WEST PALM BEACH, Fla. - The flu has charged through 17 Florida nursing homes and long-term care facilities this season, including two in Palm Beach County last month.
While the flu can cause aches, fever and coughing, for the elderly it also can lead to deteriorating health or even death.
Preventing the flu in a nursing home, where the most fragile of a susceptible population live, is a particularly daunting task -- one made more difficult because too often the staff isn't vaccinated, according to the U.S. Centers for Disease Control and Prevention.
The CDC this season has the most detailed data ever on vaccination rates among health care workers, and they show that nursing home workers had some of the worst rates. That's especially scary because the strain in widest circulation is one that vigorously targets the elderly.
According to CDC data, pharmacists and physicians have the best rates, with more than 80 percent reporting they've gotten a flu shot, while less than half of nursing home workers reported getting vaccinated, said CDC Director Tom Frieden.
One study funded by the CDC found the rate in Florida's nursing homes is lower still -- 36 percent.
"Every year we go through this challenge trying to get the staff vaccinated," said Dr. Karl Dhana, medical director at Morse Geriatric Center in West Palm Beach.
Dhana and others in the field say the obstacles they must overcome include having many part-time or contractual workers and workers with deeply held false beliefs, such as that the vaccine can cause the flu or other illnesses.
No law requires health care professionals to be vaccinated against the flu.
Hospitals have tried for years to boost vaccination rates with incentives and consequences. At least 12 nurses and health care workers across the country have been fired this year under policies that require those in contact with patients to be vaccinated.
Such policies seem to be paying off. Hospital chains such as Tenet Healthcare, which operates five hospitals in Palm Beach County, reported 90 percent compliance last year in Florida with its requirement to have a flu shot or wear a mask.
Only recently have vaccination rates been scrutinized in places such as nursing homes, said LuMarie Polivka-West, with the Florida Health Care Association.
"We feel like we're getting benchmarks now. Only then can we improve," said Polivka-West, who is program and policy director for the organization that represents 85 percent of the state's nursing homes.
In order to find a baseline, Polivka-West helped to enlist about 20 facilities from Palm Beach County to Miami-Dade County for a study conducted by Emory University and the CDC.
The researchers are calculating vaccination rates among residents and staff. They have identified obstacles to ensuring that residents have been vaccinated.
A full third of the people staying in these homes is transient, staying 20 days or fewer -- they may depart before they could get a shot and have its protection kick in.
Also, a vaccination record isn't required for admission. Workers often must rely on a resident's recollection. About 60 percent of such residents have dementia: They may not recall accurately their history and their loved ones may not know, Polivka-West said.
Finally, the shot is less effective on the elderly.
As the middle of flu season approaches, the vaccine formulation is reported to be 62 percent effective. But even though seniors get vaccinated at rates significantly higher than those of other age groups, their immune systems don't respond as robustly to vaccines -- so they are less effective.
That's why it's vital to inoculate the staff who could spread the illness.
Researchers interviewed 1,966 nursing home employees in Florida, Georgia and Wisconsin and found 65 percent believe that vaccine is effective, 61 percent believe that the vaccine does not cause the flu, and 67 percent believe that the flu is very contagious.
"So, while the majority have the 'correct' beliefs, many do not. Many believe that the vaccine causes the flu and that there is little or no risk that staff will transmit the virus to residents," said David H. Howard, an associate professor at Emory's Rollins School of Public Health. "We did not ask about fear of needles, but that is also a factor."
As for Florida's poor rates, Howard said, "Many employees are 'from the islands' and we heard from nursing home administrators that they are distrustful of Western medicine and not used to receiving preventive medical care."
The Morse Geriatric Center's Dhana, a native of Jamaica, agreed.
"Absolutely. That's a really good point. They're fearful of getting the flu (from the shot) and then there's all this misinformation that vaccines cause all these neurological complications," Dhana said. He said the myths transcend educational levels.
"I have family members who are highly educated and still, this is definitely a factor," he said.
Jennifer Stevens, administrator of the Harbour's Edge nursing home in Delray Beach, said, "Ninety-nine percent of our staff in our nursing center are from the islands. They just don't have that same belief system we do. A lot of them have come around over the years. "
But it is not only islanders, they said.
"They'll say they're young. They've never had the flu. They're not going to get it," Dhana said. "These kind of fears you really have to deal with one on one."
Morse and Harbour's Edge report more than 50 percent of their staff has gotten flu shots. Both are large facilities. They offer the shot to staff for free at any time of day and promote getting a flu shot -- efforts the CDC cites as key to getting more workers vaccinated.
What would it take to get even better vaccination rates? Maybe corporate policies or state laws requiring vaccination.
Or maybe ... Elvis.
Dhana recalls going to an infectious-disease conference a few years' back and a speaker asked the room to name the King of Rock's biggest contribution. Rock and roll? Swiveling hips? Nope.
"Elvis' biggest contribution, he went on TV and got a polio vaccine," Dhana said. "Before that, no one wanted to get it. So we need something like that to show it's safe. I don't know who has that kind of clout today."
Flu spread in Palm Beach County remains moderate
(For week ending Jan. 26)
-- Emergency room visits for flu-like symptoms remain above season norms but have decreased in recent weeks.
-- A fifth child in Florida died from the flu. The child, who was not vaccinated and had underlying health issues, was from Miami-Dade County.
-- The only flu outbreak reported this week was in a Duval County jail.
-- Statewide since season began, 246 people have died of pneumonia or flu, a number within the normal range for this time of the season.
-- Nationally since season began, there have been 3,060 deaths, normal for this time of the season. A majority of these reported deaths were people 75 years and older. ___