Apr 19, 2013

Mandatory Flu Vaccination Policies

The 2012-2013 flu season continues to take a toll on the workplace.  According to the Centers for Disease Control (”CDC”), this year’s flu season began four weeks earlier than most recent seasons and, as of the week ending March 9, 2013, flu season activity has remained elevated across the United States.  Having already taken the lives of 64 children, and with adult numbers  unavailable until the end of the flu season, many employers are considering the implementation of mandatory flu vaccination policies.  While such policies may serve business and safety needs of protecting their workplace and workforce, employers should ask themselves the following three questions before adopting such a policy:

What are the business needs for implementing the policy?
Prior to implementing a mandatory flu vaccination policy, employers need to carefully evaluate the business and safety needs for the requirement.  Whether out of a concern for the safety of patients or customers or the need to ensure an adequate and fully-staffed workplace, an employer needs to be ready to identify these reasonable business interests should an employee or applicant challenge the policy.

Is your workforce unionized?
Under the National Labor Relations Act, flu vaccination policies must be collectively bargained.  Accordingly, unionized employers cannot unilaterally impose a mandatory flu vaccination policy without first providing notice to the union and bargaining at the union’s request.  Despite this, unionized employers need to carefully evaluate the management rights clause contained in their collective-bargaining agreement.  The National Labor Relations Board recently issued an opinion finding that a union waived the right to bargain over a flu vaccination policy by agreeing to the management rights clause in the parties’ collective bargaining agreement.  Virgina Mason Hospital, 358 NLRB No. 64 (2012).  The Board recognized that this waiver allowed the hospital to require non-immunized nurses to wear face masks.  

How will you enforce the policy?
When adopting a mandatory flu vaccination policy, employers must be prepared to address objections raised by their employees.  The Equal Employment Opportunity Commission takes the view that employees may be exempt from mandatory vaccination policies based on an Americans with Disabilities Act “disability” or a sincerely held religious belief, practice, or observance.  Pandemic Preparedness in the Workplace and the Americans With Disabilities Act (2009).  Such sincerely held religious beliefs do not have to be mainstream or widely recognized religions and may include lifestyle choices such as veganism.  See Chenzira v. Cincinnati Children’s Hosp. Med. Ctr., No. 1:11-CV-00917, 2012 WL 6721098, at *4 (Dec. 27, 2012)(the court declined to dismiss plaintiff’s religious discrimination claim when her employer terminated her employment after she refused to be vaccinated for the flu on account of her veganism).  Despite this expansive definition, the EEOC stated that it is unlikely that religious beliefs include “secular philosophical opposition to vaccination.”  EEOC Informal Discussion Letter (Mar. 5, 2012).  When an employee raises a health or religious-based objection to the vaccination policy, the employer needs to discuss reasonable accommodations with the employee.  Such reasonable accommodations may include entirely excusing the employee from the policy, requiring the employee to wear a protective facemask or temporarily transferring the employee to another position.  Employers need not offer these reasonable accommodations if providing them would cause “undue hardship.”  In determining whether undue hardship exists, the EEOC found the following factors relevant: (1) the assessment of the public risk posed at a particular time; (2) the availability of effective alternative means of infection control; and (3) the potential number of employees who actually request accommodation.  EEOC Informal Discussion Letter (Mar. 5, 2012).

In addition to tackling objections raised by employees, employers need to implement the policy across its workforce uniformly.  Employers should not  terminate summarily an employee who refuses a flu vaccination without first engaging in a discussion to determine whether the employee is objecting for health or religious based reasons.  Furthermore, employers might consider gradual discipline for first-time offenders such as issuing a letter of instruction.
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Apr 18, 2013

Texas A&M will be home to $91 million vaccine-manufacturing Bio-Weapons Laboratory

The U.S. Department of Health and Human Services has approved the creation of a $91 million influenza-vaccine manufacturing facility in a joint venture between the Texas A&M University System and GlaxoSmithKline in what Chancellor John Sharp described Tuesday as “one of the most significant developments ever in the state of Texas.”
The facility will speed up the research, development and delivery of vaccines and therapeutics in cases of pandemics or other national emergencies.
The center would also supply preventive vaccine for pandemic influenza, and, once it’s up and running, will be able to supply 50 million vaccine doses within four months of receiving a strain of the flu, with initial doses ready in 12 weeks.
The facility will anchor the Center for Innovation in Advanced Development and Manufacturing in Bryan-College Station, establishing what Sharp characterized as “third coast biopharmaceuticals.” A&M is home to one of only three so-called CIADMS being created in the nation.
“It’s a game-changer not just for Texas but for folks everywhere,” Sharp said at a morning news conference with Gov. Rick Perry to announce the effort.
Perry said the center would bring more than $41 billion in in-state expenditures over the next 25 years and directly and indirectly create more than 6,800 jobs.
“More importantly there will be lives that will be saved around the world because of what is happening in the state of Texas,” said Perry.
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Apr 17, 2013

Does Aluminum Cause Alzheimer's Disease

Can aluminum cause Alzheimer's disease is a controversial question. Alzheimer's disease is the most common cause of senile brain disease and is a fatal and untreatable condition. It begins with learning memory deficits and progresses to involve all aspects of intellectual activity including judgement, calculation and language.

Post-mortem examinations of humans with Alzheimer's disease show that there are high concentrations of aluminum in the brain. However, aluminum normally is not found in healthy brain tissue and researchers do not know how the metal gets into the brain. Some researchers compared the aluminum concentration on brains of subjects affected by Alzheimer's disease and age-matched controls. They found no differences between the two groups, suggesting that elevated aluminum concentration may be associated with age. Experimentally it is proven that aluminum is toxic to nerves in animals but the neuron degeneration is different from what occurs in humans. For more detailed information please see the chemical profile on aluminum powder.

The animals that respond to aluminum treatment with neuron degeneration are rabbits, cats and dogs. If these animals are injected with aluminum salts directly into the brain they show learning memory deficits, become slower and lose curiosity. This picture resembles remarkably certain features of Alzheimer's disease. But the neuron degeneration is not the same as the one seen in Alzheimer's disease.

In conclusion, the cause of Alzheimer's disease is yet unknown and there is no absolute evidence linking aluminum exposure to Alzheimer's disease.

What are the sources of aluminum exposure?

Workers can be exposed to aluminum during production or processing of this metal and its alloys. In addition to workplace exposure, people can come into contact with aluminum in many other ways.

Aluminum is found in food, drinking water and in some medications. There has been considerable interest and controversy concerning the relationship between aluminum in drinking water and Alzheimer's disease. So far, the results of many studies have been inconclusive and contradictory. It is important to note that the content of this metal in the diet is increased by the use of aluminum and its alloys in the food industry. The cooking and storage of food in aluminum ware might double or even triple the usual daily intake.

Are there exposure limits for aluminum?

In the workplace, the American Conference of Governmental Industrial Hygienists (ACGIH) has assigned an occupational exposure limit based on respirable particle size.

The current ACGIH recommended Threshold Limit Value Time-Weighted Average (TLV-TWA) exposure limit for aluminum in the air is 1 mg/m3 for aluminum metal (CAS number 7429-90-5) and insoluble compounds.

Aluminum metal and insoluble compounds of respirable particle size are also categorized by ACGIH for carcinogenicity as A4 - Not classifiable as a Human Carcinogen; inadequate data on which to classify the substance as a human and/or animal carcinogen.

The TLV-TWA is the time-weighted average airborne concentration for a normal 8-hour workday and a 40-hour workweek to which it is believed that nearly all workers may be exposed repeatedly, day after day, without adverse health effects.

In many Canadian jurisdictions, exposure limits are the same as or similar to the ACGIH TLVs. Since the manner in which exposure limits are established, interpreted and implemented can vary, the appropriate government agency in each jurisdiction should be consulted.

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Apr 16, 2013

Aluminum Vaccine Adjuvant linked to Gulf War illness

Via: PubMed NCBI
Gulf War illness (GWI) affects a significant percentage of veterans of the 1991 conflict, but its origin remains unknown. Associated with some cases of GWI are increased incidences of amyotrophic lateral sclerosis and other neurological disorders. Whereas many environmental factors have been linked to GWI, the role of the anthrax vaccine has come under increasing scrutiny. Among the vaccine's potentially toxic components are the adjuvants aluminum hydroxide and squalene. To examine whether these compounds might contribute to neuronal deficits associated with GWI, an animal model for examining the potential neurological impact of aluminum hydroxide, squalene, or aluminum hydroxide combined with squalene was developed. Young, male colony CD-1 mice were injected with the adjuvants at doses equivalent to those given to US military service personnel. All mice were subjected to a battery of motor and cognitive-behavioral tests over a 6-mo period postinjections. Following sacrifice, central nervous system tissues were examined using immunohistochemistry for evidence of inflammation and cell death. Behavioral testing showed motor deficits in the aluminum treatment group that expressed as a progressive decrease in strength measured by the wire-mesh hang test (final deficit at 24 wk; about 50%). Significant cognitive deficits in water-maze learning were observed in the combined aluminum and squalene group (4.3 errors per trial) compared with the controls (0.2 errors per trial) after 20 wk. Apoptotic neurons were identified in aluminum-injected animals that showed significantly increased activated caspase-3 labeling in lumbar spinal cord (255%) and primary motor cortex (192%) compared with the controls. Aluminum-treated groups also showed significant motor neuron loss (35%) and increased numbers of astrocytes (350%) in the lumbar spinal cord. The findings suggest a possible role for the aluminum adjuvant in some neurological features associated with GWI and possibly an additional role for the combination of adjuvants.
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Apr 15, 2013

Death of Alzheimer Victim linked to Aluminium Pollution

Via: Nature News
Brain autopsy of pollution victim rekindles contaminant fears.

Fears of a link between aluminium and Alzheimer's disease have been reignited by the case of a British woman who died of the illness 16 years after an industrial accident polluted her local drinking water.

An autopsy on Carole Cross's brain showed that she was suffering from a rare form of early-onset Alzheimer's when she died in May 2004, and also revealed the presence of high levels of aluminium in her tissues. The researchers who investigated her brain cannot say whether the aluminium was the cause, but point out that the woman had no family history of dementia.

The polluting incident occurred in 1988 when a truck driver mistakenly emptied some 20 tonnes of aluminium sulphate — used in the early stages of wastewater treatment — into a tank containing drinking water destined for the village of Camelford in Cornwall, UK. An estimated 20,000 people may have been exposed to high levels of the chemical for several weeks.

Concerned residents are waiting to see whether more people will be similarly affected. Anecdotal reports state that several other villagers are suffering from dementia.

Something in the water

Although only a single case, the discovery has reopened the possibility that aluminium could be linked to Alzheimer's disease, say Christopher Exley, a chemist at Keele University, UK and Margaret Esiri, a University of Oxford neurologist, who publish details of their investigation on Cross in the Journal of Neurology, Neurosurgery and Psychiatry1.

Aluminium is firmly linked to some temporary forms of dementia, Esiri says. Kidney dialysis patients living in areas where water is high in aluminium, for example, sometimes experience 'dialysis dementia', as a result of the large quantities of contaminated water passing through their bodies.

“Once aluminium binds to proteins, it sticks for good. It's like trying to use superglue to mend a Swiss watch.”

Daniel Perl,
Mount Sinai School of Medicine, New York

But the link between aluminium and Alzheimer's has been more controversial, says Daniel Perl, a neuropathologist at Mount Sinai School of Medicine in New York, who has written a commentary on the Camelford case2.

Aluminium is often found in the twists of deformed protein, called 'neurofibrillary tangles', that characterize the disease. But there is no strong evidence that it is involved in the disease's onset, Perl cautions. "I realize that's quite a conservative answer," he says. "But show me a couple more cases like this and I might have to change it."

Perl points out that, of the 20 most common elements on Earth, aluminium is the only one not involved in any essential biological process. That's because of its feisty chemistry, he explains. When in solution, aluminium ions are small and highly charged, making them very reactive. "Once aluminium binds to proteins, it sticks for good," he says. "It's like trying to use superglue to mend a Swiss watch."

What makes Cross's case interesting is that she had succumbed to a very rare form of Alzheimer's, but had a genetic predisposition, through a gene called APOE, to developing a more common form of the disease later in life, says Esiri. This raises the possibility that her aluminium exposure may have accelerated the onset of disease. Previous studies of transgenic mice expressing a similar gene have shown that feeding them aluminium in drinking water can cause similar symptoms at a young age.

Cross's protein tangles were found in the blood vessels rather than in the brain tissue itself. This is consistent with the idea that the cause of the disease could have originated in the gut, reaching the brain through the bloodstream, Esiri explains.

Combined with the unusually young age at which she died (aged 58), this puts her in a category shared by only a handful of known cases worldwide, Esiri says.

The discovery may also rekindle fears over drinking and cooking using aluminium pots and pans, although Perl says that most aluminium is found in an insoluble form and therefore not dangerous. The only way to ingest aluminium would be by cooking acidic foods such as rhubarb or tomato, which would react with the metal.

The news is worrying for Camelford's residents, says Exley, who carried out the chemical analysis to spot the aluminium in the autopsy samples. "There are still 20,000 people thinking about whether they're susceptible to this chronic disease," he says. "We can't do anything to help them."
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