AMA House of Delegates

"It is our ethical duty to do no harm and prevent transmission of disease to patients," said Michael L. Butera, MD, an alternate delegate who spoke on behalf of the Infectious Diseases Society of America. The society offered a resolution calling for the AMA to back universal seasonal and H1N1 flu immunizations for health professionals.

AMA meeting: No flu shot mandate for doctors; hand sanitizer pushed

The AMA will study if there's any benefit from requiring all health professionals to receive influenza vaccine.

By , — Posted Nov. 23, 2009

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The AMA House of Delegates rejected a proposal to mandate vaccinations for health care professionals but approved other policy to prevent the spread of seasonal flu and influenza A(H1N1).

A resolution by the Infectious Diseases Society of America said the AMA should back universal seasonal and H1N1 flu immunizations unless health professionals have medical contraindications or religious objections. In October, New York state announced that it was requiring all health professionals to get the H1N1 immunization, but the mandate was suspended later that month due to vaccine shortages.

"It is our ethical duty to do no harm and prevent transmission of disease to patients," said Michael L. Butera, MD, an alternate delegate who spoke on behalf of IDSA. "Despite educational efforts, we have 40% to 70% immunization rates that are woefully inadequate." Mandates may be "the only way to achieve" the goal of universal vaccination, he said.

But delegates balked at the idea of a vaccination mandate, saying that requirements should be a last resort and can be counterproductive if implemented poorly. The house directed the AMA to study the ethical and scientific intricacies of the issue further.


Dr. Fiore

Delegates said hand sanitizer dispensers should be available in well-trafficked areas and urged large gathering places to develop plans in line with Centers for Disease Control and Prevention recommendations.

Physicians briefed on H1N1

During a session at the Interim Meeting, two CDC officials briefed delegates on the latest epidemiological data on H1N1 and how best to manage the disease. They addressed hospitalization rates, vaccine availability, dosing and vaccine testing.

Most cases of H1N1 have not required hospital care. But the highest hospitalization rates have been for children through age 4, said Anthony E. Fiore, MD, MPH, a medical epidemiologist in the CDC Influenza Division. Among hospitalized adults, 70% have an underlying medical condition. If a patient appears to have the virus, treatment should be started as soon as possible. "We encourage people not to delay treatment awaiting laboratory confirmation."


Dr. Bell

Physicians and other health care professionals need to take precautions to make sure they don't get sick, said Michael Bell, MD, associate director for infection control at the CDC Division of Healthcare Quality Promotion. Most exposure risk in hospitals is from sick workers, not patients. He cited an example of a resident at an Ohio hospital who infected 166 people with the virus. (See correction)

To prevent the spread of H1N1 in physician practices, sick workers should stay home, and ill patients should be kept away from noninfected patients. Dr. Bell recommended vaccination for doctors and their staffs, saying it doesn't make sense to put patients at risk by skipping shots.

Health care personnel who develop a fever and respiratory symptoms should be excluded from work for at least 24 hours after the fever subsides, the CDC said. Workers who develop acute respiratory symptoms without fever should be allowed to work unless assigned to areas with severely immunocompromised patients. In those cases, workers should be reassigned temporarily or excluded from work for seven days from the onset of symptoms.

Meanwhile, CDC officials on Nov. 12 said about 22 million Americans had been sickened by H1N1 and about 4,000 had died, including 540 children. About 42 million doses of vaccine have been created.

"The amount coming out will increase rapidly in the next few weeks," Dr. Fiore said.

In a Nov. 10 letter to doctors, Food and Drug Administration Commissioner Margaret A. Hamburg, MD, said no serious adverse events attributed to the vaccine had emerged in clinical trials on more than 3,600 patients. She encouraged physicians to report any vaccine-related problems to the Vaccine Adverse Event Reporting System.

Colette R. Willins, MD, a family physician in Westlake, Ohio, and a delegate for the American Academy of Family Physicians, was among the physicians at the AMA Interim Meeting who voiced frustration about not receiving H1N1 vaccines yet.

"They keep telling us to watch for it," she said. "I can't even get my staff vaccinated."

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Meeting notes: Public health

Issue: The growing popularity of computed tomography and other imaging tests is exposing patients to increasing cumulative amounts of ionizing radiation, with unclear effects on lifetime cancer risk.

Proposed action: Work with specialty societies to devise a common format to track individual patients' cumulative radiation exposure and develop related physician performance measures. [Adopted]

Issue: Physicians too often fail to spot cases of child abuse and neglect.

Proposed action: Develop a comprehensive strategy to help educate doctors about how to detect, report and treat the mistreatment of children while reducing conflicts with child protective services. [Adopted]

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This article misstated the outcome of contact between a medical resident at an Ohio hospital and other people at the hospital. The resident exposed 166 people to influenza A(H1N1). American Medical News regrets the error.

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