Coast Guard identifies vessel which rammed fishing boat off Kozhikode coast

KOCHI: The Coast Guard on Thursday identified the Panama flag merchant vessel which rammed a fishing boat off Kozhikode coast injuring three fishermen.

According to Coast Guard officials, the vessel has been identified as M V Isumo. ''We have directed the vessel to come to Kochi for further inquiry in connection with the incident," the Coast Guard officials said.

Officials said that the vessel immediately fled the scene after the accident and the vessel was traced after the Coast Guard launched a Dornier aircraft and two fast patrol vessels to track it.

It was on Wednesday afternoon that three fishermen were injured when their boat collided with the merchant vessel off Beypore coast near Kozhikode. The fishing boat sank in the collision and the fishermen were rescued by another fishing boat which was in the vicinity.

According to the coastal police officials, the fishermen jumped into the sea on seeing the ship approaching towards their boat.

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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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Notre Dame: Football Star Was 'Catfished' in Hoax

Notre Dame's athletic director and the star of its near-championship football team said the widely-reported death of the star's girlfriend from leukemia during the 2012 football season was apparently a hoax, and the player said he was duped by it as well.

Manti Te'o, who led the Fighting Irish to the BCS championship game this year and finished second for the Heisman Trophy, said in a statement today that he fell in love with a girl online last year who turned out not to be real.

The university's athletic director, Jack Swarbrick, said it has been investigating the "cruel hoax" since Te'o approached officials in late December to say he believed he had been tricked.

Private investigators hired by the university subsequently monitored online chatter by the alleged perpetrators, Swarbrick said, adding that he was shocked by the "casual cruelty" it revealed.

"They enjoyed the joke," Swarbrick said, comparing the ruse to the popular film "Catfish," in which filmmakers revealed a person at the other end of an online relationship was not who they said they were.

"While we still don't know all of the dimensions of this ... there are certain things that I feel confident we do know," Swarbrick said. "The first is that this was a very elaborate, very sophisticated hoax, perpetrated for reasons we don't understand."

Mike Ehrmann/Getty Images

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Te'o said during the season that his girlfriend, Lennay Kekua, died of leukemia in September on the same day Te'o's grandmother died, triggering an outpouring of support for Te'o at Notre Dame and in the media.

"While my grandma passed away and you take, you know, the love of my life [Kekua]. The last thing she said to me was, 'I love you,'" Te'o said at the time, noting that he had talked to Kekua on the phone and by text message until her death.

Now, responding to a story first reported by the sports website Deadspin, Te'o has acknowledged that Kekua never existed. The website reported today that there were no records of a woman named Lennay Kekua anywhere.

Te'o denied that he was in on the hoax.

"This is incredibly embarrassing to talk about, but over an extended period of time, I developed an emotional relationship with a woman I met online," Te'o said in a statement released this afternoon. "We maintained what I thought to be an authentic relationship by communicating frequently online and on the phone, and I grew to care deeply about her."

Swarbrick said he expected Te'o to give his version of events at a public event soon, perhaps Thursday, and that he believed Te'o's representatives were planning to disclose the truth next week until today's story broke.

Deadspin reported that the image attached to Kekua's social media profiles, through which the pair interacted, was of another woman who has said she did not even know Te'o or know that her picture was being used. The website reported that it traced the profiles to a California man who is an acquaintance of Te'o and of the woman whose photo was stolen.

"To realize that I was the victim of what was apparently someone's sick joke and constant lies was, and is, painful and humiliating," Te'o said.

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France to stay in Mali until stability restored

BAMAKO/DUBAI (Reuters) - France pledged on Tuesday to keep troops in Mali until stability returned to the West African country, raising the specter of a long campaign against al Qaeda-linked rebels who held their ground despite a fifth day of air strikes.

Paris has poured hundreds of soldiers into Mali and carried out 50 bombing raids since Friday in the Islamist-controlled northern half of the country, which Western and regional states fear could become a base for terrorist attacks in Africa and Europe.

Defense Minister Jean-Yves Le Drian said that, despite French air support, Malian forces had not been able to dislodge Islamist fighters from the central Malian towns of Konna or Diabaly, just 350 km (220 miles) northeast of Bamako.

A column of French armored vehicles rolled northward from the dusty riverside capital of Bamako towards rebel lines on Tuesday, the first major northward deployment of ground troops. A military official declined to comment on their objective.

Thousands of African soldiers are due to take over the offensive. Regional armies are scrambling to accelerate an operation which was initially not expected until September and has been brought forward by France's surprise bombing campaign aimed at stopping a rebel advance on a strategic town last week.

President Francois Hollande, on a visit to the United Arab Emirates during which he sought Gulf states' financial backing for the African-led mission, suggested France would retain a major role in its former colony for months to come.

"We have one goal. To ensure that when we leave, when we end our intervention, Mali is safe, has legitimate authorities, an electoral process and there are no more terrorists threatening its territory," Hollande told a news conference.

Paris has said it plans to deploy 2,500 soldiers to bolster the Malian army and work with the intervention force provided by West African states.

AFRICAN TROOPS

West African Defense chiefs met in Bamako on Tuesday to approve plans for the swift deployment of 3,300 regional troops, foreseen in a United Nations-backed intervention plan. After failing to reach a final agreement, they adjourned their talks until Wednesday.

Nigeria pledged to deploy soldiers within 24 hours, and Belgium said it was sending transport planes and helicopters to help, but West Africa's armies need time to become operational.

Mali's north, a vast and inhospitable area of desert and rugged mountains the size of Texas, was seized last year by an Islamist alliance combining al Qaeda's north African wing AQIM with splinter group MUJWA and the home-grown Ansar Dine rebels.

Any delay in following up on the French air bombardments of Islamist bases and fuel depots with a ground offensive could allow the insurgents to slip away into the desert and mountains, regroup and counter-attack.

The rebels, who French officials say are mobile and well armed, have shown they can hit back, dislodging government forces from Diabaly on Monday.

Residents said the town was still under Islamist control on Tuesday despite a number of air strikes that shook houses.

An eye witness near Segou, to the south, told Reuters he had seen 20 French Special Forces soldiers driving toward Diabaly.

In Konna, whose seizure on Thursday sparked French involvement, residents said Islamist fighters were camped just outside town. Army troops had also withdrawn after entering the town on Saturday.

Malians have largely welcomed the French intervention, having seen their army suffer a series of defeats by the rebels.

"With the arrival of the French, we have started to see the situation on the front evolve in our favor," said Aba Sanare, a resident of Bamako.

QUESTIONS OVER READINESS

Aboudou Toure Cheaka, a senior regional official in Bamako, said the West African troops would be on the ground in a week.

The original timetable for the 3,300-strong U.N.-sanctioned African force - to be 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. Col. Mohammed Yerima, spokesman for Nigeria's Defense ministry, said the first 190 soldiers would be dispatched within 24 hours.

But Nigeria, which is due to lead the mission, has already cautioned that even if some troops arrive in Mali soon, their training and equipping will take more time.

Sub-Saharan Africa's top oil producer, which already has peacekeepers in Sudan's Darfur and is fighting a bloody and difficult insurgency at home against Islamist sect Boko Haram, could struggle to deliver on its troop commitment of 900 men.

One senior government adviser in Nigeria said the Mali deployment was stretching the country's military.

"The whole thing's a mess. We don't have any troops with experience of those extreme conditions, even of how to keep all that sand from ruining your equipment. And we're facing battle-hardened guys who live in those dunes," said the adviser, who asked not to be named.

FRENCH LINING UP SUPPORT

France, which has repeatedly said it has abandoned its role as policeman of its former African colonies, said on Monday that the U.S., Canada, Denmark and Germany had also offered logistical support.

Fabius has said Gulf Arab states would help the Mali campaign, while Belgium said on Tuesday it would send two C130 transport planes and two medical helicopters following a request from Paris.

A meeting of donors for the operation was expected to be held in Addis Ababa at the end of January.

Security experts have warned that the multinational intervention in Mali, couched in terms of a campaign by governments against "terrorism", could provoke a jihadist backlash against France and the West, and African allies.

U.S. officials have warned of links between AQIM, Boko Haram in Nigeria and al Shabaab Islamic militants fighting in Somalia.

Al Shabaab, which foiled a French effort at the weekend to rescue a French secret agent it was holding hostage, urged Muslims around the world to rise up against what it called "Christian" attacks against Islam.

"Our brothers in Mali, show patience and tolerance and you will win. War planes never liberate a land," Sheikh Ali Mohamud Rage, al Shabaab's spokesman, said on a rebel-run website.

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 any place to hide," U.S. Defense Secretary Leon Panetta told reporters as he began a visit to Europe. Panetta later said the U.S. had no plans to send troops to Mali.

One U.S. military source said the haphazard nature of French involvement reminded him of the U.S. entry into Afghanistan.

"I don't know what the French endgame is for this," the source said. "Air strikes are fine, but pretty soon you run out of easy targets. Then what do you do? What do you do when they head up into the mountains?"

(Additional reporting by Elizabeth Pineau and Raissa Kasolowsky in Abu Dhabi, Felix Onuah in Abuja and Tim Cocks in Lagos, Abdi Sheikh in Mogadishu, Michelle Nichols and Louis Charbonneau at the United Nations,; Richard Valdmanis in Dakar, Joe Bavier in Abidjan, Jan Vermeylen in Brussels; Writing by Pascal Fletcher, Daniel Flynn and David Lewis; editing by Richard Valdmanis, Giles Elgood and Will Waterman)

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Punggol East ward saw 3-way fight in 2011 GE

SINGAPORE: In the 2011 General Election, the Punggol East Single Member Constituency (SMC) saw a three-way fight among political parties that contested.

The People's Action Party's (PAP) Michael Palmer won over half of the votes.

The Punggol East SMC had over 30,000 voters in the 2011 General Election and it was the only constituency that saw a three-cornered fight.

Then, the PAP's Michael Palmer, The Workers' Party's Lee Li Lian and the Singapore Democratic Alliance's Desmond Lim campaigned for residents' hearts and minds.

The three focused largely on ground concerns during the hustings.

Mr Lim promised new facilities of over a million dollars for residents if he won.

It was something Mr Palmer cast doubt on. He was the ward's incumbent, elected in 2006 when the area was still under Pasir Ris-Punggol Group Representation Constituency, before it was carved out as a single seat.

Mr Palmer had said his time in the ward was used to build cohesion among residents, and hoped for continuing support.

Ms Lee, on the other hand, chose to look at estate cleanliness and cost of living issues.

When the dust settled, Mr Palmer won, taking around 55 per cent of votes.

Ms Lee took about 41 per cent.

And Mr Lim got around four per cent.

- CNA/ck

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Army Chief to meet martyred soldier's family in Mathura

MATHURA: Army Chief General Bikram Singh, will meet the family members of Lance Naik Hemraj here on Wednesday amid demands that the severed head of the martyred soldier be brought back.

General Singh had earlier on Monday said he would visit Hemraj's home.

"I will go. They are my people. Tomorrow is Army Day, I will send my senior officer there. I will definitely go. Let this event, the Army Day, be over, I will definitely go and meet the family. If that is the demand, I shall be there," General Singh told the media in New Delhi.

General Singh, who conveyed his condolences to the families of the two jawans killed brutally, had also said that the Pakistan army should be pressurised to return Hemraj's head.

General Singh had also warned Pakistan that India reserves the right to retaliate at the time and place of its choosing.

Hemraj's wife and mother had gone on a six-day fast demanding that the Army Chief must visit their house and assure them that the martyred soldier's severed head will be brought back.

The Prime Minister yesterday termed as 'barbaric' the brutal killing of Indian jawans along the Line of Control (LoC), and said there cannot be business as usual with Islamabad.

Manmohan Singh, who broke his silence on the prevailing tension with Pakistan on the LoC, said the attack on the Indian jawans is unacceptable.

"After this barbaric act, there cannot be business as usual with Pakistan. Pakistan must be held accountable for what happened on the LoC. Hope Pakistan will bring the perpetrators of beheading to justice. The future peace process depends on Pakistan," he said.

Tension between the two Asian neighbours has escalated ever since Indian jawan Lance Naik Hemraj was beheaded in an attack by Pakistani troops along the Line of Control on January 8.

India has lodged a strong protest against the ceasefire violations by Pakistan along the LoC and made it clear to it that the Army reserves the right to retaliate if provoked.

The Army's position was conveyed at a brigadier-level flag meeting between the two sides at Chakan-Da-Bagh crossing-point in Poonch sector of the Jammu region on Monday.

Pakistan has denied India's claim that its troops crossed the Line of Control to ambush a patrol party in the Mendhar sector in Poonch district.

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Risk to all ages: 100 kids die of flu each year

NEW YORK (AP) — How bad is this flu season, exactly? Look to the children.

Twenty flu-related deaths have been reported in kids so far this winter, one of the worst tolls this early in the year since the government started keeping track in 2004.

But while such a tally is tragic, that does not mean this year will turn out to be unusually bad. Roughly 100 children die in an average flu season, and it's not yet clear the nation will reach that total.

The deaths this year have included a 6-year-old girl in Maine, a 15-year Michigan student who loved robotics, and 6-foot-4 Texas high school senior Max Schwolert, who grew sick in Wisconsin while visiting his grandparents for the holidays.

"He was kind of a gentle giant" whose death has had a huge impact on his hometown of Flower Mound, said Phil Schwolert, the Texas boy's uncle.

Health officials only started tracking pediatric flu deaths nine years ago, after media reports called attention to children's deaths. That was in 2003-04 when the primary flu germ was the same dangerous flu bug as the one dominating this year. It also was an earlier than normal flu season.

The government ultimately received reports of 153 flu-related deaths in children, from 40 states, and most of them had occurred by the beginning of January. But the reporting was scattershot. So in October 2004, the government started requiring all states to report flu-related deaths in kids.

Other things changed, most notably a broad expansion of who should get flu shots. During the terrible 2003-04 season, flu shots were only advised for children ages 6 months to 2 years.

That didn't help 4-year-old Amanda Kanowitz, who one day in late February 2004 came home from preschool with a cough and died less than three days later. Amanda was found dead in her bed that terrible Monday morning, by her mother.

"The worst day of our lives," said her father, Richard Kanowitz, a Manhattan attorney who went on to found a vaccine-promoting group called Families Fighting Flu.

The Centers for Disease Control and Prevention gradually expanded its flu shot guidance, and by 2008 all kids 6 months and older were urged to get the vaccine. As a result, the vaccination rate for kids grew from under 10 percent back then to around 40 percent today.

Flu vaccine is also much more plentiful. Roughly 130 million doses have been distributed this season, compared to 83 million back then. Public education seems to be better, too, Kanowitz observed.

The last unusually bad flu season for children, was 2009-10 — the year of the new swine flu, which hit young people especially hard. As of early January 2010, 236 flu-related deaths of kids had been reported since the previous August.

It's been difficult to compare the current flu season to those of other winters because this one started about a month earlier than usual.

Look at it this way: The nation is currently about five weeks into flu season, as measured by the first time flu case reports cross above a certain threshold. Two years ago, the nation wasn't five weeks into its flu season until early February, and at that point there were 30 pediatric flu deaths — or 10 more than have been reported at about the same point this year. That suggests that when the dust settles, this season may not be as bad as the one only two years ago.

But for some families, it will be remembered as the worst ever.

In Maine, 6-year-old Avery Lane — a first-grader in Benton who had recently received student-of-the-week honors — died in December following a case of the flu, according to press reports. She was Maine's first pediatric flu death in about two years, a Maine health official said.

In Michigan, 15-year-old Joshua Polehna died two weeks ago after suffering flu-like symptoms. The Lake Fenton High School student was the state's fourth pediatric flu death this year, according to published reports.

And in Texas, the town of Flower Mound mourned Schwolert, a healthy, lanky 17-year-old who loved to golf and taught Sunday school at the church where his father was a youth pastor.

Late last month, he and his family drove 16 hours to spend the holidays with his grandparents in Amery, Wis., a small town near the Minnesota state line. Max felt fluish on Christmas Eve, seemed better the next morning but grew worse that night. The family decided to postpone the drive home and took him to a local hospital. He was transferred to a medical center in St. Paul, Minn., where he died on Dec. 29.

He'd been accepted to Oklahoma State University before the Christmas trip. And an acceptance letter from the University of Minnesota arrived in Texas while Max was sick in Minnesota, his uncle said.

Nearly 1,400 people attended a memorial service for Max two weeks ago in Texas.

"He exuded care and love for other people," Phil Schwolert said.

"The bottom line is take care of your kids, be close to your kids," he said.

On average, an estimated 24,000 Americans die each flu season, according to the Centers for Disease Control and Prevention. People who are elderly and with certain chronic health conditions are generally at greatest risk from flu and its complications.

The current vaccine is about 60 percent effective, and is considered the best protection available. Max Schwolert had not been vaccinated, nor had the majority of the other pediatric deaths.

Even if kids are vaccinated, parents should be watchful for unusually severe symptoms, said Lyn Finelli of the CDC.

"If they have influenza-like illness and are lethargic, or not eating, or look punky — or if a parent's intuition is the kid doesn't look right and they're alarmed — they need to call the doctor and take them to the doctor," she advised.

___

CDC advice on kids: http://www.cdc.gov/flu/protect/children.htm

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NRA Ad Calls Obama 'Elitist Hypocrite'

Jan 16, 2013 12:04am

Pablo Martinez Monsivais/AP Photo

As the White House prepares to unveil a sweeping plan aimed at curbing gun violence, the National Rifle Association has launched a preemptive, personal attack on President Obama, calling him an “elitist hypocrite” who, the group claims, is putting American children at risk.

In 35-second video posted online Tuesday night, the NRA criticizes Obama for accepting armed Secret Service protection for his daughters, Sasha and Malia, at their private Washington, D.C., school while questioning the placement of similar security at other schools.

“Are the president’s kids more important than yours? Then why is he skeptical about putting armed security in our schools, when his kids are protected by armed guards at their school?” the narrator says.

“Mr. Obama demands the wealthy pay their fair share of taxes, but he’s just another elitist hypocrite when it comes to a fair share of security,” it continues. “Protection for their kids and gun-free zones for ours.”

The immediate family members of U.S. presidents – generally considered potential targets – have long received Secret Service protection.

The ad appeared on a new website for a NRA advocacy campaign – “NRA Stand and Fight” — that the gun-rights group appears poised to launch in response to Obama’s package of gun control proposals that will be announced today.

It’s unclear whether the video will air on TV or only on the web. The NRA did not respond to ABC News’ request for comment.  The domain for the website is registered to Ackerman McQueen, the NRA’s long-standing public relations firm.

The White House had no comment on the NRA ad.

In the wake of last month’s mass shooting at Sandy Hook Elementary School, the Obama administration has met with a cross-section of advocacy groups on all sides of the gun debate to formulate new policy proposals.

The NRA, which met with Vice President Joe Biden last week, has opposed any new legislative gun restrictions, including expanded background checks and limits on the sale of assault-style weapons, instead calling for armed guards at all American schools.

Obama publicly questioned that approach in an interview with “Meet the Press” earlier this month, saying, “I am skeptical that the only answer is putting more guns in schools. And I think the vast majority of the American people are skeptical that that somehow is going to solve our problem.”

Still, the White House has been considering a call for increased funding for police officers at public schools and the proposal could be part of a broader Obama gun policy package.

Fifty-five percent of Americans in the latest ABC News/Washington Post poll say they support adding armed guards at schools across the country.

“The issue is, are there some sensible steps that we can take to make sure that somebody like the individual in Newtown can’t walk into a school and gun down a bunch of children in a shockingly rapid fashion.  And surely, we can do something about that,” Obama said at a news conference on Monday.

“Responsible gun owners, people who have a gun for protection, for hunting, for sportsmanship, they don’t have anything to worry about,” he said.

ABC News’ Mary Bruce and Jay Shaylor contributed reporting. 

SHOWS: Good Morning America World News

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New Holocaust museum opens at gruesome WW2 site

BRUSSELS: Belgium's newly-opened Holocaust and human rights museum stands symbolically on the site of barracks commandeered by the Nazis as a wartime transit centre for Jews and Gypsies being sent to the death camps.

The new "Kazerne Dossin" in the Flemish town of Mechelen, comprising a museum, memorial and documentation centre, is located at the site of an 18th century barracks that officials dub "a silent witness to the greatest war crime, in the form of genocide, in Belgium".

The new World War II remembrance complex some 30 kilometres from Brussels was inaugurated by Belgian King Albert II and opened to the public last month.

Like the Drancy camp outside Paris where Jews were rounded up and sent to death camps, the Dossin barracks -- directly linked to the Belgian rail network -- was turned into a last-stop transit centre for the notorious Auschwitz-Birkenau camp run by the Nazis during the war.

More than 25,500 Jews and 350 Gypsies from both Belgium and northern France were sent there after their arrest, often with the help of local police.

There were more than 70,000 Jews in Belgium before the Second World War broke out, notably 18,000 in the nearby port city of Antwerp.

After two or three months at Dossin, deportees were herded into trains for the Third Reich's death camps. Only five percent of the Jews and Gypsies who left Mechelen in 28 convoys ever returned.

Last September, Belgian Prime Minister Elio Di Rupo presented the country's apologies for crimes committed by people who had worked hand-in-hand with Nazis to deport Jews.

"This new museum takes a more profound look at the history of the persecution of the Jews in Flanders and Belgium, based on new historic sources of information and insights," said Kris Peeters, who heads the Dutch-speaking government of Flanders.

"It also provides a link between the concepts of holocaust and human rights."

In 1995, members of the Jewish community opened a small museum in a part of the barracks but much of the building had already been turned into flats and sold.

The new complex, built with the help of a 25-million-euro investment by the government of Flanders, adds a state-of-the-art cube-like museum designed by celebrated Flemish architect Bob Van Reeth.

The top fourth floor, destined to house temporary exhibitions, is open to the light of day but the other three storeys smack of a mausoleum.

Rectangular shapes in the white facade symbolise bricked-up windows while the heavy sliding steel door recalls those on the freight trains used to carry the victims to their death.

Van Reeth said the total volume was equivalent to that of the freight cars used in the 28 convoys to the death camp; the number of bricks used being the same as the number of people deported.

The three floors touch on three themes -- intolerance, fear and death.

The museum expects to see 100,000 visitors a year.

- AFP/al

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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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