Fall has arrived. Many people joyfully anticipate the cooler weather and the spectacular colors of the autumn foliage. I am not among the cold weather fans but readily confess my love of an annual drive along the Blue Ridge Parkway or some other winding country road to catch the leaves at their peak. With a little preparation my drive usually pays a great reward.

As a preventive medicine specialist I also look at fall as a call for prevention. It is a good time to change the batteries in my smoke detectors, call the technician to check my HVAC and get my flu shot. I have received over 40 doses of influenza vaccine in my lifetime. I have maintained the records for every dose since 1983. I didn’t keep the record of the 1976 swine flu vaccine, but I was among the first to roll up a sleeve for the mass vaccination program at my school that year and determined to always take advantage of opportunities in the future. In 2009, I needed two doses since the novel H1N1 strain didn’t appear until after the formulation of the regular seasonal flu vaccine that year. In the last couple of years I have chosen to receive the quadrivalent influenza vaccine to maximize my chances of immunity against the strain which will predominate during the peak of the coming influenza season. When I reach retirement age I will almost certainly choose the higher dose formulated for seniors over 65 years of age to provide a higher immune response.

My motivation for a flu shot may be greater than the average person. My great-grandfather died of Spanish influenza in 1918 at 35 years of age. He left behind a wife and three children under the age of 10 years. Influenza afflicted one third of the world population that year and globally an estimated 20 to 50 million died, according to most accounts.

The Flu Facts
It has been a century since we have seen a pandemic flu of the same virulence as Spanish influenza; however, modern influenzas are far from benign. According to Centers for Disease Control and Prevention (CDC), influenza costs the United States approximately $87 billion every year and is responsible for the loss of about 17 million workdays. Nearly 200,000 people are hospitalized each flu season. During the 2013-14 season 60 percent of hospitalized patients were between the ages of 18 and 64 years. In a good year as few as 3,000 Americans die of influenza—in a bad year, 49,000 die from flu-related illnesses in the U.S. From my personal clinical experience, most deaths occur among the elderly or the very young, but sadly, some of these deaths are among individuals in their prime like my great-grandfather.

Businesses have a vested interest in the prevention of illness among the workforce. It is always better to prevent than to treat. Prevention saves lives, health care resources, work production losses, and the socio-economic impacts on the family. In July 2008 health policy organization Trust for America’s Health reported a small investment in disease prevention could result in significant savings in health care costs. The report, “Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities,” concluded an investment of $10 per person in certain community-based programs could save more than $16 billion annually within five years. This is an average return of $5.60 for every $1.

Prevention Practices
The two most important ways to prevent influenza include personal
hygiene and vaccination. Businesses should encourage both. Personal hygiene includes handwashing and covering coughs. Transmission of influenza may occur directly through cough droplets or indirectly through the hands.
Common sense tells us to avoid people with a cough and most people realize the importance of handwashing, but we sometimes forget when in a rush. Good handwashing practices are easier if the facilities are adequate. Restrooms should be well maintained and supplied with running water, soap, and either paper towels or hand driers. (The CDC has signage available for download on its website. See sidebar.) These easy interventions likely add little, if anything, to the usual daily operational budget.

Vaccines may yield even higher dividends than the average $5.60 per dollar. Sachiko Ozawa and co-researcher at the Department of International Health at the Johns Hopkins Bloomberg School of Public Health analyzed and projected the return on investment (ROI) over a 10-year period (2011-2020). They estimated a $16 ROI for every dollar invested in vaccines during the decade, taking into account treatment costs and productivity losses. This return may be realized in diminished absenteeism, enhanced production and decreased health insurance costs.

Many health care plans already include a flu shot as a benefit to the policy holder. As with handwashing we can encourage vaccination by improving access. The trend in pharmacies to offer flu shots without the need for a doctor’s visit has helped make the flu vaccine more accessible. However, workers must still take the time to go by the pharmacy to receive a shot. Employees must choose a convenient time and place to go. Vaccination can be made more convenient by offering in-house flu shots at the work place through special vaccine clinics for employees wishing to take advantage of the service. In many cases service providers can take advantage of insurance benefits so businesses will incur no cost.

Ultimately everyone gains.