Whilst I respect your Paramedic skills and knowledge, I'm pretty sure the rule of self preservation don't really apply here now does it?

Yes it does there's a risk involved, some may not be prepared to take that risk.

But again, I'm willing to be proven wrong when you show me some evidence of high probability of morbidity or mortality caused by seasonal flu vaccinations

Side effects exist with pretty much every drug and vaccine it doesn't need to be high for people to choose not to have it.

I'm sorry, but you've given me no evidence of an 'informed opinion', and that really riles me up, I've met too many NHS staff who believe they know best because people come to them and ask them for medical advice.

I'm sorry neither have you, like I say Googling for articles doesn't really count.

I'm sorry neither have you, like I say Googling for articles doesn't really count.

Drac, you still aren't getting it (unfortunately) I don't have to make an informed opinion as I've already had it and I don't have to put immunocompromised patients at risk as part of my job. The search engine I use to search for medical articles is irrelevant be it Google scholar, pubmed or any of the others out there, at least I've attempted to put forward some justification for my point of view – you haven't.

Maybe you'd prefer I went back down the medical library and scanned through microfiches, got the journals off the shelf photocopied them and posted the articles to you, would that be better than finding them via a search engine? I remember those days well, not sure I want to revisit them though!

I'll leave you with my last thought on the matter and let the experts highlight the debate better than I can (and yes I used a search engine to find this article shame on me!):

Should healthcare workers have the swine flu?

That's just it Hagi you don't work in the health care profession but seem to think we're not allowed the choice of taking a vaccine and we have a duty of care to take it. What if members of the public started dictating you should be made to do something as it's your job and that there should be no choice.

Read that article and again it's encouraging healthcare workers to vaccinate to keep the system alive and not so much to prevent spread of infection.

That's just it Hagi you don't work in the health care profession but seem to think we're not allowed the choice of taking a vaccine and we have a duty of care to take it.

Actually you are correct there I don't work in the health profession (any more). However, if you actually care to read any of my posts you will see that I've said all along that I fully support the individuals choice, my opinion is that you have to have a genuine reason for not taking it given the potential impact to those whose lives you are supposed to be saving.

You did but others seemed to think we don't, I kind of see where your coming from but people still have the right to choose if they inject anything into their body. Some will do it because the risk of a reaction, others because they seen the small health risks there may be a few who choose not to because they've had it before and felt ill after, even most evidence suggests this is coincidence. Still I prefer people to have the choice, I've had people refuse all sort of treatment that can help getting worse, save their lives or just make them feel well. They have the right to refuse, yeah your going to say they aren't going to cause problems for others but we have the right to refuse healthcare workers or not.

How ironic. Just checked my work email and there's a clinic on my station in just over a week so now have to try to encourage as many as my staff as I can to have the jab. Wonder if I should print of Hagi's thoughts. 😀

Regarding the "it hasn't been tested enough" argument:

I'm interested if this is just a general feeling or based in fact?

Does anyone know how much testing it has actually had compared to other vaccines and drugs? And do people with this concern generally limit themselves to only taking 30-40 year old drugs where the long term effect is better known, or are they treating the swine flu vaccine with more suspicion than normal for some reason?

How ironic. Just checked my work email and there's a clinic on my station in just over a week so now have to try to encourage as many as my staff as I can to have the jab. Wonder if I should print of Hagi's thoughts.

Lol! I'd suggest that BMJ article as a slightly more useful starting point – theres also some interesting comments in response to it.

Lol! I'd suggest that BMJ article as a slightly more useful starting point – theres also some interesting comments in response to it.

It's ok there is loads of stuff lying around at work and we all got a letter and leaflet the other day about it. Still I won't and can't force my staff to have it only encourage them.

GrahamS – It was tested on 8,000 people IIRC but as I've mentioned earlier it only varies slightly from the seasonal one anyway so essentially the base of it has been tested millions of times.

Drac, thanks. That fits with my understanding. The base medium is well known and thoroughly tested; there is a good understanding of attenuated flu viruses in vaccines in general; and there is base knowledge about the H1N1.

So, as I understand it, the "untested" bit is a very slight risk that attenuated H1N1 in that medium doesn't perform the same as all the previous attenuated strains that are used every year?

And the trial of 8,000 showed no indication of that?

So, as I understand it, the "untested" bit is a very slight risk that attenuated H1N1 in that medium doesn't perform the same as all the previous attenuated strains that are used every year? And the trial of 8,000 showed no indication of that?

Suppose there is but can't say for sure as never looked into too much.

Picking up on Grahams’s point about been able to trust drugs in common use of the last 30 – 40 years, over the last few years I’ve seen a number of clients who have cognitive impairment of unusual presentation and have taken psycho-active drugs over a long period of time. The implication been that the medication is a significant factor – as yet these are fairly rare cased and little research carried out (and due to the way research funding goes is unlikely) – so you never know
Essential all drugs have both positive and negative effect most of these are know, but you never know what else pop out of the blue – as all individuals are just that and therefore can & do react differently to chemicals introduced into the body. Unless you are detained under the mental health act or have been assessed as lacking capacity under the capacity act you basically have free choice as whether or not to accept medication, neither do you need to justify that decision nor can coercion be used to make you have it

DOH, TJ – of course it is likely you get mild flu symptoms after a flu jab, that is the idea of a vaccine. it is not a magic pill.

They introduce an inactive virus into your body, the bodies immune system fights it, this immune response can often cause the usual noticable affects (mucus, temperature, head ache etc) like a cold. BUT Because the virus is inactive it doesnt replicate and spread and block up and damage important bits of your body, but importantly your bodies Immune System remembers it and attacks it imediately should it meet an active Virus of the same or very similar strain in the future.

Hagi, Drac, you both agree that NHS staff should have a right to refuse the jab, you both agree that the jab is the best thing to do too…

I think that NHS staff should be given the choice too, have the jab or some education until you have the jab, or find another job.

I have still to see any evidence of complications of the swine flu jab (other than the "usual" list that Pharmaceutical companies use to cover their backs)

Furthermore until i see stats where i am more likely to get serious complications from the vaccine, than swine flu, it surely still makes sense to have the vaccine? anyone care to argue why fears of swine flu vaccine unbased in fact or experience, are more justified that fears of a little known Pandemic flu strain with the proven ability to kill healthy adults? Anyone? Anyone????

oh and btw the 1976 Guillon Barre "incident" doesnt count, as the vaccination process has moved on since, and there hasnt been a reoccurence.

Anyone? Free deore rear mech in it for you?

complications of the swine flu jab??? watch this space we start immunising tomorrow.!!

Tim Drayton – I do know how vaccines work thank you.

I also understand risk assessment and freedom of choice – unlike you. The bottom line remains – its my choice. I am far more likely to catch illness from a patient than they are to catch it from me.

Find one example of a healthcare worker transmitting swine flu.

Forcing NHS professionals to have an immunisation that carries its own risks is simply not on.

what risks? please elaborate TJ?

I am far more likely to catch illness from a patient than they are to catch it from me.

? please explain ? no really I am honestly interested in hearing you explain this one….

Find one example of a healthcare worker transmitting swine flu.

how would this be acomplished when Swine Flu cases are not being clinically tested anymore?

Are you saying that it is not possible for a healthcare worker to transmit swine flu?

So you dont think that any of the thousands of people currently with swine flu are health care workers? And you assume that every health care workers first priority is the people they come into contact with, rather than their wages?

This is precisely why health care workers should have the vaccine.

Because they meet at risk groups, because their level of knowledge of this Pandemic varies, and because some of them (as you have so excellently displayed) think they are better informed than the CDC.

calm down tim this isnt a particularly virulent strain of flu.

Yes is he seen it on John Craven's Newsround.

All immunisations carry risk. You can say this risk is high or low but none are risk free. Simple fact. The risks vary in likelihood and sseverity

The risk of me in my particular circumstances being a vector for swime flu transmission are low. If I was working in the medical admissions unit of a busy district general hospital it would be rather different

Why should a very small risk of me being a vector for swine flu mean that my rights to self determination should be restricted?

Of course I am not saying healthcare workers can't transmit swine flu.

Its a simple argument about self determination. You seem satisfied to remove a basic right from me for not quantifiable benefit and its questionable there will be any.

Its clear the main thrust of vaccination for healthcare workers is to reduce sick leave. This is not a particularly dangerous disease.

Notice its the healthcare professional that are doubtfull about this and understand the issues.

Notice its the healthcare professional that are doubtfull about this and understand the issues.

but are seemingly unwilling to actually discuss them !!

from Drac's earlier post "…Still I won't and can't force my staff to have it only encourage them…." it doesn't sound like he's much in doubt about the benefits of being vaccinated.
No-one is really denying any individuals right to refuse medication, but are interested in the reasons why they may refuse, other than a stubborn 'won't have it because you're telling me to'…..

it doesn't sound like he's much in doubt about the benefits of being vaccinated.

I hope not I'm a manager too so have to sound convincing.

doctornickriviera – I am pretty calm, just got sucked into an emotive subject for me, I really should know better than arguing on an internet forum….

TJ – Regarding the sick leave thing, agreed, but I have specific reasons for wanting healthcare workers swine flu free. As i have already said my wife has no immune system and is particularly susceptible to pneumonia bugs. Pretty much the only people she meets are healthcare workers, so I think she has the right to not be given swine flu by them. I accept that this doesnt rule out the possibility that I will go to Asda, be coughed over and give it to her, but my point is that they (healthcare workers) could reduce the odds by doing the sensible thing.

And we never mentioned all nhs workers, obviously there is a scale of risk dependant on your exposure to the public, my assumption was we were talking about front line healthcare workers….

I'll be having mine – maybe tomorrow, dunno

Mostly to avoid giving it to my parents (& maybe kids, though if pandemic kicks off proper they'll be passing it round the schools like nobody's business)

couple of thoughts generally:

I'm a bit unsure of the assertion that vaccination won't stop transmission. Immunity (if achieved) should prevent rapid, large increases in viral load in an exposed individual and also coughing etc and I'd agree with those who suggested it "must" reduce transmission.

Also (though I think the argument was a bit of a red-herring anyway) I'm not aware of a (human) carrier state for flu – has this been reported? (I believe cariers generally tend to be non-immune but luckily for them also non-susceptible). It's the non-immune bit that would allow transmission isn't it (?), and vaccines would mostly sort that out

It's a condition of my employment (and pretty typical within NHS) that I must be immune to rubella (G measles) purely because of the risk I might pose to patients, specifically pregnant women. If I hadn't already been immune I'd have been obliged to have the vaccine or look elsewhere for work.

the several H1N1 vaccines aren't licensed in the typical way and don't all correspond to seasonal flu in terms of manufacture. They are however compliant with the WHO's spec for pandemic vaccines and were licensed largely on the basis of prior work using the same methods but for H5N1 a few years ago. They have, of course, had some human testing – including a recent trial for the 2 currently available ones on UK kids

I've no axe to grind, I think I support others' right to decline but I'm disappointed that your (drac, TJ) reasons are either so nebulous that they can't be articulated or else pretty unconvincing to me based on a "for the greater good" starting premise.

Tim – my point is I don't meet your wife or people like her. If I worked with immuno suppressed people then I would have it.

I am neither in circumstance where I am more likely to catch it than the general population, nor are the people I look after at much greater risk of serious complications of swine flu than the general population. I don't go into the big general hospitals.

There are far more serious risks out there including other health care acquired infections.

There is really little point in me having it

Following this with interest… I am not trying to be a conspriacy starter but there are some issues that don't add up to me and these issues worry me and lead me to not jump on the bandwagon.

Why have they only planned to vaccinate at risk groups? Given as mentioned above that it "can kill a healthy person" seems weird, surely you would jab everyone? **( I know in the BMJ article linked above that it says everyone, i have been told otherwise)

The way the anti-virals have been dished out seems to generate questions, handing them out so willingly with a simple website/phone based test that is easy to fool, with the problem that officially only one antiviral per person should be issued. The WHO advised that Tamiflu (the antiviral) is not administered Tamiflu to children, yet it is currently being done so, and with such disregard, I have heard of all the people given tamiflu, the actual occurence of swine flu is below 20%, that is risking harm without reason.

You question the individuals here who have admited they wouldn't like to take the vaccine… but http://www.dailymail.co.uk/news/article-1208716/Half-GPs-refuse-swine-flu-vaccine-testing-fears.html shows nearly half of GP's are concerned and would decline, now either theres a massive lack of information OR they know something me and you don't! I personally have reason to think misinformation is an issue here.

Given the issues above i am not seeing the vaccine as a holy grail and so am not rushing to have it. I think it is an individuals decision.

hmmmm, just re-read the thread & think drac's just arguing against coercion & isn't saying he aint having it, hence no reasons cited – fair enough

Precisely I'm happy to have but only as I choose to and not because some says I have to.

**** going to be late for work. bye!

Why have they only planned to vaccinate at risk groups?

I believe that given the well publicised issues with getting enough of the vaccine made available in time, the priority is for at-risk groups and people in close contact with at-risk groups.

The way the anti-virals have been dished out seems to generate questions,

Indeed, it is experiences like this which probably make so many people question the ability of the govenrment to correctly handle a mass vaccination program.

shows nearly half of GP's are concerned and would decline, now either theres a massive lack of information

You've hit the nail on the head there, several studies have been published that prove higher uptake of vaccines in healthcare workers when they properly understand the risks vs the benefits.

Unfortunately the percieved view is that everybody who works in the healthcare profession is capable of making an informed judgement on the safety and efficacy of vaccination. Better education is the key here, not allowing people to make judgements based on what they've read in the tabloids.

As I've said all along, nobody should be forced to take the vaccine, but all of those who choose not to should have a genuine reason (as TJ does) that they can explain to their colleagues and managers because the current body of evidence suggests that not taking it could cost lives.

dr_adams my understanding is that Vaccine stocks are currently limited, so they are starting with the most vulnerable first, and then will roll it out in greater numbers when stocks allow.

The widespread Tamiflu prescribing seems to have been a mixture of panic reaction, public placation, (and if you believe it) a means to reduce over stocking of shortly out of date antivirals.

It is widely thought to be less effective once a patient is symptomatic, and even then to only reduce the period of illness by 24 hours.

TJ – you are still yet to provide any reason or proof to not have the vaccine? the fact that you are not likely to meet my wife, aside from this in itself being at least some comfort to her, does not stop you passing it on to people around you and doesnt add to herd immunity does it?

and its a bit selfish really?

everyone should have it, otherwise we run the risk of just being left with intelligent people able to differentiate fact and sense from unbased fear and distrust? ………. oh wait a minute

moving aside from the question of whether (because i will as soon as I'm offered it, with a recent history of asthma rapidly becoming chest infections / pneumonia) – but does anyone know any details of when / how?

All i can see on the flu websites is that we will be contacted by our GP's and invited to be vaccinated, but with postal strikes and the like, anyone know how this will be done. And also any idea how long to roll out vaccination to the at risk groups (sure this will vary from practice to practice but surely there's a basic plan?)

And lastly – assuming I'm in an at risk group, are my family supposed to be vaccinated too, to reduce their chances of getting it and passing it on to me (although if I'm vaccinated and it works, what benefit does this bring?)

theotherjonv – Not a cop out but probably best to ring your Drs and speak to them they will have someone appointed for the doing the programme in your area. Other areas may have a different format of walk in clinics some may give individual appointments.

Tim with the highest repect you sound panicy and over the top, I understand your concerns but there is no need for everyone to be vaccinated. It is a flu virus a new strain but still a flu virus, flu kills 100s very year anyway, it's the fact that it's a new strain that means it has spread, in a year or so time when it has been around for awhile there will be no offer of a vaccince but the riks will still be there.

Dr_dams does have a point about the diagnoses of it, they originally confirmed it was Swine Flu blood test and cases were low bet there. Then it became so a person in a call centre could diagnose it and the cases rockted, it was published hugely in the media that the pandemic had started don't you think there was a reason for this?

Then it became so a person in a call centre could diagnose it and the cases rockted, it was published hugely in the media that the pandemic had started don't you think there was a reason for this?

Drac, given your arguements earlier, you are the last person I would have suspected to be making things up without any evidence!

Transmissibility is therefore substantially higher than that of seasonal flu, and comparable with lower estimates of R0 obtained from previous influenza pandemics.

My wife is an Orthopeadic surgeon, and currently pregnant.

She got a very bad chst infection last week, which scared us both a bit, ok she didn't have a temperature, but she ended up taking it every few hours just to be sure.

Added to this, apparently if the poo hits the fan, medical doctors will continue looking after medical patients, and surgeons will be tasked with looking after the flu cases on surgical wards.

In terms of research, I know she said the research is poor/non existent, however pregnant women have been using the drug in Australia over their winter with no (known) side affects.

Yes she's worried, and me probably more than her, not about what the drug might do to her, but any long term side affects for our baby…

Yep we're in a very similar situation FunkyDunc.

But we're pretty persuaded that the safest action is to go for the vaccine. Our midwife told us she is seeing one pregnant lady a week with swine flu.

As has been said already the only really novel part of this drug is that it has attenuated H1N1 virus in it instead of the regular flu strains.

Seems to me that this means the only novel bit is basically the same bit you would get if you caught swine flu for real. No?

Transmissibility is therefore substantially higher than that of seasonal flu, and comparable with lower estimates of R0 obtained from previous influenza pandemics.

Yeah it is spread quicker as I say it's a new strain so will spread quicker, same happens with any new virus. Funny how the huge estimates they were giving earlier in the year for deaths has dropped dramatically though. It's a real threat but the media is hugely responsilbe for causing panic about swine flu and panic over vaccines.

moving aside from the question of whether (because i will as soon as I'm offered it, with a recent history of asthma rapidly becoming chest infections / pneumonia) – but does anyone know any details of when / how?

I believe that vaccines are being given to GP's within the next 3 weeks. Healthcare staff are being done separately in different clinics but Gp's will receive stocks and then send for people in the normal way that they would with seasonal flu…

As has been said already the only really novel part of this drug is that it has attenuated H1N1 virus in it instead of the regular flu strains.

I am not so sure, the impression i got from the WHO website is that there are different cases as regards emergency approval of medication in emergency circumstances (which this has been classed as) and one of them is altered medication but this not the class that the vaccines have been treated as, they have been treated as new medication… This might be a lack of understanding on my behalf but obviously shows there is concern, and if you look at other sources they do speak about the contents of the medication and list certain compounds that cause concern. I am not a pharmacist so i can't truely form my own opinion on that but there is no official responce and so that does raise questions.

You've hit the nail on the head there, several studies have been published that prove higher uptake of vaccines in healthcare workers when they properly understand the risks vs the benefits.

My concern with the above is that these studies are conducted by parties with an interest in the success of the trials. Normal medication takes years to go through the system and yet these vaccines have been rushed through. The source of this "better education" would be of interest to me, i am willing to learn but i see lack of independant verification. [You state that the risks are very low compared to the benefit but the general feeling amongst people i speak to is that the true risk is unknown, Yes there are the risks as per any vaccination but there has been little testing time to see if there is anything long term, as far as i am aware the trials have been for only one month] ( [ through ] represents what i have as my understanding, there is no impartial evidence and normally that wouldn't bother me, i don't read clinical trials of asprin before i take it but i do feel that this is a knee jerk reaction and the lack of an instant confident responce from those in power makes me question more).

I am not looking for an arugement or trolling, just curious…

Unfortunately the percieved view is that everybody who works in the healthcare profession is capable of making an informed judgement on the safety and efficacy of vaccination.

I am sorry but i found that quote a bit mean, you agree there might be a lack of evidence and so how can someone make an informed decision without that information? if that information is not present then you have to decline until the required data is there and so there is a possibility that anyone who declines are the people who are wanting to make an informed decision and not blindly follow the advice of a government who mentioned before have handled this whole situation badly.

Yeah it is spread quicker as I say it's a new strain so will spread quicker, same happens with any new virus.

I think what you are referring to is the epidemic curve.

Luckily although H1N1 can spread reasonably fast it fortunately doesn't result in a high death rate. Now if the H5N1 outbreak from a couple of years ago had the same or similar R0 value as this strain we wouldn't be having this argument.

[Quote]It's a real threat but the media is hugely responsilbe for causing panic about swine flu and panic over vaccines. [/quote]

Couldn't agree more, it has been overhyped (as usual) by the media, and its this sort of nonsense which causes issues when it comes to serious discussion of any medical issue.

dr_adams

My concern with the above is that these studies are conducted by parties with an interest in the success of the trials.

Really? There are plenty published in peer reviewed journals also quoting their sources of funding. Obviously there is no guarantee they are 100% unbiased, but then the same applies to any published work.

I am sorry but i found that quote a bit mean

I stand by it as the information is there but I wouldn't expect a receptionist or a junior nurse to be able to fully understand and interpret it.

To be honest there are a number of GPs who I also wouldn't trust to be able to understand and interpret a lot of the information out there. This brings me back to my point that we need better education – I don't know what literature is being distributed internally or whether or not it is suitable, but if there isn't somebody with an in-depth understanding of immunology and vaccination campaigns to answer and reassure people, then its never going to work is it?

Hmmmm……….

While you are having this lovely informed debate about the pros and cons, people are actually dying of H1N1 infections.

Intensive care units are currently pretty full; with bed occupancy rates running at over 100%. Not all H1N1, but the additional load is beginning to cause problems.

I don't think people realise how quickly this could move from a few poorly people to a complete Hollywood style nightmare.

We are coping at the moment, and there are robust plans in place should the worst case scenario develop, but I'm in the 'front line', and I'm somewhat concerned….