The Boston Home is a long-term care facility for physically disabled adults (average age 55). Of the 96 residents living at The Boston Home, 85% are diagnosed with Multiple Sclerosis. We employ approximately 200 employees.
In 1999, The Boston Home suffered a catastrophic outbreak of influenza amongst its residents and staff. Using a case definition of fever of above 100 and one of the following: cough, coryza, sore throat or cold symptoms, 28 of the 35 people who became ill were defined as cases during the month of February 1999.
Twelve residents required hospitalization. Five died in the hospital as a consequence of the flu or a secondary pneumonia. The week after the outbreak, the staff started to get sick and two staff members were hospitalized with influenza.
We called the Department of Public Health, placed the facility on quarantine and ultimately treated all employees and residents with amantadine to stop the spread of the virus. As I told my colleagues back then, I felt like I was living a chapter out of a science-fiction novel.
How many times have we heard the phrase, “I had a touch of the flu”? I can tell you there is no such thing as a “touch of the flu.” When you have influenza, you are deathly ill. I vowed to learn as much about influenza as possible and we employed the assistance of a local school of public health and the Department of Public Health to assist us.
We learned about “herd” immunity and that if we vaccinated at least 85% of the populations (staff, residents and frequent visitors) we could achieve 100% protection.
At the time of the outbreak, we had a voluntary vaccination program. About 60% of our residents were vaccinated for influenza and a smaller percentage against pneumonia. Employee vaccination was also voluntary and we estimated that about 40% were vaccinated at that time. We were not even close to herd immunity.
With a lot of education, our vaccination rate increased to 85% of the residents and 65% of the staff in 2000. The flu hit the Boston area early in that flu season but we experienced only one case of resident influenza and one case of employee influenza. We had a rapid response plan in place and avoided another outbreak.
We learned that the residents with muscle wasting were probably not getting full protection from the vaccination because the injections are intramuscular. We also learned that it was important for staff with the flu to stay out of work for a full 48 hours after their last symptom — meaning that they would be out of work seven to 10 days.
Over the next two years, we phased in a mandatory vaccination policy for employees and now experience 95% rates of vaccination for employees and residents. And remarkably since the year 2003, we have not had any documented cases of influenza. In addition, not one employee or resident has had an adverse reaction to the vaccine.
It makes me sad to hear others from my profession argue against flu vaccination with statements such as, “I never got the flu and I have never been vaccinated.” That is not the point. There is sound evidence that the vaccine is safe, that the vaccine works and it saves lives.
Healthcare institutions and organizations recognize that truth but have still been reticent to support mandatory vaccination. Education works to a point, but if you cannot achieve herd immunity with education alone — and it certainly appears that this is the case — then mandatory vaccination (with exclusions for medical contraindication) seems to be the only real alternative.
Cindy Walsh, RN, BSN, MSCN, is the Director of Clinical Services, The Boston Home, in Dorchester, MA.
