Organized labor officials and NIOSH's research council criticized the Centers for Disease Control and Prevention's plan to back off last year's call for use of N95 respirators to protect health care workers from the flu, saying the proposal is a retreat from the agency's stance following the outbreak of the H1N1 virus last year. Meanwhile the American Hospital Association (AHA) endorsed the respiratory protection changes.

CDC is proposing to replace last year's guide with a new one that treats H1N1 as seasonal flu and says face masks, as opposed to respirators, are sufficient to protect health care workers from airborne exposures.

But unions and the National Occupational Research Agenda (NORA), a public/private council of occupational safety and health experts facilitated by NIOSH, disagree. On Thursday, NORA called for CDC to maintain last year's guidelines until studies can show the changes are appropriate and warranted. The council said the principal driver for the changes on CDC's part seems to be the lower than originally anticipated mortality and morbidity experienced during last year's pandemic, but said that's insufficient reason to change the respiratory protection guidance, especially due to the differential toll H1N1 took on working-age people.

NORA noted that CDC cited three factors for its revisions to last year's guidance: there is now a widely available and safe and effective vaccine for H1N1; the overall risk of hospitalization and death among people infected with the strain is now known to the substantially lower than originally thought; and traditionally, flu viruses have been thought to spread from person to person through large-particle respiratory droplet.

But NORA rebutted each of these arguments. The council said CDC unpublished data showed the vaccine was only 62 percent effective and that CDC is placing an over-reliance on protection afforded by the vaccine. NORA also cited the demographic differences in H1N1 versus traditional seasonal flu, as well as new research showing it is a false dichotomy to separate droplets from airborne droplet nuclei from coughs, sneezing and even talking and normal breathing, and studies showing the flu virus has an airborne component.

AFL-CIO likewise protested the changes. “In drafting this proposed revision to its current guideline on 2009 H1N1, CDC has taken a step backwards in its recommendations for protecting health care workers,” wrote Bill Kojola, industrial hygienist for the AFL-CIO, to the agency in response to the planned guidance. “On the basis of an overstated claim that we have an effective vaccine and an irrelevant and irresponsible contention that because the risks of severe outcomes among those infected were less than a scenario of worst-case assumptions, CDC decides it can retreat from the respiratory protection that health care workers need to protect them from airborne transmission of the H1N1 virus.”

The union specifically urged CDC to issue a revised guidance that retains the recommendation that health care workers be provided respiratory protection whenever they come into close contact with patients with suspected or confirmed H1N1 flu. “Our nation's health care work force deserves nothing less from CDC when it comes to protection of those who provide care to patients who are made sick from a pandemic flu virus,” Kojola wrote.

AHA, on the other hand, supports CDC's emphasis on annual vaccination as the most important measure to prevent seasonal flu infection in health care personnel, visitors and patents. Rick Pollack, AHA's executive vice president, wrote in a July 22 letter to CDC: “We also agree that to improve influenza vaccination rates, hospital and health systems need strong internal leadership that supports annual vaccinations and provides clear, fact-based and timely education and communication initiatives,” Pollack wrote.

Pollack said he understood CDC's initial conservative posture last year to suggest use of N95 respirators because H1N1 was an unknown and novel type of flu, but he added: “However, it quickly became clear that H1N1 influenza transmitted in much the same way as seasonal influenza, primarily through large-particle respiratory droplet transmission and to a lesser extent through indirect contact transmission from virus-contaminated hands or surfaces to mucosal surfaces of the face,” Pollack wrote.

The agency in June issued its updated guidance on the flu strategies, providing notice with a comment period ending July 22. The revision would update an interim guidance the agency posted on its Web site in 2009 for infection control measures for H1N1 in health care settings.

The proposed CDC guidance is under scrutiny by stakeholders at the same time as OSHA has requested information for a potential rule on infectious diseases. The comment period on the OSHA request ends Aug. 4.

Click here to read how the AFL-CIO responded to the CDC.