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With all the news coverage in the last few years of people scrambling to find a flu shot, it is interesting to note that not everyone recommended for annual vaccination and able to access it chooses to do so. Surprisingly, one such group that avoids flu shots is the people administering the vaccines. In fact, only 40% of all healthcare workers were vaccinated in 2003.1


Healthcare professionals-and nurses in particular-are key to preventing the spread of influenza, a debilitating and highly contagious respiratory infection. It is caused by a virus and leads to an average of approximately 200,000 hospitalizations and 36,000 deaths in the United States each year.2 Because of their frequent and direct patient contact, nurses can spread the virus to patients in their care.3 This is problematic for the many patients at high risk for influenza-related complications that could lead to hospitalizations and even death. Influenza can also be spread from one healthcare worker to another or from patient to healthcare worker. In an era of nursing shortages, understaffing, and mandatory overtime, nurses do not want to burden their coworkers by taking sick days related to something as easily preventable as influenza.


The influenza vaccine remains the best way for nurses to protect themselves, their families, and the patients in their care during the annual influenza epidemic. An annual intramuscular vaccination, the influenza vaccine is one of few immunizations that are recommended for all healthcare professionals, regardless of any special conditions such as pregnancy, human immunodeficiency virus infection, severe immunosuppression, renal failure, asplenia, diabetes, and alcoholism/alcoholic cirrhosis. Another option for most healthcare providers is the live intranasal influenza vaccine. This live vaccine is approved for use by healthy persons 5 to 49 years of age who are not pregnant and do not provide care for severely immune-compromised persons requiring care in a protected environment.


Since 1984, the Centers for Disease Control (CDC) and the Advisory Committee on Immunization Practices have recommended that healthcare professionals (inclusive of doctors, nurses, and other staff who work directly with patients) receive an annual influenza vaccination. Because the vaccine is altered nearly every year to match the circulating strain, and because immunity from the vaccine wanes over time, the vaccine must be given each year-ideally in October or November.



Despite the established benefits of the influenza vaccine, however, several misconceptions exist in the nursing community. The most common myth is that the influenza vaccine can actually cause influenza. In reality, the vaccine cannot cause influenza. Some nurses also mistakenly believe that they are automatically immune to influenza or have stronger immune systems merely because they work around sick people every day. Because influenza viruses are constantly changing, past exposure to influenza will not provide protection against newly emerged strains.


Another misconception is that the side effects of the vaccine are worse than getting influenza itself. The truth is that the most serious side effect is an allergic reaction in people who have a severe allergy to eggs (the vaccine viruses are grown in eggs). For this reason, influenza vaccination is contraindicated for persons with an egg allergy. The most common side effects are redness at the injection site and a sore arm. These symptoms are mild and resolve in 1 to 2 days.


Finally, some people might argue that because the influenza vaccine is not 100% effective (it is 70%-90% effective in healthy adults), they will get influenza anyway. Even if the vaccine does not prevent all individuals from getting influenza, they are still likely to be far less sick than they would have been without the shot. The vaccine also greatly reduces the chance of hospitalization and death. People at greatest risk for influenza-related complications include people 65 years and older; residents of nursing homes and other chronic care facilities; people with chronic pulmonary or cardiovascular conditions; people with diabetes mellitus; and children less than 2 years of age.



Although influenza is primarily spread by droplet transmission, the virus can also live in objects such as doorknobs, telephone receivers, utensils and food trays, beds, and medical equipment for possibly up to 1 day. Some people infected with influenza may not develop symptoms at all, but may be infectious to others. For infected persons who do develop symptoms, they can be contagious the day before they get symptoms. Thus, nurses can transmit the virus even before they realize they are infected. The period of greatest contagion is during the first 3 days of illness and can last for 5 to 7 days in otherwise healthy adults.


Influenza usually starts suddenly and may include the following symptoms:


* Fever (usually high)


* Headache


* Tiredness (can be extreme)


* Cough


* Sore throat


* Runny or stuffy nose


* Body aches


* Diarrhea and vomiting also can occur infrequently but are more common in children.



General treatment of influenza includes bed rest, drinking plenty of fluids, and taking over-the-counter medicines such as acetaminophen. Children suspected of having influenza should not be given aspirin because this may increase the risk of a complication known as Reye Syndrome. In addition, there are several prescription antiviral medicines (such as amantadine, rimantadine, and oseltamivir) that can help to prevent influenza infection and, when used within the first 48 hours of illness, can reduce duration and severity of the influenza illness. Some persons infected with influenza may also need antibiotics if their healthcare provider suspects a secondary or concomitant bacterial infection.


Nurses have long played a key role in preventing much influenza-related morbidity and mortality by ensuring that at-risk patients, particularly elderly patients and young children, are vaccinated against influenza every year. The time is long overdue for nurses to take care of themselves as well and protect against the influenza virus by getting a vaccination.


For more information about influenza and the influenza vaccine, visit or call 800-CDC-INFO (800-232-4636) or contact




1. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practice (ACIP). MMWR. 2004;53(RR06):1-40. [Context Link]


2. Centers for Disease Control and Prevention. Influenza: the disease. November 15, 2004. Available at: [Context Link]


3. National Foundation for Infectious Diseases. Improving influenza vaccination rates in health care workers. Strategies to increase protection for workers and patients. Bethesda, Md: National Foundation for Infectious Diseases; 2004. [Context Link]