Large study confirms flu vaccine safe in pregnancy


NEW YORK (AP) — A large study offers reassuring news for pregnant women: It's safe to get a flu shot.


The research found no evidence that the vaccine increases the risk of losing a fetus, and may prevent some deaths. Getting the flu while pregnant makes fetal death more likely, the Norwegian research showed.


The flu vaccine has long been considered safe for pregnant women and their fetus. U.S. health officials began recommending flu shots for them more than five decades ago, following a higher death rate in pregnant women during a flu pandemic in the late 1950s.


But the study is perhaps the largest look at the safety and value of flu vaccination during pregnancy, experts say.


"This is the kind of information we need to provide our patients when discussing that flu vaccine is important for everyone, particularly for pregnant women," said Dr. Geeta Swamy, a researcher who studies vaccines and pregnant women at Duke University Medical Center.


The study was released by the New England Journal of Medicine on Wednesday as the United States and Europe suffer through an early and intense flu season. A U.S. obstetricians group this week reminded members that it's not too late for their pregnant patients to get vaccinated.


The new study was led by the Norwegian Institute of Public Health. It tracked pregnancies in Norway in 2009 and 2010 during an international epidemic of a new swine flu strain.


Before 2009, pregnant women in Norway were not routinely advised to get flu shots. But during the pandemic, vaccinations against the new strain were recommended for those in their second or third trimester.


The study focused on more than 113,000 pregnancies. Of those, 492 ended in the death of the fetus. The researchers calculated that the risk of fetal death was nearly twice as high for women who weren't vaccinated as it was in vaccinated mothers.


U.S. flu vaccination rates for pregnant women grew in the wake of the 2009 swine flu pandemic, from less than 15 percent to about 50 percent. But health officials say those rates need to be higher to protect newborns as well. Infants can't be vaccinated until 6 months, but studies have shown they pick up some protection if their mothers got the annual shot, experts say.


Because some drugs and vaccines can be harmful to a fetus, there is a long-standing concern about giving any medicine to a pregnant woman, experts acknowledged. But this study should ease any worries about the flu shot, said Dr. Denise Jamieson of the Centers for Disease Control and Prevention.


"The vaccine is safe," she said.


___


Online:


Medical journal: http://www.nejm.org


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Futures signal mixed Wall Street open

LONDON (Reuters) - U.S. stock futures pointed to a mixed open on Wall Street on Thursday, with futures for the S&P 500 rising 0.1 percent, Dow Jones futures down 0.2 percent and Nasdaq 100 futures falling 0.1 percent.


Airlines scrambled on Thursday to rearrange flights as Europe, Japan and India joined the United States in grounding Boeing Co's 787 Dreamliner passenger jets while battery-related problems are investigated.


Earnings reports from major U.S. companies such as Citigroup , Intel , Bank of America and BlackRock , due later in the day, will be scrutinized for hints about the market's near-term direction.


First-time claims for jobless benefits for the week ended January 12 are due at 1330 GMT. Economists forecast a total of 365,000 new filings, compared with 371,000 in the previous week.


The Commerce Department releases housing starts and permits for December at 1330 GMT. Economists in a Reuters survey forecast a total of 903,000 permits in December, compared with 900,000 in the previous month.


Top executives at Goldman Sachs have been considering deep cuts to staffing levels and pay for at least two years, but feared too many layoffs would leave the firm unprepared for an eventual pickup in business, people familiar with the bank said.


Shares in Dutch telecoms company KPN rose more than 4 percent on Thursday after a report that U.S. peer AT&T is looking at an acquisition in Europe, including KPN and UK carrier Everything Everywhere.


AT&T is considering buying a telecoms company in Europe to offset growth constraints in its home market, the Wall Street Journal reported, citing unnamed people familiar with the company's thinking.


Taiwan Semiconductor Manufacturing Co Ltd reported a 32 percent rise in fourth-quarter profit as its cutting-edge technology keeps it ahead of rivals in the mobile gadget boom.


Philadelphia Federal Reserve Bank releases its January business activity survey at 1500 GMT. Economists forecast a reading of 5.8, versus 4.6 in December.


The pan-European FTSEurofirst 300 index <.fteu3> was flat in morning trading on Thursday.


The S&P 500 ended nearly flat on Wednesday as solid earnings from two major banks and a bounceback in Apple shares offset concerns about a lower forecast for global growth in 2013.


The Dow Jones industrial average <.dji> was down 23.66 points, or 0.17 percent, at 13,511.23 on Wednesday. The Standard & Poor's 500 Index <.spx> was up 0.29 points, or 0.02 percent, at 1,472.63. The Nasdaq Composite Index <.ixic> was up 6.77 points, or 0.22 percent, at 3,117.54.


(Reporting by Atul Prakash; Editing by Catherine Evans)



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Israeli left seeks to regain appeal with focus on economy


JERUSALEM (Reuters) - In decline since the peace it sought with the Palestinians unraveled into violence, Israel's Labour Party looks set to regain some lost ground in next week's election after waging an economy-focused campaign.


Opinion polls forecast an easy victory for conservative Prime Minister Benjamin Netanyahu in Tuesday's vote, which may push Israel further to the right, if as widely expected, he then enlists pro-settler and religious allies to his coalition.


But center-left Labour, bolstered by public discontent with high living costs and the flagging political fortunes of the once-governing centrist Kadima party, seems poised for its strongest parliamentary showing in years.


Netanyahu has made Israel's security the main campaign issue of his right-wing Likud party, fielding a joint list of candidates with the ultranationalist Yisrael Beitenu party.


He has cited Iran's nuclear ambitions, civil war in Syria and a new Islamist government in Egypt as reasons why, as Likud's campaign posters say, Israel needs a "strong" leader.


While Netanyahu plays his security card, a revamped Labour Party is using economic and social issues to try to claw its way back, focusing on Israeli concerns about rising living costs.


Opinion polls forecast a respectable second-place finish for the center-left party, now focused on pocketbook rather than peace issues, with talks on Palestinian statehood frozen since 2010 in a dispute over Israel's settlement-building policies.


Abraham Diskin, a political scientist at Jerusalem's Hebrew University, said Labour was also benefiting from a steep decline in support for Kadima, which won the most assembly seats at the last election in 2009, but failed to retain power.


Kadima was outmaneuvered by Netanyahu, who became prime minister after drawing a clutch of right-wing and religious parties into a coalition with a big parliamentary majority.


Diskin attributed much of Kadima's election success in 2009 to former Labour voters. "They are now returning to the Labour Party," he said.


Some opinion polls predict that Kadima, now led by Shaul Mofaz, a dour ex-defense minister, will win no seats next week.


The party, a relative newcomer to politics and lacking a historical power base, was founded in 2005 by then-Prime Minister Ariel Sharon, who quit the Likud after a rebellion in its ranks over Israel's unilateral pullout from Gaza that year.


DOMINATION


Labour, now led by a former journalist, Shelly Yachimovich, dominated the first three decades of Israel's statehood and forged interim peace deals with the Palestinians in the 1990s.


But an ultranationalist assassin killed its leader, Prime Minister Yitzhak Rabin, in 1995, Netanyahu won an election the following year after Palestinian suicide bombings, and a Labour return to power in 1999 was cut short when Ehud Barak failed to clinch a final peace accord and a Palestinian uprising erupted.


"Over years, the left was challenged by realities, not only by right-wing Israeli forces but by Middle East realities, and it never rose to the challenge," said political commentator Ari Shavit, who writes for the left-wing Haaretz daily.


"It is perceived by most Israelis as being totally irrelevant," he told Reuters.


However, unprecedented social protests in Israel in mid-2011 when hundreds of thousands took to the streets angered by high housing costs and soaring prices, gave Labour an opportunity.


Its election campaign has homed in on a struggling middle class. Under a photo of Yachimovich and the slogan "It can be better here", the party's website features a link to an economic plan it promises will narrow the gap between rich and poor.


It proposes higher taxes for the rich and for corporations and faster construction of affordable public housing.


Opinion polls show Labour taking up to 20 of parliament's 120 seats compared with about 34 for Likud-Yisrael Beiteinu. Labour won just 13 in 2009, a tally reduced to eight when Barak, now defense minister, and four others left the party in 2011.


DEFICIT


Labour latched onto some bad financial news on Monday to contest Netanyahu's claim to be a skilful economic manager.


"Tell me how much longer he can keep calling himself Mr Economy," Yachimovich said after figures showed Israel's budget deficit had risen to 4.2 percent of gross domestic product last year, double the original estimate.


Labour candidate Erel Margalit, referring to Israel's high-tech prowess, also hammered home the economic message, saying: "Netanyahu turned the start-up nation into a stagnant nation."


Unlike other center-left leaders, Yachimovich has pledged not to join a Netanyahu-led coalition.


Factions to Netanyahu's left also include two new centrist parties - Hatnua, led by Tzipi Livni, a former foreign minister and ex-Kadima chief, and Yesh Atid, headed by TV talk show host Yair Lapid.


Opinion polls predict eight seats for Hatnua and 11 for Yesh Atid. Livni's attempts to entice Yachimovich and Yesh Atid into a center-left alliance failed, perhaps due to clashing egos.


Taking his own swipe at Netanyahu's economic policies, Lapid provided a bright moment in a generally lackluster campaign when he publicly drew a red line through a cartoon depiction of a bomb listing price rises that have hit the middle class.


The stunt mimicked Netanyahu's own sketching of a red line through a cartoon bomb at the United Nations in September, when he said Iran was moving closer to a nuclear weapons capability.


While Labour, Yesh Atid and Hatnua compete for the political center, the small Meretz party carries a torch for the left.


"We're not ashamed, we are a left-wing social democratic party, we are proud to be called left-wing," Nitzan Horowitz, a Meretz legislator, told Reuters.


The party, led by Zahava Gal-On, has three parliamentary seats and opinion polls show it may double that total next week.


Horowitz outlined the "three pillars" of Meretz's platform as separating religion and state, ensuring social justice and promoting peace between Israel and its Arab neighbors.


Meretz opposes settlement activity and says Israel should immediately recognize a Palestinian state along the lines that existed before the Jewish state captured the West Bank, the Gaza Strip and east Jerusalem in the 1967 Middle East war.


(Additional reporting by Rinat Harash, Lianne Gross and Rami Amichai; Writing by Jeffrey Heller and Ori Lewis; Editing by Alistair Lyon)



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Apple scoops PBS on “Downton Abbey” episodes, but PBS is cool with it






NEW YORK (TheWrap.com) – Apple is making the entire third season of “Downton Abbey” available on iTunes before every episode airs on PBS – and that’s just fine with PBS.


Fans who buy a season pass on iTunes beginning January 29 will get to see three episodes before they air on PBS. The Season 3 finale airs February 17.






But PBS CEO Paula Kerger isn’t worried that viewers will watch the show online, then tune out PBS. In fact, she says, Apple isn’t the only place Americans can see “Downton” before they can see it on her network.


“You can also buy the DVD sets. They’re being shipped at the end of January, and the DVD sets and Apple are going up at the same time,” Kerger told TheWrap. “I think that for people who are really passionate and want to have it, it’s a great thing.”


Kerger says she hopes more viewers will discover “Downton” on whatever format they like best – and then watch it on PBS next season.


“At the end of the day, my interest is just in seeing it get to the widest possible audience, and there are people that would pick it up on Apple that may not pick it up anywhere else,” she said.


The first episode of the third season premiered to a record 7.9 million viewers earlier this month. Many of those viewers, no doubt, caught up on the previous seasons online or through DVD viewing.


“Downton” airs in the U.K. in the fall but on PBS in January, which means PBS viewers must shield themselves from spoilers. That has led to some grumbling from American fans.


But Kerger said airing the show in January allows the show to get more attention domestically than it might otherwise receive in the crowded fall season.


Internet News Headlines – Yahoo! News





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It's a Boy for Elton John




Celebrity Baby Blog





01/15/2013 at 10:00 PM ET



Elton John Welcomes Second Child
George Pimentel/WireImage


Elton John is a father again!


The musician and David Furnish welcomed their second child, son Elijah Joseph Daniel Furnish-John, via surrogate on Friday, Jan. 11 in Los Angeles, the couple confirm to HELLO.


Born at 6:40 p.m., Elijah weighed in at 8 lbs., 4 oz.


John and Furnish, who married in 2005, are already parents to son Zachary Jackson Levon, 2.


“Both of us have longed to have children, but the reality that we now have two sons is almost unbelievable. The birth of our second son completes our family in a most precious and perfect way,” the couple say in a statement.


“It is difficult to fully express how we are feeling at this time; we are just overwhelmed with happiness and excitement.”


John, 65, has been open about his desire to expand their family.


“I know when he goes to school there’s going to be an awful lot of pressure, and I know he’s going to have people saying, ‘You don’t have a mummy,’” says the singer-songwriter of his decision to have another baby.


“It’s going to happen. We talked about it before we had him. I want someone to be at his side and back him up. We shall see.”


– Sarah Michaud


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ER visits tied to energy drinks double since 2007


SAN FRANCISCO (AP) — A new government survey suggests the number of people seeking emergency treatment after consuming energy drinks has doubled nationwide during the past four years, the same period in which the supercharged drink industry has surged in popularity in convenience stores, bars and on college campuses.


From 2007 to 2011, the government estimates the number of emergency room visits involving the neon-labeled beverages shot up from about 10,000 to more than 20,000. Most of those cases involved teens or young adults, according to a survey of the nation's hospitals released late last week by the Substance Abuse and Mental Health Services Administration.


The report doesn't specify which symptoms brought people to the emergency room but calls energy drink consumption a "rising public health problem" that can cause insomnia, nervousness, headache, fast heartbeat and seizures that are severe enough to require emergency care.


Several emergency physicians said they had seen a clear uptick in the number of patients suffering from irregular heartbeats, anxiety and heart attacks who said they had recently downed an energy drink.


More than half of the patients considered in the survey who wound up in the emergency room told doctors they had downed only energy drinks. In 2011, about 42 percent of the cases involved energy drinks in combination with alcohol or drugs, such as the stimulants Adderall or Ritalin.


"A lot of people don't realize the strength of these things. I had someone come in recently who had drunk three energy drinks in an hour, which is the equivalent of 15 cups of coffee," said Howard Mell, an emergency physician in the suburbs of Cleveland, who serves as a spokesman for the American College of Emergency Physicians. "Essentially he gave himself a stress test and thankfully he passed. But if he had a weak heart or suffered from coronary disease and didn't know it, this could have precipitated very bad things."


The findings came as concerns over energy drinks have intensified following reports last fall of 18 deaths possibly tied to the drinks — including a 14-year-old Maryland girl who died after drinking two large cans of Monster Energy drinks. Monster does not believe its products were responsible for the death.


Two senators are calling for the Food and Drug Administration to investigate safety concerns about energy drinks and their ingredients.


The energy drink industry says its drinks are safe and there is no proof linking its products to the adverse reactions.


Late last year, the FDA asked the U.S. Health and Human Services to update the figures its substance abuse research arm compiles about emergency room visits tied to energy drinks.


The Substance Abuse and Mental Health Services Administration's survey was based on responses it receives from about 230 hospitals each year, a representative sample of about 5 percent of emergency departments nationwide. The agency then uses those responses to estimate the number of energy drink-related emergency department visits nationwide.


The more than 20,000 cases estimated for 2011 represent a small portion of the annual 136 million emergency room visits tracked by Centers for Disease Control and Prevention.


The FDA said it was considering the findings and pressing for more details as it undertakes a broad review of the safety of energy drinks and related ingredients this spring.


"We will examine this additional information ... as a part of our ongoing investigation into potential safety issues surrounding the use of energy-drink products," FDA spokeswoman Shelly Burgess said in a statement.


Beverage manufacturers fired back at the survey, saying the statistics were misleading and taken out of context.


"This report does not share information about the overall health of those who may have consumed energy drinks, or what symptoms brought them to the ER in the first place," the American Beverage Association said in a statement. "There is no basis by which to understand the overall caffeine intake of any of these individuals — from all sources."


Energy drinks remain a small part of the carbonated soft drinks market, representing only 3.3 percent of sales volume, according to the industry tracker Beverage Digest. Even as soda consumption has flagged in recent years, energy drinks sales are growing rapidly.


In 2011, sales volume for energy drinks rose by almost 17 percent, with the top three companies — Monster, Red Bull and Rockstar — each logging double-digit gains, Beverage Digest found. The drinks are often marketed at sporting events that are popular among younger people such as surfing and skateboarding.


From 2007 to 2011, the most recent year for which data was available, people from 18 to 25 were the most common age group seeking emergency treatment for energy drink-related reactions, the report found.


"We were really concerned to find that in four years the number of emergency department visits almost doubled, and these drinks are largely marketed to younger people," said Al Woodward, a senior statistical analyst with the Substance Abuse and Mental Health Services Administration who worked on the report.


Emergency physician Steve Sun said he had seen an increase in such cases at the Catholic hospital where he works on the edge of San Francisco's Golden Gate Park.


"I saw one young man who had mixed energy drinks with alcohol and we had to admit him to the hospital because he was so dehydrated he had renal failure," Sun said. "Because he was young he did well in the hospital, but if another patient had had underlying coronary artery disease, it could have led to a heart attack."


___


Follow Garance Burke on Twitter at http://twitter.com/garanceburke


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Stock index futures point to lower open on Wall Street, Boeing in focus

LONDON (Reuters) - U.S. stock index futures pointed to a lower open on Wall Street on Wednesday, with futures for the S&P 500 down 0.3 percent, Dow Jones futures off 0.2 percent and the Nasdaq 100 contract 0.1 percent lower at 0922 GMT.


Banks <.sx7p> will be in focus, with results due from several big names, including BNY Mellon, Goldman Sachs and JPMorgan Chase & Co.


Of the S&P 500 <.spx> companies that have reported to date, 25 percent have missed fourth-quarter earnings forecasts and 29 percent have undershot on revenues, according to Thomson Reuters StarMine data.


Shares in General Motors fell after the bell on Tuesday after the automaker said it expects operating profit to rise "modestly" this year - a comment that is expected to prompt analysts to downgrade their forecasts.


Boeing will be in focus on concerns about the safety of its Dreamliner. Japan's two leading airlines grounded their fleets of 787s on Wednesday after one of the passenger jets made an emergency landing.


India will decide on whether to ground national carrier Air India's Dreamliner jets after the U.S. company submits a report on the aircraft's safety.


Global growth concerns remain in the spotlight after the World Bank slashed its economic forecasts for developed nations this year.


A plunge in European car sales in December added to the gloom.


U.S. December inflation figures are due at 1330 GMT, followed by industrial output at 1415 GMT.


The Dow Jones industrial average <.dji> added 27.57 points, or 0.20 percent, to 13,534.89 on Tuesday, while the S&P 500 <.spx> gained 1.66 points, or 0.11 percent, to 1,472.34 after stronger-than-expected retail data.


Tech heavyweight Apple dragged on the Nasdaq for a third day <.ixic>, with the index falling 0.2 percent.


Major European indexes edged lower on Wednesday, after recent gains took them to multi-month highs <.fteu3><.eu>. Profit taking also pushed Japan's Nikkei benchmark to its biggest one-day drop in eight months <.n225>.


(Reporting By Toni Vorobyova; Editing by Susan Fenton)



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France keeps up Mali air strikes, African troop plan advances


BAMAKO (Reuters) - France kept up its air strikes against Islamist rebels in Mali as plans to deploy African troops gathered pace on Tuesday amid concerns that delays could endanger a wider mission to dislodge al Qaeda and its allies.


France has already poured hundreds of troops into Mali and carried out days of air strikes since Friday in a vast desert area seized last year by an Islamist alliance that combines al Qaeda's north African wing AQIM with Mali's home-grown MUJWA and Ansar Dine rebel groups.


Western and regional powers are concerned the insurgents will use Mali's north as a launchpad for international attacks.


West African defense chiefs were to meet in Bamako on Tuesday to approve plans to speed up the deployment of 3,300 regional troops foreseen in a U.N.-backed intervention plan to be led by Africans.


Speaking from a French military base in Abu Dhabi at the start of a day-long visit to the United Arab Emirates, President Francois Hollande said French forces in Mali had carried out further strikes overnight "which hit their targets."


"We will continue the deployment of forces on the ground and in the air," Hollande said. "We have 750 troops deployed at the moment and that will keep increasing so that as quickly as possible we can hand over to the Africans."


He saw the African troop deployment taking "a good week".


France plans to field a total 2,500 soldiers in its former colony to bolster the Malian army and work with the intervention force provided by the ECOWAS grouping of West African states.


Foreign Minister Laurent Fabius - accompanying Hollande on a visit aimed at firming up trade relations and making progress on a possible sale of 60 French Rafale fighter jets - said he was confident Gulf Arab states would also help the Mali campaign.


Fabius said there would be a meeting of donors for the Mali operation most likely in Addis Ababa at the end of January.


He predicted the current level of the French involvement in Mali would go on for "a matter of weeks".


ECOWAS mission head in Bamako Aboudou Toure Cheaka said the West African troops would be on the ground in a week. Their immediate mission would be to help stop the rebel advance while preparations for a full intervention plan continued.


The original timetable for the 3,300-strong U.N.-sanctioned African force - backed by western logistics, money and intelligence services - did not initially foresee full deployment before September due to logistical constraints.


Senegal, Burkina Faso, Niger, Nigeria and Guinea have all offered troops. But regional powerhouse Nigeria, which is due to lead the mission, has cautioned that even if some troops arrive in Mali soon, training will take more time.


The plan is being fast-tracked after a plea for help by Mali's government after mobile columns of Islamist fighters last week threatened the central garrison towns of Mopti and Sevare, with its key airport.


"SAFEGUARD MALI"


French Prime Minister Jean-Marc Ayrault said France's goals were to stop the Islamist rebels, to "safeguard the existence of Mali" and pave the way for the African-led military operation.


U.S. officials said Washington was sharing information with French forces in Mali and considering providing logistics, surveillance and airlift capability.


"We have made a commitment that al Qaeda is not going to find anyplace to hide," U.S. Defense Secretary Leon Panetta told reporters as he began a visit to Europe.


As French aircraft bombarded mobile columns of Islamist fighters, other insurgents launched a counter-attack further to the south, dislodging government forces from the town of Diabaly, 350 km (220 miles) from Bamako.


French intervention has raised the risk for eight French hostages held by al Qaeda allies in the Sahara and for 30,000 French expatriates living in neighboring, mostly Muslim states. Concerned about reprisals at home, France has tightened security at public buildings and on public transport.


The U.N. said an estimated 30,000 people had fled the latest fighting in Mali, joining more than 200,000 already displaced.


U.N. Secretary-General Ban Ki-moon on Monday welcomed the French-led military intervention in Mali and voiced the hope that it would halt the Islamist assault.


Amnesty International said at least six civilians were killed in recent fighting in the town of Konna, where French aircraft had earlier bombarded rebel positions, and called on both sides to spare non-combatants.


France, which has repeatedly said it has abandoned its role as the policeman of its former African colonies, is among the toughest proponents of a speedier deployment of the African troops, and convened a U.N. Security Council meeting Monday to discuss the crisis.


French U.N. Ambassador Gerard Araud told reporters after the meeting that the U.S., Canada, Belgium, Denmark and Germany had also offered logistical support for France's Mali operation.


"I felt that all the members of the Security Council were expressing their support (for) and understanding of the French decision," Araud told reporters.


No Europeans or other African Union members will be allowed in the defense chiefs meeting in Bamako on Tuesday, a western diplomat told Reuters, requesting not to be named.


"They don't want any French pressure at the meeting," the diplomat said.


(Additional reporting by Elizabeth Pineau and Raissa Kasolowsky in Abu Dhabi; Michelle Nichols and Louis Charbonneau at the United Nations; Richard Valdmanis in Dakar, Brian Love in Paris and David Alexander in Lisbon; Editing by Pascal Fletcher and Anna Willard)



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PlayStation 4 could be unveiled in May









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Hospitals crack down on workers refusing flu shots


CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.


"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.


Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.


Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.


In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.


Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.


Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.


"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."


Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."


Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.


"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."


For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.


A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.


At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.


The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."


The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.


According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.


The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.


Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.


Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.


Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.


Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.


Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.


While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.


Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.


Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.


Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.


"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.


Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.


Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.


Calhoun, the Illinois nurse, says she is unsure of her options.


"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."


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Online:


R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf


CDC: http://www.cdc.gov


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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


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