Flu vaccine?

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mouse2562

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I'm starting rotations this summer, and one of the vaccination requirements is getting a flu shot. I'm perfectly aware that flu shots typically *don't* actually make anyone sick. I happen to be one of the few people who it does negatively affect, however. Each of the 3 times I've gotten the shot, I became incredibly sick. I was actually hospitalized 2/3 times I received it (I also have asthma). While the virus in the shot is dead and obviously doesn't directly give me the flu, it does seem to affect my immune system negatively- and I get *very* sick.

At the recommendation of the ICU doctor, the last hospitalization marked the last time I've gotten the flu shot. That was about 10 years ago. I'm very concerned about getting this vaccine. I mentioned it to my current (new) doctor, but the response was an eye-roll and a "what a coincidence!" when I said I got very sick each time... so the likelihood of getting any sort of support from her about me not receiving it is extremely low.

Thoughts? Advice?
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Has your asthma improved in that 10 years?

Im pro-vaccine. I think it saves lives. Im pen-allergic and had a terrible, full-body rash with Augmentin over a year ago. Would I try a penicillin de-sens protocol? Absolutely. *shrug*
 
Thanks to HIPAA, I'm pretty sure you can just say "the flu vaccine is contraindicated based on my confidential medical history." And be done with it. If people seem grumpy about it, you could offer to wear an N95 mask during flu season.
 
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zelman said:
Thanks to HIPAA, I'm pretty sure you can just say "the flu vaccine is contraindicated based on my confidential medical history." And be done with it. If people seem grumpy about it, you could offer to wear an N95 mask during flu season.
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Nope, most places require verification or a statement signed by a medical doctor.
 
All4MyDaughter said:
Nope, most places require verification or a statement signed by a medical doctor.
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A lot of places expect you to give up your rights willingly. Unless they are providing you medical care, it's none of their business. You can ask to discuss further with their HIPAA compliance officer.
 
zelman said:
Details about your medical history?
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HIPAA prevents a health care provider from disclosing your medical history or details about your care without your permission. It has nothing to do with an employer or an educational institution requiring health related information as a condition of employment/enrollment. I had to submit vaccination history from 30 years ago in order to enroll in pharmacy school. Several of my rotations required PROOF of immunization and a few required titers. I had to provide health history to work for the county health center. I had a complete physical when I started working for the VA. Almost every health care job requires PPD or chest x-ray to screen for TB. You don't just get to say, "Nope! I don't have TB!" and then run to the HIPAA officer when they ask for documentation.

Every medical release from vaccination that I've ever seen required documentation from a health care provider. They don't require details, but do require that a health care provider attest to the contraindication.

A similar situation arises when one is injured on the job. When I got injured on the job at the VA, I could not return to work until the orthopedic surgeon released me. HR didn't get details of my injury or medical care, but they most definitely got the signed release before I was allowed back at work.
 
All4MyDaughter said:
HIPAA prevents a health care provider from disclosing your medical history or details about your care without your permission. It has nothing to do with an employer or an educational institution requiring health related information as a condition of employment/enrollment. I had to submit vaccination history from 30 years ago in order to enroll in pharmacy school. Several of my rotations required PROOF of immunization and a few required titers. I had to provide health history to work for the county health center. I had a complete physical when I started working for the VA. Almost every health care job requires PPD or chest x-ray to screen for TB. You don't just get to say, "Nope! I don't have TB!" and then run to the HIPAA officer when they ask for documentation.

Every medical release from vaccination that I've ever seen required documentation from a health care provider. They don't require details, but do require that a health care provider attest to the contraindication.

A similar situation arises when one is injured on the job. When I got injured on the job at the VA, I could not return to work until the orthopedic surgeon released me. HR didn't get details of my injury or medical care, but they most definitely got the signed release before I was allowed back at work.
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I see what you're saying now. There are some state laws that would prevent this disclosure, however. Here's one in Maryland.

One could also make an argument that the inability to receive a flu shot in this instance might be considered to be a disability, which would bring the federal Americans with Disabilities Act into play.
 
zelman said:
A lot of places expect you to give up your rights willingly. Unless they are providing you medical care, it's none of their business. You can ask to discuss further with their HIPAA compliance officer.
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Yeah, you refuse to answer their questions, they refuse to let you on site. If you're going to be a potential risk to their patients, do you think they will allow you there?
 
zelman said:
I see what you're saying now. There are some state laws that would prevent this disclosure, however. Here's one in Maryland.

One could also make an argument that the inability to receive a flu shot in this instance might be considered to be a disability, which would bring the federal Americans with Disabilities Act into play.
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Except that the Maryland law doesn't prevent your employer from requiring a flu vaccine:

An employer may not require an applicant for employment to answer an oral or written question that relates to a physical, psychiatric, or psychological disability, illness, handicap, or treatment unless the disability, illness, handicap, or treatment has a direct, material, and timely relationship to the capacity or fitness of the applicant to perform the job properly.
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If it's a requirement of the site that one be fully immunized, then one must demonstrate full immunization to be considered fit for the job. And if someone claims a medical exemption from ANY work requirement, the employer is within his or her rights to require documentation. They need the documentation to determine if they can provide reasonable accommodation. In this case, that MIGHT include allowing the employee/student to wear a mask in lieu of vaccination.

I developed a temporary disability during my last pregnancy. My doctor had a standard statement that said something like, "A4MD is under my care for a medical condition and requires the following accomodations: ___________, ____________, and ____________." My residency sites wanted that documentation, as any employer would. Neither the ADA or state law prohibits this.
 
All4MyDaughter said:
Except that the Maryland law doesn't prevent your employer from requiring a flu vaccine:



If it's a requirement of the site that one be fully immunized, then one must demonstrate full immunization to be considered fit for the job. And if someone claims a medical exemption from ANY work requirement, the employer is within his or her rights to require documentation. They need the documentation to determine if they can provide reasonable accommodation. In this case, that MIGHT include allowing the employee/student to wear a mask in lieu of vaccination.

I developed a temporary disability during my last pregnancy. My doctor had a standard statement that said something like, "A4MD is under my care for a medical condition and requires the following accomodations: ___________, ____________, and ____________." My residency sites wanted that documentation, as any employer would. Neither the ADA or state law prohibits this.
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Performance of job duties doesn't directly relate to vaccination history.
 
zelman said:
Performance of job duties doesn't directly relate to vaccination history.
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On what planet?

Maybe if you're sitting in a mail order facility working you could argue that. If you're even in the room with a patient, vaccination history has a direct implication to peformance duties. I.e. you can't perform your duties if you're not vaccinated because rotation sites/jobs frown upon you spreading pertussis/etc. to their patients.
 
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mouse2562 said:
I'm starting rotations this summer, and one of the vaccination requirements is getting a flu shot. I'm perfectly aware that flu shots typically *don't* actually make anyone sick. I happen to be one of the few people who it does negatively affect, however. Each of the 3 times I've gotten the shot, I became incredibly sick. I was actually hospitalized 2/3 times I received it (I also have asthma). While the virus in the shot is dead and obviously doesn't directly give me the flu, it does seem to affect my immune system negatively- and I get *very* sick.

At the recommendation of the ICU doctor, the last hospitalization marked the last time I've gotten the flu shot. That was about 10 years ago. I'm very concerned about getting this vaccine. I mentioned it to my current (new) doctor, but the response was an eye-roll and a "what a coincidence!" when I said I got very sick each time... so the likelihood of getting any sort of support from her about me not receiving it is extremely low.

Thoughts? Advice?
Click to expand...
What type of sick? Asthma exacerbation? Im not familiar with detailed mechanism of flu shots, but could it be related to histamine release? Many drugs, such as opioids can cause release and is a known irritant for asthmatics. Until there is clarity in what you're sickness is, I'll leave it at that...unfortunately, if your having pt. Contact you may have no choice. Also, you may check and see if they will let you get by with wearing a mask for the duration of your rotation.
 
eagles22 said:
On what planet?

Maybe if you're sitting in a mail order facility working you could argue that. If you're even in the room with a patient, vaccination history has a direct implication to peformance duties. I.e. you can't perform your duties if you're not vaccinated because rotation sites/jobs frown upon you spreading pertussis/etc. to their patients.
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My job description says something along the lines of "verify accuracy and appropriateness of prescriptions". It doesn't address the transmission of specific strains of specific communicable diseases. The inability to perform duties the law is addressing is more along the lines of someone with spinal stenosis and two torn rotator cuffs can't hide that history when getting a job lifting heavy boxes in a warehouse.
 
Probably along the lines if perform the duties of a pharmacist and you can't do that in certain settings if you are not immunized fully (or wearing a n95 mask). It's insane that we have pharamcists that are against immunizing themselves when they are responsible for the care of others and themselves
 
Read the book, The Panic Virus by Seth Mnookin. Then you'll understand the importance of getting vaccinated.
 
npage148 said:
Probably along the lines if perform the duties of a pharmacist and you can't do that in certain settings if you are not immunized fully (or wearing a n95 mask). It's insane that we have pharamcists that are against immunizing themselves when they are responsible for the care of others and themselves
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$20,000. That's the average cost of a respiratory hospitalization that ends up in the ICU (without intubation). I'm a thousand percent for immunization of everyone who will not potentially die from it and/or cost the healthcare system tens of thousands of dollars. When someone's ICU doc recommends against it, I tend to agree with them.
 
zelman said:
$20,000. That's the average cost of a respiratory hospitalization that ends up in the ICU (without intubation). I'm a thousand percent for immunization of everyone who will not potentially die from it and/or cost the healthcare system tens of thousands of dollars. When someone's ICU doc recommends against it, I tend to agree with them.
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Then "someone's ICU doc" needs to sign the medical waiver. I tend to agree with the current doctor who thinks perhaps the past illnesses were coincidental. My thought is that they were related more to poor control of asthma than the flu vaccine.

And I don't know where that $20,000 figure comes from for respiratory illness and the ICU. It seems low. I had outpatient surgery in December and the bill was a bit more than 10K. My son had an outpatient MRI and the total bill was over 15K.
 
All4MyDaughter said:
Then "someone's ICU doc" needs to sign the medical waiver. I tend to agree with the current doctor who thinks perhaps the past illnesses were coincidental. My thought is that they were related more to poor control of asthma than the flu vaccine.

And I don't know where that $20,000 figure comes from for respiratory illness and the ICU. It seems low. I had outpatient surgery in December and the bill was a bit more than 10K. My son had an outpatient MRI and the total bill was over 15K.
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I think that was a 2008 figure for COPD patients. ICU plus intubation was $44k with a standard deviation over $80k, so it can go much higher than average.
 
zelman said:
$20,000. That's the average cost of a respiratory hospitalization that ends up in the ICU (without intubation). I'm a thousand percent for immunization of everyone who will not potentially die from it and/or cost the healthcare system tens of thousands of dollars. When someone's ICU doc recommends against it, I tend to agree with them.
Click to expand...

Assuming the poster isnt a non-trad, the event probably happened when they were a minor. As I understand it, asthma can get better as children get older so perhaps a lifetime ban on the flu vaccine is a little overkill.
 
First, if you had that kind of reaction it would be medically interesting as I have never seen a severe non-allergic reaction to the flu vaccine reported in the medical literature.

My place of practice required a Flu vaccine (proof) or requires you wear an N95 mask 100% of the time in the hospital for the entire flu season (Sept-March)

HIPPA doesnt guard against non-covered entities. Your employer is not covered by HIPPA. Basically if they don't give you a privacy act notice, HIPPA doesn't apply.

You might qualify under ADA, but you would need documentation.

My advice: If you insist on forgoing the flu vaccine - ask about the N95 mask option. Also know, that you will probably have to deal with this question from here on out.
 
KidPharmD said:
My advice: If you insist on forgoing the flu vaccine - ask about the N95 mask option. Also know, that you will probably have to deal with this question from here on out.
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This is probably true. Also, I'd bet there's a pill mill out there that would document that you received a flu shot if you're looking to go the dishonest route just as a stop-gap measure to get through school.
 
Were the reactions experienced with the same or different flu formulations? Perhaps a different route, strength or adjuvant would work better than what has been used in the past.
 
ml142009 said:
Were the reactions experienced with the same or different flu formulations? Perhaps a different route, strength or adjuvant would work better than what has been used in the past.
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Perhaps someone with an allergy to amoxicillin can take penicillin, but you rarely test that.
 
eagles22 said:
And expose yourself and patients to the flu.
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Hello. people still aren't washing their hands in direct patient care. Let us not pretend that the patients are the real interest. Patient care is synonymous with loss of reimbursement these wonderful days. Institutions are out to protect their assets which requires them to stop fumbling the ball where patient care is concerned hence they document to cover their collective asses and screw the little guy with the idiosyncratic reaction.

My heart goes out to the mouse on hisher lonely journey. At least the quantiferon gold ended my bull**** battle with the PPD allergy that no ever believed. Were it not for that I would be on INH prophylaxis 5 times over. Pllllllllllllllllllllllllllllll. Mini rant.... Ahhhh.
 
StellargalS said:
At least the quantiferon gold ended my bullcrap battle with the PPD allergy that no ever believed. Were it not for that I would be on INH prophylaxis 5 times over. Pllllllllllllllllllllllllllllll. Mini rant.... Ahhhh.
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I thought positive PPD just meant you needed a chest x-ray?
 
StellargalS said:
Hello. people still aren't washing their hands in direct patient care. Let us not pretend that the patients are the real interest. Patient care is synonymous with loss of reimbursement these wonderful days. Institutions are out to protect their assets which requires them to stop fumbling the ball where patient care is concerned hence they document to cover their collective asses and screw the little guy with the idiosyncratic reaction.

My heart goes out to the mouse on hisher lonely journey. At least the quantiferon gold ended my bullcrap battle with the PPD allergy that no ever believed. Were it not for that I would be on INH prophylaxis 5 times over. Pllllllllllllllllllllllllllllll. Mini rant.... Ahhhh.
Click to expand...

And guns are more dangerous than knives but people don't advocate allowing people to carry around knives because there's something worse out there. flu vaccines still do play a part in keeping people healthy. You can't have flu virus on your hands if you don't have the flu.
 
zelman said:
I thought positive PPD just meant you needed a chest x-ray?
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no
zelman said:
I thought positive PPD just meant you needed a chest x-ray?
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This is my response to all regarding my experience with PPD.

My last experience with the illustrious and outdated PPD.
Believe it or don't.

I got two PPD within 2 months of one another because I couldn't get the record that cleared my first reading. The first reading was negative but a reaction ensued after the 48 hour read that lasted almost 2 weeks. I went and got it reread to ensure that I wasn't a risk and the ID nurse said no it is negative but it seems you have an allergy.

So now flash forward to PPD 2. I informed the administering person of the hx of rxn and got the usual apathetic patient blow off that I witness on the other end as a HCP. She was supposed to use a half strength titre but didn't. Within 3 hours of the administration my arm looked like it had 3 gauge catheter inserted from the wrist to the arm pit and it was red and hot with satellite papules sprinkled about. When I return within 48 hours the reaction had subsided but looked like a basic positive PPD. The reader acknowledged my account of the reaction but was dumbfounded by what to do about it. At the end of the day she and another physician read the PPD as positive and sent me for a chest xray which was negative. HOWEVER, the dimwits insisted that I take INH prophylaxis and I said "you can write the RX and I will pick it up. That is all I am willing to do." Perhaps they came to their senses and never issued the rx but I couldn't tell you because I ended up leaving the job and never followed up further on it. This was my experience. Jackasses want to keep poking me with the PPD until I blow up but the Quantiferon precludes this as a necessity. Further QG reads "not exposed."

Weather or not the INH was appropriate is inconsequential. These dimwits were the authority and to them it was requisite to my clearance for duty. I was to be exposed to a hepatotoxic drug due to an outlier response that the system can't deal with appropriately. This is what matters.

The OP shouldn't be questioned and treated with cynicism but that is our lovely culture. Plllllllllllllllllll again. I am a patient and a HCP just as you all are. You got it straight and narrow? Good for you! The in-club looks incredulously at the outlier which I find a bore but I am used to it. I was merely trying to console the OP because I understand the hassle and agony of being an outlier. You want to imply that the outlier is a liar or crazy no problem. IMO People who minimize the plight of the outlier are miniminded non-helpers. :zip:
 
Flu shots are a profit driver for the medical industrial complex. CDC's own website lists a meager 47% VE for individuals under the age of 60. Over the age of 60 there is no VE established. Watch how every January the corporate media hits the flu panic button. There is very little evidence for the herd protection theory. We should be given the choice to opt out of an ineffective and potentially harmful procedure.
 
StellargalS said:
no


This is my response to all regarding my experience with PPD........
.
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That's really astonishing. It is interesting that your employer's health department (or similar) doesn't follow the CDC recommended guidelines for PPD testing. I tested positive on PPD this year, and I was sent to the Health Department and had my CXR (clear). Employer only asked that I go. Never asked if I chose treatment or not. CDC states that treatment for Latent TB is optional. I finish my Rifampin course this week. What zelman said are actually the recommendations given by the CDC for distinguishing of Latent TB and Active TB.

Hope you have a better experience next time its time for TB testing (QFG first maybe?).

Not trying to criticize the OP, but I still think vaccination or N95 are going to be his options. Did we ever find out what his employer said about a mask?
 
mouse2562 said:
I'm starting rotations this summer, and one of the vaccination requirements is getting a flu shot.
Click to expand...

This occurs to me now! You begin rotations in the off season right? Run from administrative people until the shot is unavailable. Huh huh huh huh? Work the system to buy time then when they corner you make your choice.

Your choices will be the gas mask or the shot.

In scenario one it is a rotation and as a student you stick out like a sore thumb anyway so you dawn the required gas mask. You will never see those people again. To many of the them you are just free labor any way so fu3k them.

In scenario two go to the doctor NOT the CVS or Walgreens for your shot. Preface the shot with your medical history and concerns THEN return with your hosp admission records and say: "now about that outlier response, throw me a bone and write me a medically binding golden ticket to end my suffering. Please?" Because it is a yearly ordeal better stick an expiration on it and discuss the opportunity for revarification in case the doctor croaks or something. At a minimum shoot for a 5 year waiver. (All this is just in case thinking as I have no idea how such disclaimers work thanks to Quantiferon Gold.)

Both options blow but as an outlier you have the experience the mainstream lacks and this gives you an edge in the provision of more efficient and compassionate patient care. I wouldn't trade this edge for anything.:angelic: Why? The reasons are many but from the most practical stand point patients, not other healthcare professionals, are your work. Evaluating them from a position of doubt and scrutiny is counterproductive really. Quality of life is a valid outcome. On the flip side the other healthcare professionals can make it really hard for you to get work. The choice is yours. Chin chin.
 
KidPharmD said:
That's really astonishing. It is interesting that your employer's health department (or similar) doesn't follow the CDC recommended guidelines for PPD testing. I tested positive on PPD this year, and I was sent to the Health Department and had my CXR (clear). Employer only asked that I go. Never asked if I chose treatment or not. CDC states that treatment for Latent TB is optional. I finish my Rifampin course this week. What zelman said are actually the recommendations given by the CDC for distinguishing of Latent TB and Active TB.

Hope you have a better experience next time its time for TB testing (QFG first maybe?).

Not trying to criticize the OP, but I still think vaccination or N95 are going to be his options. Did we ever find out what his employer said about a mask?
Click to expand...

To me I say "Holy defensive batman!" Thanks for your diplomacy. Despite the defensive tone I do have humor in hindsight. At the time it was like reasoning with Dumb and Dumber. They won the rights to diagnose in the safety net clinic and they handled my pre-employment screening. It is not a myth that the poor get poor quality care.

That was 2009. Since then I have been cleared q year with the QFG.

I worked per diem for a major hospital system and the N95 was offered as the alternate to vaccination. IMO it sucks. People will frown on the wearer of N95. You are pretty much writing your own pink slip with that choice. Since the OP is cheap student labor, I mean on rotations, the concern may be less but I wouldn't bank on a recommendation from that preceptor (I have no idea what the game is there).
 
StellargalS said:
In scenario one it is a rotation and as a student you stick out like a sore thumb anyway so you dawn the required gas mask. You will never see those people again. To many of the them you are just free labor any way so fu3k them.
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And people seriously wonder why it is so hard for some people to find a job?
 
owlegrad said:
And people seriously wonder why it is so hard for some people to find a job?
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Um yeah Owlgrad I went to your alma matter. I have no doubts as to why it is difficult to find a job. This is an anonymous forum and I am sharing thoughts, experience and frustration. I don't run around voicing my opinion in the real world. So...please... save it sarcasm machine.
 
StellargalS said:
Um yeah Owlgrad I went to your alma matter. I have no doubts as to why it is difficult to find a job. This is an anonymous forum and I am sharing thoughts, experience and frustration. I don't run around voicing my opinion in the real world. So...please... save it sarcasm machine.
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I don't know Alma Matter. Is that someone's name? If not, what kind of matter is it, solid, liquid or gas? 😛
 
StellargalS said:
Um yeah Owlgrad I went to your alma matter. I have no doubts as to why it is difficult to find a job. This is an anonymous forum and I am sharing thoughts, experience and frustration. I don't run around voicing my opinion in the real world. So...please... save it sarcasm machine.
Click to expand...

You are still giving the OP terrible advice. "Fu3k them?" Not exactly the way to leave a good impression for future job prospects. You can whine all you want about being an outlier blah blah blah but that doesn't mean you should go around telling people to have a bad attitude with potential future employers.
 
owlegrad said:
You are still giving the OP terrible advice. "Fu3k them?" Not exactly the way to leave a good impression for future job prospects. You can whine all you want about being an outlier blah blah blah but that doesn't mean you should go around telling people to have a bad attitude with potential future employers.
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What great career shaping take a ways did I miss from your one and two sentence condescensions? Your passive aggressive mocking probably did the OP a world of good that I just can't fathom. So I used the f bomb... lighten up Mary Popins. Next time I will say bippity bopidy boo them in honor of you. :bullcrap:
 
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