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Physicians aren't immune from influenza or flu shots, and like many patients, they aren't immune from anxiety and imagined or real discomfort. Among those receiving free flu shots from employee health manager Ruth Shanahan in December was faculty pathologist Howard Sussman.

Hospital plans for flu contingencies and so should physicians

Caregivers need to protect themselves and their patients as the 2003-04 flu season moves into January and Stanford Hospital implements a state mandated plan for dealing with flu contingencies, said Lucy S. Tompkins, professor of medicine and director of the hospital's infection control program.

So far, the hospital has aggressively provided flu vaccine to all employees. By mid-December, as supplies were running out, nearly 4,000 of 7,000 employees had received the vaccine, nearly 1,000 more than the previous year, Tompkins said.

"I think it's contingent on any caregiver to receive the flu vaccine," Tompkins said in December, "and it really is never too late to be vaccinated - if supplies are available." She said that the currently distributed vaccine doesn't prevent but does mitigate the Fujian strain of flu that health experts had not predicted.

Last November, the Santa Clara County Public Health Department recommended that "doctors, nurses, and other employees in hospitals and doctors' offices, including emergency workers, should be among those who receive the vaccine."

Tompkins said if the injectable vaccine supplies are depleted, physicians should consider the nasal (live) vaccine for themselves and select patients. But she added that the vaccine is restricted by FDA protocols to persons between the age of 5 and 49, is expensive, and theoretically could allow flu to be transmitted to patients.

Staff members and physicians who work with immunocompromised patients are receiving detailed information and instructions about protecting patients from flu, Tompkins noted.

But some advice is simple. "If you get the flu, don't come to work," she said. "While viral testing is generally available for physicians, most doctors do suspect when their respiratory infection is influenza." (Influenza is normally characterized with sudden onset of symptoms, while other viruses build symptoms more slowly).

Both older and newer antiviral drugs can reduce and shorten the duration of symptoms for physicians and patients, Tompkins said. M2 inhibitors, amantadine and rimantidine, are active against influenza A, while neuramindase inhibitors, zanamivir and oseltamivir, are active against both influenza A and B, according to Tompkins and other authorities.

Tompkins said she personally prefers oseltamivir because it appears to cause fewer side effects than alternatives. The neuraminidase inhibitors are more expensive than the older group of drugs. Both classes of antivirals appear to be antiviral resistance free when used prophylactically, although resistance has been observed when M2s are used for treatment, she said. Prophylaxis is not recommended for health care workers unless there is a hospital epidemic which Stanford has not experienced.

Other measures SHC is implementing based on the California Department of Health Services' recommendations include encouraging physicians to vaccinate high risk patients, notices warning persons with respiratory symptoms to avoid contact with patients, monitoring to ensure staffing could be geared up to deal with flu contingencies, and isolating patients with flu whenever relevant and feasible in private rooms.