Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

___

Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

___

Online:

CDC flu: http://www.cdc.gov/flu/index.htm

Read More..

Nordstrom hostages made to strip naked; 1 sexually assaulted, police say

Los Angeles police confirmed Sunday evening the arrests of three suspected gang members in the takeover robbery at the Nordstrom Rack in Westchester last week.

The Times first reported two arrests, one on Friday and the second Saturday in Phoenix. Sources familiar with the investigation described the man arrested in Phoenix as a principal suspect but would give no further details.

In a press release Sunday, the LAPD said that a total of three suspects had been arrested but did not give additional details.

Police would not release the suspects’ identities, nor would they detail how the suspects were taken into custody or their alleged roles in the robbery and hostage situation.

Sources said they had strong evidence linking the men to the crime, including physical evidence and security camera video. Prosecutors will decide this week whether to file charges.

The incident began about 11 p.m. Thursday at the Promenade at Howard Hughes Center, near the 405 Freeway. The LAPD called a tactical alert and closed off the area around the shopping center.
When the Police Department's SWAT officers arrived, they surrounded the store. At one point, one suspect exited, saw the police and ran back inside.

A second suspect walked out with an unidentified woman, saw police and also headed back inside. The officers entered the store at 3:30 a.m. and freed the hostages.

At least three of the hostages were injured, including one woman who was sexually assaulted. Another woman was stabbed in the neck and sustained non-life-threatening injuries, and a third employee was pistol-whipped, police said.

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India Ink: Woman Raped by Seven Men in Punjab, India, Police Say

NEW DELHI — Police said Sunday that a  29-year-old woman had been raped by a bus driver, a bus conductor and five other men in the north Indian state of Punjab, in an incident that recalls the recent attack in Delhi that has caused widespread outrage.

The woman boarded a bus on Friday bound for Gurdaspur, to visit her in-laws, the police chief of Gurdaspur, Raj Jit Singh, said in a telephone interview. When she got off the bus, the driver offered her a ride on his motorcycle, perhaps to her in-laws village, the police said. Instead, he took her to a nearby village where he and six other men, including the bus conductor, raped her repeatedly through the night.

The next morning, the driver dropped her at her in-laws home, where the woman told her family members of the incident, and then reported it to the police, Mr. Singh said.

Six men, including the bus driver and conductor, have been arrested, he said. All of the men are their twenties.

Gurmesh Singh, the deputy superintendent of police for the  region, said it was unclear how or why the bus driver persuaded the woman to go with him on his motorcycle. She was in a state of distress during the bus ride, Mr. Singh said, and originally refused to get off of the bus when it reached its final destination.

The Press Trust of India reported that the bus driver did not stop at her stop when requested.

The gang-rape of a woman on a moving bus in New Delhi on Dec. 16, and her subsequent death from injuries sustained during the rape, has sparked widespread protests and calls for increased policing and tougher laws against sexual assault in India.

The case against five of the men arrested in that rape is being heard this month in a special fast-track court created just for incidents of sexual assault.

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Prince William and Kate Advertise for Royal Housekeeper

By Simon Perry

01/13/2013 at 02:45 PM EST

The Duchess and Duke of Cambridge

REX USA

The Duke and Duchess of Cambridge are staffing up.

The royal couple are looking for a housekeeper for their home in Kensington Palace, PEOPLE has confirmed.

What are the job requirements? The applicant must be willing to keep their home clean, tend to the glass and silverware and run some basic errands for the couple. That could even mean looking after little Lupo, their cocker spaniel.

The position is a "standard housekeeping" role, a spokesman says, and it has been advertised internally to other royal household staff.

Shortly after their marriage in 2011, they advertised for similar help. But William and Kate reversed the decision, removing the advertisement after they told aides they didn't need household help just yet.

But things change: Now, as they are expecting their first child and prepare to move into their new, larger home at Apartment 1A of Kensington, they're ready for some assistance.

And they aren't short of applicants. The U.K.'s Sunday Express, which broke the story of opening in the royals' staff, says 15 people have put their hat in the ring.

The new post will be the couple's second recent appointment. Late last year they took on their first orderly – a Fijian corporal, seconded from the Parachute regiment. He has been driving the couple (and was seen behind the wheel at Kate's visit to her prep school, St. Andrew's in Pangbourne, just before she announced her pregnancy) and helping with logistics on their visits.

He reportedly will also be on hand to help periodically with Prince William's clothes.

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Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

___

Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

___

Online:

CDC flu: http://www.cdc.gov/flu/index.htm

Read More..

Female deputy claims Sheriff commanders sexually coerced her

L.A. County Sheriff's Department investigators are probing a deputy's allegations that she was the victim of sexual
misconduct involving three top sheriff's officials.

"I take this very seriously, and I will find out what did
or did not happen," Sheriff Lee Baca said in a statement.

The deputy is the daughter of a top aide to the sheriff.

Capt. Joseph Stephen of the
Malibu station confirmed that he was one of the targets of the probe and
had been questioned by investigators Friday. He denied any wrongdoing.
Also being investigated are retired Chief Ronnie Williams and Capt.
Anthony Ward, who was heading up the auto-theft unit until he recently
retired, according to four sources. Williams denied any wrongdoing, and
Ward could not be reached for comment.

All of the sources asked for anonymity because the investigation is ongoing and they were not authorized to speak to the media.

The deputy who leveled the allegations referred a reporter's inquiry
to her attorney. Her attorney initially said, "I think she wants it to
come to light," but later canceled an interview. The Times generally
does not name potential victims of sex crimes.

Sheriff's officials said the probe was in the preliminary phase.

The deputy's allegations involved sexual coercion by officials who outranked her, sources said.

She made the accusations after facing her own allegations of
misconduct, sources said. Court records show she has a pending felony
charge of vandalism and misdemeanor counts of battery. She pleaded not
guilty. She has been placed on leave without pay, according to a
spokesman.

Reached by phone Friday afternoon, Stephen said he was waiting to
find out if he was going to be removed from his command. He called the
deputy's allegations "absolutely, unequivocally" untrue but declined to
say if they had had a sexual relationship.

"I don't want to get into that," he said.

Stephen said he never directly supervised the deputy. He accused her
of trying to deflect attention from her own legal troubles. "She's
trying to save her own skin," he said. "She's trying to lash out and see
what sticks."

Williams, the retired chief, told The Times that he has not been
interviewed by investigators. He said he never supervised the alleged
victim, and that although he is her "partial friend," the relationship
is platonic.

"She never was assigned to my division. How could I coerce her to do
anything?" said Williams, who left the department four years ago.

-- Robert Faturechi and Richard Winton

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Venezuela Governors Warned Not to Question Government’s Legitimacy

CARACAS, Venezuela — Top government officials are threatening to take action against opposition governors and issuing dark warnings about conspiracies against the government of President Hugo Chávez, who is ailing and remains incommunicado in Cuba.

At a large rally for the cancer-stricken Mr. Chávez on Thursday, the day designated for his inauguration, Vice President Nicolás Maduro sent a warning to government critics who had objected to a Supreme Court ruling that endorsed the indefinite postponement of the president’s swearing-in.

Many interpreted his words to be directed at Henrique Capriles, the governor of Miranda State who lost to Mr. Chávez in the presidential election in October. He is the most likely opposition candidate if a special election has to be held should Mr. Chávez die, resign or become too sick to continue in office.

“Some governors out there have come out to make declarations, playing with words,” Mr. Maduro said. “We say to them, ‘Stop the waffling.’ If you don’t recognize the legitimate government of President Chávez, we are evaluating legally very forceful actions, because if you don’t recognize me, I’m not obligated to recognize you. It’s that simple.”

He added: “Watch your words and your actions. Take care not to get involved in coups and destabilizing adventures.”

Before leaving for cancer surgery in Havana in early December, Mr. Chávez designated Mr. Maduro as his political heir and said that he wanted him to run for president if a special election became necessary.

It is not unusual for Venezuelan officials to threaten or lash out at the opposition, which they routinely characterize as an enemy bent on overthrowing Mr. Chávez’s revolution. But in recent days, amid an intense debate over the constitutionality of postponing the president’s swearing in, the tone has gotten harsher.

Later on Thursday, Mr. Capriles posted a reply on Twitter saying, “Threats from No. 2s make us laugh, let’s see if starting tomorrow they get back to work, Government in paralysis.”

Mr. Capriles added in another post: “What do you know, they didn’t let Al Capone speak, what happened?”

Vladimir Villegas, a former ambassador who is now critical of the government, said that in Mr. Chávez’s absence, Mr. Maduro and other officials were using the clash with the opposition to promote unity among their followers.

“They can’t live without an enemy,” Mr. Villegas said. “The confrontation with the opposition holds them together.”

The vice president is appointed by the president, and some in the opposition have argued that Mr. Maduro cannot continue to serve in the new term without being reappointed by Mr. Chávez. But the Supreme Court ruled that Mr. Maduro and other appointees could continue in their posts.

Mr. Capriles has pointed out repeatedly that although Mr. Maduro is now at the head of the government, he is not an elected official.

“He was not elected Oct. 7,” Mr. Capriles said last week, referring to the recent presidential election. “He shouldn’t come and talk to us about legitimacy.”

The front page of the newspaper Tal Cual on Friday showed a caricature of Mr. Maduro with the headline: “The Usurper.” Another newspaper opposed to the government, El Nacional, ran a front-page headline that said: “The new term starts with legality questioned.”

On Thursday, Mr. Maduro also said the government had uncovered a plot to destabilize the country, although he offered no evidence and was vague in his description of the conspiracy.

“There is a plan by sectors of the ultraright to find a cadaver, two cadavers and fill the streets of Venezuela with protests,” Mr. Maduro said, adding that the opposition was planning “a kind of sabotage and constant fires in the cities.”

“We alerted all the police security forces to be very careful of their actions because they are looking to stain the political life” of the country, Mr. Maduro said.

Also last week, the government said it was starting an administrative proceeding against Globovisión, a television station closely allied with the opposition, over its coverage of the constitutional controversy around Mr. Chávez’s swearing-in. The proceeding could result in a large fine or the temporary shutdown of the station.

The National Telecommunications Commission announced the proceeding on Wednesday, several hours after Diosdado Cabello, president of the National Assembly and a top Chávez ally, said in a speech that the station should be sanctioned for its coverage of the issue.

The director of the commission, Pedro Maldonado, said punishment could include a fine of up to 10 percent of the station’s gross revenue and a 72-hour shutdown.

Globovisión paid a fine of about $2.2 million last year for its coverage of a deadly prison riot in 2010. The government said its reporting threatened public order and fomented anxiety.

On Friday, Globovisión ran a short spot several times showing a section of the Constitution that defends free speech followed by Mr. Maldonado announcing the proceeding against the station. It ends with the words, “Censorship of the Constitution.”

Meanwhile, Mr. Maduro flew to Cuba on Friday to visit the president and his family and speak with his doctors.

Mr. Chávez has not been seen or heard from since his cancer surgery on Dec. 11 in Havana. Officials have said that he is fighting a severe lung infection. In past trips to Cuba for cancer treatment, starting in June 2011, Mr. Chávez stayed in the public eye, posting on Twitter, making phone calls to government-run television stations and on one occasion conducting a televised government meeting from Havana.

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“Storage Wars” porn lawsuit: alleged Brandi Passante video distributor found in contempt

LOS ANGELES (TheWrap.com) – “Storage Wars” star Brandi Passante has won a legal victory over the man accused of distributing a fake pornographic video of her on the Internet.

Or, at least, the alleged porn-monger has suffered a legal setback.

Federal judge James V. Selna of U.S. District Court in Central California found Hunter Moore, former operator of the website Is Anyone Up, in contempt of court on Tuesday. Selna ruled Moore failed to comply with a preliminary injunction ordering him to remove the images of Passante from the websites that he posted them to.

According to the order issued by Selna, if Moore has not “purged his contempt” (presumably, meaning “removed the images,” but feel free to supply your own mental imagery) by the time he has received the order, he will be fined $ 50 for each day that he fails to comply with the injunction.

After that, the fine increases to $ 100 per day, and a warrant for his arrest will be issued if he fails to comply after 14 days.

As reported earlier by TheWrap, Passante sued Moore in October, claiming that he published photos and video purporting to depict Passante in pornographic situations. (Passante claims that the images are fake.)

The suit says that Passante first became aware of the images when she received a tweet reading, “Love the pics” from Is Anyone Up’s Twitter account.

The complaint goes on to claim that Moore later posted the video to porn-friendly website Fleshbot.com, adding that when users clicked on the video, a virus immediately began to download onto their computers.

Since filing the suit, Passante has claimed to suffer further headaches due to Moore’s efforts. In November, the “Storage Wars” buyer and her attorney Linda S. McAleer filed declarations that Moore had violated a temporary restraining order by targeting the pair in a digital harassment campaign.

According to the declarations, Moore published a number of obscene tweets with Passante’s Twitter handle tagged, ensuring that she would see them.

In another instance, McAleer claimed, when she emailed a copy of the restraining order to Moore, he replied with a message asking “if brandi had missed this?” with a photo of himself naked from the waist down and in an aroused state.

(Pamela Chelin contributed to this report)

Internet News Headlines – Yahoo! News

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Adele Shops for Baby in Los Angeles

Caught in the Act

01/12/2013 at 01:30 PM EST

She may or may not win a trophy at Sunday's Golden Globe Awards, but Adele is already picking up some little treasures in Los Angeles.

After arriving Thursday, the new mom, whose son was born in October, shopped at upscale baby boutique Bel Bambini in West Hollywood on Friday.

"She was in a great mood and just focused on picking up essentials for her baby boy," an eyewitness tells PEOPLE.

What did her lucky little boy get? According to a customer, the British superstar spent an hour at the store and purchased a "lot of loot," including baby wash, shampoos and a changing pad.

A bodyguard type helped the mom, who wore head-to-toe black with a blue coat and a hat, load her purchases into a waiting car.

The Globes, which air live Sunday (8 p.m. ET) on NBC, will be the first official appearance for Adele since she and boyfriend Simon Konecki welcomed their son, whose name is still unknown.

She's nominated for best original song for her James Bond tune, "Skyfall."

• Reporting by PERNILLA CEDENHEIM

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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 policikfriedenes 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."

__

Online:

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

CDC: http://www.cdc.gov

___

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

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