stinging addendum: Get vaccinated or get fired.

But some nurses and many other health care providers say the regulation violates their personal freedom and leaves them vulnerable to vaccine injury. And they cite deaths associated with the last federal government swine-flu vaccination program in 1976.

Refusing to be immunized against H1N1 because of the vaccine debacle in 1976 ?is like saying a plane crashed 33 years ago so I?ll never fly again,? said Dr. Richard Daines, New York State health commissioner.

New York is the only state in the nation to require that health care workers be vaccinated, though other states are considering such measures. Health workers, including doctors, must be immunized by Nov. 30. Opponents say it?s simply unnecessary.

Several registered nurses said they will neither contract nor transmit the flu because they?re constantly washing their hands.

While dozens of demonstrators are expected at the rally from throughout the state, many are from Stony Brook University Medical Center. A meeting was held last week for hospital staff on the importance of vaccination for health care workers; a special session was held for employees in the Neonatal Intensive Care Unit, because many nurses there had expressed concern about the vaccination plan.

?We cannot force employees to be vaccinated; however we do not have an infinite number of non-patient care positions available to reassign those who simply refuse the vaccine,? said hospital spokeswoman Lauren Sheprow.

Darcy Wells, spokeswoman for the Public Employees Federation, which represents 9,000 health care workers statewide, including 3,000 at Stony Brook, said the union disapproves of mandatory vaccination, but is urging members to comply with the regulation.

The opponents also say it?s wrong that all five swine flu vaccine makers contracting with the federal government have been indemnified against lawsuits if someone gets sick or dies.

Daines said the vaccination directive stemmed from particular concern about institutional outbreaks ? in hospitals, nursing homes and hospice centers. In a typical year, only 40 percent to 50 percent of health care workers take advantage of voluntary flu vaccination programs, and the state has about 150 institutional outbreaks of influenza. But with seasonal and H1N1 in circulation in the fall, institutional outbreaks could worsen.

?Anyone who is concerned about the safety of the vaccine should read about the death of a previously healthy nurse in California who died of H1N1,? Daines said.

He referred to a 51-year-old nurse in Carmichael, Calif., who died in July after she was exposed to swine flu on the job.

Reed and Kristi Tramposch, both registered nurses in the neonatal intensive care unit at Stony Brook University Medical Center, say as parents of a child with an autism spectrum disorder, they oppose vaccination because of possible links to the neurodevelopmental condition.

?There are a lot of toxic substances that go into vaccines,? Kristi Tramposch said. ?I would like to see a lot of people get it [the swine flu vaccine] before I consider it.?

Daines expressed dismay that neonatal intensive care nurses would consider shunning flu shots for personal or philosophical reasons. More than simply protecting themselves from infection, he added, health care providers are also protecting patients from the flu.

Like other protesters, the Tramposches said the newly approved H1N1 vaccine is no different from the swine flu immunization of 1976, which was linked to the nerve-damaging disorder Guillain Barre syndrome, and even death.

But Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital in Manhasset, said while he questions the state?s move to make flu shots mandatory now, he said no relationship exists between the vaccine of 33 years ago and the current vaccine.


?I took the swine flu vaccine in 1976,? said Farber, ?and I plan to take the H1N1 flu vaccine now.?


http://www.newsday.com/long-island/mandatory-flu-vaccination-splits-workers-1.1481242

 

[Snowy Owl]

Re: Health workers under pressure to get flu shots

Dr Butler-Jones in the last two press conferences has said and I quote we have enough vaccines for those who wants ans those who will have to take it.

That implies forces vaccination on healthcare workers in Canada.

Snowy Owl

 

[Pathfinder]

Re: Health workers under pressure to get flu shots

It's a Jab or Your Job

By Alice Park Monday, Oct. 19, 2009

At Winthrop hospital on New York's Long Island, the signs are everywhere. They're posted at every nurses' station, papered above the security panels against which employees swipe their ID cards and even attached to paychecks. The notices are there to remind the hospital's staff ? which includes everyone from the doctors and nurses who care for patients to the administrative, housekeeping and food-service personnel ? that every employee must be vaccinated against both seasonal and H1N1 flu or face possible termination.

The mandate comes from the health department of New York, which over the summer became the first state to require that all health-care workers be vaccinated against influenza. In other states, individual hospitals have taken the same aggressive position. Given that the pandemic H1N1 strain is circulating the globe ? and that one of the seasonal-flu strains is resistant to Tamiflu, a commonly used antiviral treatment ? such a policy seems logical. But is it legal? Flu-vaccine requirements are being challenged by health-care workers who maintain that decisions about vaccination should be theirs and theirs alone. In the state of Washington, the State Nurses Association, which in general supports vaccinations, is suing a local health system over its decision to make the flu shot a condition of employment, while dozens of New Yorkers went to the state capital in September to protest the new immunization ultimatum.
(See what you need to know about the H1N1 vaccine.)

Health-care workers are especially vulnerable to both getting sick with influenza and spreading it to patients. That's why the U.S. government has singled out these workers, along with other high-risk groups, to receive the first batches of 2009 H1N1 vaccine, which are just starting to arrive in some states. Vaccination can reduce the risk of getting influenza 70% to 80% and is the most effective way to curb the pandemic. "It is within the purview of health authorities that we engage in certain infection-control activities," says Susan Waltman, general counsel of the Greater New York Hospital Association, "and immunization of health-care workers is certainly among those activities."

Employers, notes Alabama labor-and-employment attorney Jennifer Swain of the firm Baker Donelson, can set conditions of employment. So does that mean any company could impose an H1N1-vaccine requirement as part of its business-continuity plan? Most likely yes, but Swain is betting that few non-health-care companies would be willing to endure the inevitable protests against such a policy. "In health care, it strengthens an employer's argument that an employee might cause a direct threat by not being vaccinated," she says.

Many states already require that people working in hospitals be immunized against measles, mumps and rubella, for example, and an influenza-vaccine mandate shouldn't be seen as any different from these standards. Yet when it comes to the flu shot, those in the medical field are notoriously incompliant: nationwide, only half of them voluntarily roll up their sleeves each year. "That just doesn't deliver the safe immunity level we need in a hospital," says Dr. Richard Daines, commissioner of health for New York State. It doesn't make sense, he says, for health-care workers not to be immunized against influenza. "That's just not tolerable in health-care institutions, where patients come to be safe."

But rigorous vaccination efforts, even voluntary ones, can brush up against thorny privacy issues. At Maryland's Johns Hopkins Hospital, personnel who choose to get a flu shot are provided with a colored clip to attach to their hospital ID. The idea is to make easily identifiable those who are unvaccinated and therefore need to wear masks when caring for patients with respiratory illnesses. The hospital intended to have two colored clips this year: one for seasonal flu and one for H1N1. But administrators realized that since the H1N1 vaccine is prioritized for specific groups, such as pregnant women and people with a weakened immune system, the clips would ? at least initially ? single out people with those conditions.
(See how not to get the H1N1 flu.)

So for now, only those receiving the seasonal-flu vaccine will get a colored clip ? this year it's yellow ? and the system seems to be motivating employees to get their shots. "It introduces a bit of peer-pressure incentive to get vaccinated," says Dr. Aaron Milstone, a member of the hospital's infection-control committee. Still, in case the H1N1 situation worsens and not every health-care worker chooses to get immunized, Hopkins officials are considering additional measures, like making all those directly caring for patients wear a mask.

That is the type of alternative to mandatory vaccination that Angela, a nurse at Winthrop who prefers that her last name not be published, wants her hospital to offer. She has concerns about the mercury used in some flu shots and also feels that the New York State requirement is an infringement on her right to decide what treatments she receives. But neither of these reasons is sufficient to exempt her; only a medically documented condition like an egg allergy (flu vaccine is grown in chicken eggs) is an acceptable reason for not getting immunized.

If Angela does not get vaccinated by Nov. 30, she will be suspended. If she doesn't comply within 15 days after that, she could be fired. "We are still in open negotiations with the [hospital] administration," she says, hopeful that her employer can find some way to accommodate the objections she and others have to getting the shot. "I am not willing to be terminated, but I am willing to take it that far."

http://www.time.com/time/magazine/article/0,9171,1929232,00.html