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A staff worker receives a flu vaccination at the Victoria General Hospital in Victoria, B.C., October 21, 2014.

CHAD HIPOLITO/The Globe and Mail

The question

My father was recently admitted to an Ontario hospital. While he was there, he ended up getting the flu. I was told he might have caught the bug from a nurse, a doctor or another health-care worker. That surprised me. Why don't people who work in hospitals get flu shots?

The answer

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Most Canadian hospitals put a lot of effort into encouraging their staff members to get the annual influenza vaccination. But, for a variety of reasons, a significant proportion of them decline the shot.

Last flu season, about 53 per cent of health-care workers in Ontario's hospitals were immunized, says David Jensen, a spokesperson for the Ontario Ministry of Health and Long-Term Care.

The rate was better in long-term care homes, where 72.4 per cent of staff got vaccinated.

It's worth noting that health-care providers are more likely to roll up their sleeves for a needle than the general population, of which roughly one-third opt for an annual flu shot.

However, to properly protect patients, the vaccination rate should be higher, says Dr. Mary Vearncombe, medical director of infection prevention and control at Sunnybrook Health Sciences Centre.

"Health-care workers have a responsibility to not harm their patients," Vearncombe says. "If they become ill and go to work, then they are exposing their very vulnerable patients to an unnecessary risk."

Frail patients, with multiple health problems, can develop potentially deadly complications from influenza. In Canada, it's estimated that about 3,500 people die from the flu every year.

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Vearncombe readily acknowledges the annual flu shot isn't perfect. Its effectiveness varies from year to year, depending on whether the vaccine contains protection against the specific flu strains in circulation for that season. As well, some people with weakened immune systems fail to produce sufficient antibodies to fight off the flu even when they do get the vaccine.

On average, though, the annual flu shot is about 50 per cent to 60 per cent effective. Studies clearly demonstrate that it reduces transmission, hospitalizations and deaths. In many ways, vaccinations are among the great success stories of modern medicine.

So, why do some health-care workers shy away from the vaccine? "We are supposed to be evidence-based people. But the fact of the matter is that health-care providers can be swayed by the same myths, misconceptions and erroneous beliefs that influence people in the community," Vearncombe says.

And, unfortunately, public support for vaccinations has been undermined by misleading reports and discredited research, such as the fabricated British study that falsely claimed certain shots were linked to autism. Although that study was retracted years ago, it has taken on a life of its own through the Internet and social media.

"It's really hard to reverse the damage that's done," says Dr. Susy Hota, medical director of infection prevention and control at the University Health Network in Toronto.

Meanwhile, a new flu season is getting under way. How do hospitals protect patients when a sizable percentage of staff shuns flu shots? Not all hospitals agree on what's the best approach.

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Some hospitals – including Sunnybrook – require staff members who haven't had a vaccination to wear a mask when they are working in patient-care areas during flu season.

Flu symptoms can vary from mild to severe, notes Dr. Allison McGeer, medical director of infection prevention and control at the Sinai Health System, where a vaccine or mask policy is followed.

Sometimes people's symptoms are so mild they may not realize they have influenza. Yet they can still be shedding the virus through their respiratory droplets, says McGeer. "Masking people who are shedding virus will reduce the amount they spread around."

However, other hospitals – such as Toronto General Hospital, which is part of UHN – have not adopted a mask policy. "There really isn't much evidence that using a mask when you are not symptomatic with flu-like symptoms would have any impact on transmission," says Hota. Making people wear masks might be viewed as a "punitive measure" that contributes to staff alienation, she adds.

McGeer disagrees, saying the goal of the mask is to protect patients – it's not intended to penalize staff. "And, in truth, wearing a mask is not a terrible thing," McGeer says, adding that it's only required in close proximity to patients.

Despite the differences of opinion regarding masks, there is one thing on which hospitals agree: Health-care workers should not come to work when they're sick and that applies to all infectious respiratory illnesses.

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Sick workers not only endanger patients, but they can also spread germs to co-workers, Vearncombe says. When an outbreak hobbles a department, it can have a ripple effect causing delays throughout a hospital.

But there are some people who insist on coming to work ill. That kind of dedication to duty is actually counterproductive, Vearncombe says.

You might think that people who work in health care would know better. "It is kind of mindboggling," Vearncombe says. Sadly, getting people to change their behaviour and dispelling false beliefs is never easy.

Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook's Your Health Matters

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