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Seasonal Influenza Vaccination and Health Care Workers (HCWs)


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Title: Seasonal Influenza Vaccination and Health Care Workers (HCWs)

Seasonal Influenza Vaccination and Health Care
Workers (HCWs)
  • 2015-2016 Influenza Season

Health Protection Surveillance Centre
National Immunisation Office
Protect yourselfProtect others
Format slide bank pick those slides that
suit your audience best
  • Influenza
  • Symptoms and burden in general and in HCWs
  • Risk groups
  • Vaccine uptake / HCWs in Ireland
  • Reasons why HCWs decline
  • Effectiveness in HCWs
  • Safety of the vaccine
  • Effectiveness in protecting patients
  • Strategies to improve uptake
  • Controversy in relation to influenza systematic
    reviews from Cochrane

Influenza (Flu)
  • The flu is an infection that is caused by a flu
    virus. There are many different types of flu
  • The flu affects the lungs, throat, nose, and
    other parts of the body.
  • Unlike the common cold, the flu comes on
    suddenly, makes you very sick for a week or
    longer, and you may end up in hospital.

In healthy adults symptoms of flu can range from
classic influenza to mild illness or asymptomatic
Symptoms Cold Classic Flu
Fever Rare , except in very young children Usual ( 38oC 100.4 F) lasts 3-4 days, reduced in elderly
Headache Rare Prominent
General aches/ pains Slight Often severe
Fatigue/ Weakness Mild Sudden onset and can last up to 3 weeks
Extreme exhaustion Never Early and prominent
Stuffy nose Common Sometimes
Sneezing Usual Sometimes
Sore throat Common Sometimes
Cough, Chest discomfort Mild to moderate Common and can become severe
Influenza complications
  • Bacterial superinfections
  • bacterial pneumonia
  • croup
  • respiratory disorders
  • Decompensation of chronic diseases
  • pulmonary disease
  • heart disease
  • renal insufficiency
  • metabolic disease

How Does the Flu Spread?
  • Flu is spread through tiny droplets sprayed into
    the air when a sick person coughs, sneezes, or
    even talks.
  • You can get sick from the droplets if they land
    in your nose, eyes, or mouth.
  • You can also get the flu by touching a surface
    like a table or a doorknob that has the virus on
    it, then touching your mouth or nose.
  • .

Courtesy CDC/ Brian Judd
Who is most at risk of complications?
  • Diseases
  • Those with chronic medical conditions e.g.
    Chronic respiratory, cardiac etc., Diabetes
    Mellitus, neurological disorders,
    immunosuppressed either through disease or
    treatment including those with asplenia or
    splenic dysfunction, morbid obesity-BMI 40
  • Vulnerable age
  • Young children lt 5 years
  • hospitalisation rates comparable to those aged
  • those under 6 months have highest hospitalisation
    rate of any age
  • gt 65 years
  • Account for 90 deaths from seasonal flu
  • Pregnancy
  • SAGE WHO background
    paper on Influenza vaccines and Immunization

Flu is Dangerous
  • When some people get the flu it may be mild, but
    for many others it could be fatal.
  • Most of these excess deaths are in the
    elderly/those with underlying illness
  • Death 0.5-1/1000 cases (1/10,000 pop per year).
  • Approximately, 200-500 Irish people will die
    each year because of flu. In a bad year this can
    be up to 1000 people (2008-2009)
  • Recent European study reported weeks of excess
    mortality coincided with medium or high influenza
    activity weeks
  • Of the 411 people admitted to ICU in Ireland with
    lab confirmed flu since 2009
  • 18 were healthy people with no underlying
    illness most were lt 65 years median age of
    those admitted to ICU ranged from 18 66 years
    depending on year Case fatality ratio varied,
    (range 18-36)
  • K Mølbak et al. Excess mortality among the
    elderly in European countries, December 2014 to
    February 2015 (ttp//
  • HPSC ICU influenza surveillance

Risk of Myocardial Infarction and Strokeafter
Acute Infection or Vaccination
  • There was no increase in the risk of myocardial
    infarction or stroke in the period after
    influenza, tetanus, or pneumococcal vaccination.
  • However, the risks of both events were
    substantially higher after a diagnosis of
    systemic respiratory tract infection (incidence
    ratio for myocardial infarction, 4.95 95 percent
    confidence interval, 4.43 to 5.53 incidence
    ratio for stroke, 3.19 95CI, 2.81 to 3.62).
  • Smeeth L et al. Risk of Myocardial Infarction and
    Stroke after Acute Infection or Vaccination. N
    Engl J Med 2004 Dec 16351(25)2611-8

Influenza vaccination inpatients with CHD
  • Case control study of 218 patients with coronary
    heart disease (CHD) during the 199798 influenza
    season in the USA
  • Efficacy of influenza vaccine in reducing the
    risk of recurrent myocardial infarction (MI) in
    patients with CHD

Vaccination associated with a reduced risk of
recurrent MI
Past and current influenza vaccination
reducesthe risk of recurrent MI in CHD patients
Naghavi M et al. Circulation 2000 102
Risk of influenza-associated deaths
  • Risk Risk to die within one year due to
  • 1200 Smoking more than 10 cigarettes/day
  • 15000 Influenza
  • 18000 Street accident
  • 112,000 Leukaemia
  • 1500,000 Accident on railway
  • 110,000,000 Lightning strike

Calman KC. BMJ. 1996313799-802.
Everyone is at risk
  • ?100 million people infected every year in
    Northern Hemisphere

110 adults
13 children
10,000-40,000 deaths in the USA
In North America, Europe, and Japan. ESWI.
Available at http//
/0499-4.html. CDC. MMWR. 200150(RR-04)1-46.
Transmission of Influenza by HCW
  • In a neonatal intensive care unit1
  • 19/54 infants were infected and one died
  • 15 of staff were vaccinated against influenza
  • Only 29 of staff who reported influenza-like
    illness took time off work
  • In an organ transplant unit attack rate 332
  • Each patient was in an individual room and 3/4
    had no visitors to account for the spread
  • 3/27 (11) HCWs on the ward had influenza not
  • In long-term facility3
  • 65 residents developed influenza
  • Over half developed pneumonia, 19 hospitalized, 2
  • 10 of HCW were vaccinated

Influenza infection can remain asymptomatic but
1Cunney et al. Infect Control Hosp Epidemiol.
20002144951 2Malavaud S, et al.
Transplantation. 2001725357 3CDC. MMWR
19914129-131 4Elder G, et al. BMJ.
Characteristics of Influenza Hospitalisations in
Ireland over 6 influenza seasons
2014/2015 data provisional, further reported
cases expected.
Characteristics of Influenza ICU admissions,
Ireland, over 6 influenza seasons
2014/2015 data provisional, further reported
cases expected.
Summary influenza/ILI general outbreaks by
institution type 2014/2015 influenza season
Location No. of outbreaks Total number ill Total number hospitalised Total Number dead Total number lab confirmed
Comm. Hosp/Long-stay unit 26 355 39 2 80
Hospital 17 380 4 5 250
Residential institution 15 163 18 5 43
School 1 17 0 0 -
Total 59 915 61 12 373
Source CIDR
Summary influenza/ILI general outbreaks in
institutional settings (all) by HSE area
2014/2015 flu season
HSE-area No. of outbreaks Total no. ill Total no. hospitalised Total no. dead Total no. lab confirmed Total no. lab investigated
East 17 407 1 6 240 64
Midlands 2 25 1 1 1 11
Midwest 6 69 24 3 27 25
Northeast 1 8
Northwest 11 116 5 1 30 42
Southeast 6 52 2 0 15 21
South 13 201 20 0 37 36
West 3 37 8 1 23 24
 Total 59 915 61 12 373 223
Source CIDR data
ILI consultation rate, positive influenza A and B
specimens (NVRL), by week and year
Data for 2014-2015 not available at time of
presentation 1/10/2015
But I dont get the flu
  • One serosurvey showed 23 of HCW had serologic
    evidence of influenza virus infection during a
    single influenza season
  • the majority had mild illness

    or subclinical

Elder G, et al. BMJ. 199631312412. Kuster SP
et al 2011. PLoS ONE 6(10)e26239.
How can you help?
  • Stay home from work when you feel sick.
  • Wash your hands or use hand sanitisers, sneeze
    in your sleeve or a tissue.
  • But this is not enough
  • People can still spread the flu even when they
    DONT feel sick.
  • Up to 50 of infected people dont have symptoms
    when they are infected.
  • People can spread flu germs before they feel
  • Flu is also spread through tiny droplets spread
    into the air when people cough or sneeze.
  • The best protection is VACCINATION.

Good News!!
  • YOU can help protect your family, friends,
    patients, and yourself from the flu.

Since Im Not at High Risk, Do I Need to Get the
Flu Vaccine?
  • YES.
  • When you get the flu it may be mild, but for
    those at high risk it could be fatal.
  • Patients.
  • Family Members and Friends.
  • Getting the flu vaccine helps to protect the
    people you work so hard to keep healthy.

Influenza Vaccine for all HCWs
  • Recommended annually since 1999
  • Increased risk of exposure
  • Reduce staff illness and absenteeism
  • Known to spread from workers to patients
  • Vital to care of high risk patients
  • Recent emphasis on influenza vaccine to ensure
    patient safety and as quality measure for
  • RCPI National Immunisation Guidelines for
    Ireland. (editions 1999/2202/2008/2013)
  • HCWs all staff (including ancillary staff, such
    as cleaners, porters, kitchen staff) working in
    health care setting or health related activities
    in acute and non acute health care settings,
    including those working in health related
    activities in the community settings

The vaccine
  • This years (2014-2015) seasonal flu vaccine
    contains 3 strains of flu viruses as recommended
    by the World Health Organization (WHO) as the
    strains most likely to be circulating this
    season. The three strains are
  • Influenza A/California/7/2009 (H1N1)pdm09-like
  • Influenza A/Switzerland/9715293/2013 (H3N2)-like
  • Influenza B/Phuket/3073/2013-like virus
  • This vaccine is an inactivated split virion
    vaccine, does not contain any adjuvant.
  • It does not contain thiomerosal.
  • Is there anyone who cannot get flu vaccine?
  • Most people can get flu vaccine.
  • It is not recommended for those who have
  • a history of anaphylaxis following a previous
    dose of flu vaccine or any part of the vaccine. 
  • What about people with egg allergy?
  • People with egg allergy can get seasonal flu
    vaccine. This may be given by your occupational
    health unit or GP or you may need referral to a
    hospital specialist. See RCPI NIAC guidelines

Influenza vaccines- two types available
  • Inactivated trivalent vaccine
  • contains antigens from two type A and one type B
    virus strains cultured in eggs or in cell lines
  • whole virus, split-virus (subvirion), and
    surface-antigen vaccines are of equivalent
    efficacy but the latter two are less likely to
    induce febrile reactions in children.
  • supplied in a prefilled syringe for IM injection.
  • 2. Live attenuated influenza quadrivalent vaccine
  • contains antigens from two type A and two type B
    virus strains cultured in eggs.
  • vaccine is administered intranasally

Source NIAC guidance updated August 2015.
Administration of vaccines
  • Inactivated vaccine
  • dose is 0.5ml given by intramuscular injection
    into the anterolateral thigh or deltoid.
  • Live attenuated influenza vaccine (LAIV)
  • dose is 0.2ml given by nasal spray 0.1 ml into
    each nostril
  • LAIV immunisation must be given intranasally.
  • Children lt 9 years of age and those who are
    immunosuppressed require two doses of vaccine,
    separated by 4 weeks if receiving the vaccine for
    the first time.
  • Not routinely available from HSE

European Council Recommendation on seasonal
influenza vaccination 22 December 2009
  • Member States are recommended
  • To achieve vaccination coverage in older age
    groups and risk groups of individuals suffering
    from chronic diseases and conditions
  • Recommended Target 75 by the winter season of
  • To mitigate the impact of seasonal influenza
    among health care workers
  • For 2014/2015 Ireland (provisional data
  • Uptake among elderly gt 65 years of age
    (medical/GP only card holders) was 63 (source

HCW and vaccination Why are we concerned?
  • HCWs frequently implicated as the source of
    influenza transmission in health care settings
  • Employees continue to work while sick with
  • Unvaccinated workers who are not sick can still
    spread the virus
  • Benefits of influenza vaccination of HCWs
  • Reduce risk of outbreaks in health care
  • Decrease staff illness and absenteeism
  • Reduce costs resulting from loss of productivity

Yet still HCW vaccination rates remain low
VENICE studySeasonal influenza vaccination
uptake among HCWs in 15 EU/EEA Member States,
Health care workers in GPs practice Source
VENICE survey http//
Uptake by Hospital Staff Category by Season
Results based on complete returns consisting of
eligible and vaccinated staff numbers by HSE
grade in 21 hospitals that reported back in each
survey over the past four seasons
Uptake by LTCF Staff Category by Season
Results based on complete returns consisting of
eligible and vaccinated staff numbers by HSE
grade in 21 LTCFs that reported back in each
survey over the past four seasons
Reasons for not taking vaccination advanced by
health care workers
The flu vaccine can give me the flu
I never get the flu and I dont feel I need the
Since I am around sick people all the time, I am
already immune to the flu
I am a healthy person and would prefer my immune
system to protect me against the flu
I am worried about having an adverse reaction to
the vaccine
I dont believe in it
The vaccine doesnt work on me. I got the flu
Reasons for not getting influenza vaccine among
Irish HCWs (n 92), 2006
Mereckiene J et al. Euro Surveill. 200712(12).
Does the Flu Vaccine Work?
  • YES!
  • Systematic reviews have shown that flu vaccine
    has reduced the flu incidence rate from 18.7 in
    unvaccinated HCWs to 6.5 in vaccinated HCWs
  • Kuster SP et al. Incidence of Influenza in Health
    adults and Health Care Workers A systematic
    review and Meta Analysis 2011 PLoS ONE
    6(10)e26239. doi10.1371/journal.pone.0026239
  • .

Factors influencing vaccine efficacy
  • Closeness of the match between the vaccine strain
    and the circulating virus
  • Age of vaccinee
  • older people do not respond as well
  • Health of the vaccinee
  • people with chronic illnesses and immune system
    disorders do not respond as well as healthy
  • Number of vaccinations
  • in children under 9 two doses are required in the
    first year of use
  • Type of vaccine used
  • adjuvanted vaccines can give better immune

Effectiveness of inactivated influenza vaccine in
  • Effectiveness dependent on match with circulating
  • Seasonal
  • Vaccine closely matched to circulating strain
  • 73 effective in healthy adults lt65 years of age
    against influenza symptoms, whereas 44 when not
    well matched
  • Jefferson T et al Vaccines for preventing
    influenza in healthy adults Cochrane Database
    Syst Rev 2010CD001269
  • Pooled efficacy results of 59 in adults aged
  • Osterholm MT, Kelley NS, Sommer A, Belongia EA.
    Efficacy and effectiveness of influenza vaccines
    a systematic review and meta-analysis. Lancet
    Infect Dis. Jan 201212(1)36-44.

Is Flu Vaccine Safe?
  • YES! The flu vaccine is very safe. The benefits
    far outweigh any possible side effects.
  • Some people may have redness and soreness where
    they received the vaccine
  • Serious side effects are rare.
  • Guillain Barré recent studies show reduced after
    vaccine but increased after influenza
  • Narcolepsy has not been linked to seasonal flu

Does flu vaccine give you the flu?- NO
  • It cannot cause flu
  • influenza viruses in vaccine currently used in
    Ireland are inactivated (killed) during
    manufacturing process
  • cannot cause infection
  • batches of vaccine are tested to ensure safety
  • Randomised placebo (saline , vaccine diluent)
    controlled studies have demonstrated safety
  • only differences in symptoms between vaccinated
    and non-vaccinated was increased soreness in the
    arm and redness at the injection site
  • no differences in terms of body aches, fever,
    cough, runny nose or sore throat.

Carolyn Bridges et al. (2000). JAMA.
284(13)16551663. Kristin Nichol et al.
(1995). NEJM. 333(14) 889-893.
Vaccine side-effects
  • Most common side effect of seasonal flu vaccine
  • soreness at injection site, usually lt 2 days
  • Rare symptoms
  • fever, muscle pain, and feelings of discomfort or
  • usually begin soon after vaccination and last 1-2
  • Frequency
  • local reactions 15-20 recipients
  • Fever, malaise not common, resolve
  • Allergic reactions rare
  • Neurological reactions very rare

Debunking the Myths I got sicker from the
vaccine than when I actually got the fluN Engl
J Med 20013451529-36.)
Rhinitis 44.8 45
Sore throat 28.3 28.7
Cough 46.1 45.7
Headache 39.6 37.8
Myalgia 25.1 20.8
Chills 12.2 11.1
Fever 5.1 5.0
Fatigue 27.9 28.6
What is Guillain-Barré Syndrome (GBS)?
  • a rare neurological disease that causes
    temporary weakness or paralysis of the muscles
  • Frequently preceded by a viral or bacterial
    illness (campylobacter)
  • In the literature
  • 1976 influenza vaccine associated with increased
    risk vaccine was discontinued
  • Since then no clear association between GBS and
    influenza vaccines
  • If risk exists, estimated at 1 - 2 cases per
    million people vaccinated
  • Risk of GBS after vaccination is lower than the
    risk of GBS after influenza

Stowe J et al. Am J Epidemiol 2009169382-8
If I get vaccinated, will it really make a
difference to my patients?
Does Vaccinating Health Care Workers (HCWs)
Really Help?

Many studies have shown that increasing the
vaccination rates of HCWs decreases patient
illness and death. One study showed a 40
reduction of influenza related deaths in
hospitals with higher rates of HCP influenza
Carman WF GD, et al. Lancet 2000355937.
Vaccination of HCW reducesnosocomial influenza
  • Monitored for 12 years (87-99)
  • Coverage rate increased from 4 to 67
  • Lab confirmed cases-staff
  • Dropped from 42 (1990-93) to 9 (1997-2000)
  • Nosocomial cases among hospitalized patients
  • Decreased 32 to 0 (plt0.0001)

Salgado et al. Infect Control Hosp Epidemiol
Patient outcomes
  • Most reported trials in nursing homes
  • Studies of staff vaccination have shown decrease
    mortality of residents 1, 2
  • One cluster randomised clinical trial3 with 44
    nursing homes residents
  • When staff offered vaccine (48 coverage) vs. not
    offered (6 coverage), impact on residents
  • Decrease mortality
  • Decrease in ILI
  • Decrease in medical visits for ILI

1. Carman WF, et al. Lancet 200035593--7. 2.
Potter J, et al. J Infect Dis 19971751--6. 3.
Hayward AC, et al.BMJ 20063331241.
Vaccinating HCWs and impact on patient mortality
Increased vaccination rates of HCWs working in
long-term care geriatric hospitals have been
associated with a reduction in patient mortality
20 long-term care geriatric hospitals in Scotland
randomised and followed for 6 months during the
199697 season (1217 HCWs, 1437 patients)
HCWs in 10 hospitals not offered vaccination
HCWs in 10 hospitals offered vaccination
HCWs in 10 hospitals not offered vaccination
HCWs in 10 hospitals offered vaccination
5 of HCWs vaccinated
50 of HCWs vaccinated
5 of HCWs vaccinated
50 of HCWs vaccinated
688 patients monitored
749 patients monitored
749 patients monitored
Crude patient mortality 22
Crude patient mortality 14
Crude patient mortality 14
Carman WF, et al. Lancet. 2000355937.
Benefits of Influenza Vaccination in Health Care
  • 1) protects HCW against influenza
  • 2) provides indirect protection against influenza
    to the high-risk patients
  • 3) reduces absenteeism from work
  • 4) is cost-effective and probably cost-saving

Does getting vaccinated really keep the workforce
more healthy?
Absenteeism of HCW
  • Double blind, randomised, placebo controlled
  • 2 large teaching hospitals over 3 years
  • Vaccinated vs. controls
  • Vaccinated group with lower incidence of
    influenza (1.7) compared to controls (13.4)
  • Estimated vaccine efficacy against serologically
    defined influenza A and influenza B infection of
    88 and 89
  • Trend toward
  • fewer total respiratory illnesses (28.7 per 100
    persons) vs. controls (40.6 per 100 persons)
  • Fewer days of lost work (9.9 per 100 persons) vs.
    21.1 per 100 persons for controls

Wilde JA, McMillan JA, Serwint J, Butta J,
O'Riordan MA, Steinhoff MC. Effectiveness of
influenza vaccine in health care professionals a
randomized trial. JAMA 1999281908--13.
Vaccination and reduction of HCW absenteeism
427 HCWs in two Finnish paediatric hospitals
randomized to influenza vaccine or placebo and
followed (double blind) for 4 months during
199697 season
216 vaccinated against influenza
211 received placebo
301 days sick leave due to respiratory infections
218 days sick leave due to respiratory infections
  • Vaccination was associated with a 28 decrease (p
    0.02) in absenteeism related to respiratory
  • No effect on the total number of days with
    respiratory infections (with or without sick
    leave) nor on antibiotic use

Saxen H, et al. Pediatr Infect Dis J.
What the vaccine does/does not do
  • Does
  • protect against influenza from 2 weeks after
    vaccination up to a year later
  • Decreases risk of influenza disease and
  • Hospitalisation and severe illness incl. Guillain
    Barre after influenza-like illness
  • Does not
  • Prevent influenza-like illnesses caused by
    other viruses
  • Increase risk of Guillain Barré syndrome after

Stowe J et al. Am J Epidemiol. 2009 Feb
Cost-effectiveness for healthy adults
  • Healthy adults (lt65 years of age) savings
  • 13-44 fewer health-care provider visits
  • 18-45 fewer lost workdays
  • 18-28 fewer days working with reduced
  • 25 decrease in antibiotic use for ILI
  • Savings categories
  • Reduction in direct medical costs
  • Decreased indirect costs from lost work
  • gt70 of cost savings

Molinari NA, Ortega-Sanchez IR, Messonnier ML,
et al. The annual impact of seasonal influenza in
the US measuring disease burden and costs.
Vaccine 2007255086--96.
Influenza in HCWs has a substantial economic
impact on healthcare structures
  • University Hospital of Zurich, 19992000 season
  • 200 employees
  • 4.3 days off work per employee presenting with an
    influenza-like illness
  • 29.5 attack rate
  • Overall economic impact on the hospital
    (including 5,525 employees)
  • Cost of lost productivity for influenza
    represented 0.050.1 of overall personnel

Productivity loss (days) Annual personnel expenditure (US)
Influenza-like illness 3,0969,079 0.421.2 million
Laboratory-confirmed influenza 6461,943 102,500300,000
Szucs TD, et al. Infect Control Hosp Epidemiol.
Strategies to increase uptake
  1. Organised vaccination programmmes
  2. Emphasis on Duty-of-Care
  3. Education and debunking the myths
  4. Support from senior staff
  5. Mandatory vaccination/declination
  6. Provision of free, easily accessible vaccines in
    a convenient matter

Rates with Different Interventions
Factor Vaccination rate in Programmes with Vaccination rate in Programmmes without
Weekend provision of vaccine 58.8 43.9
Train-the-trainer programs 59.5 46.5
Report of vaccination rates to administrators 57.2 48.1
Letter sent to employees emphasizing the importance of vaccination 59.3 47
Any form of visible leadership support 57.9 36.9
Required declination 56.9 55
Talbot TR. Dellit TH. Hebden J. Sama D. Cuny J.
Factors associated with increased healthcare
worker influenza vaccination rates results from
a national survey of university hospitals and
medical centers. Infect Control Hosp Epidemiol.
31(5)456-62, 2010 May
If You Dont Get the Flu
  • You wont need to take time off from work because
    you are sick with the flu.
  • HCWs who receive flu vaccine take about 50 fewer
    sick days.
  • You wont need to pay for doctor visits and
    medication to treat the flu.
  • Immunised HCWs have about 44 fewer doctor
  • You wont need to cancel activities with friends
    and family because you are sick with the flu.
  • Immunized HCWs have a 59 reduction in illness
    during vacation time.

Wilde JA, et al . Effectiveness of influenza
vaccine in health care professionals a
randomized trial. JAMA 1999281908--13.
Nichol KL, M, et al. The effectiveness of
vaccination against influenza in healthy, working
adults. N Engl J Med 199533388993..
Influenza Vaccination of Health-Care Personnel
Recommendations of ACIP and HICPAC-MMWR 2006
Since Ive Been in the Health Care Field for a
Long Time, am I Already Protected Against the
  • No, this is not possible.
  • Flu virus changes every year.
  • Your body cannot protect itself from new types of
    flu because your immune system does not recognise
  • A different vaccine is needed every year.
  • You need to get a flu vaccine every year.

Why Get Vaccinated Against the Flu?
  • Protect yourself.
  • Protect your patients.
  • Protect your family and friends.
  • Flu vaccination
  • is FREE.
  • is safe.
  • is quick and easy.
  • can save you time and money.
  • Vaccination is the BEST protection
  • you have against the flu!

Why annual vaccination?
  • Influenza viruses always changing.
  • Strains monitored by WHO surveillance
  • WHO recommends strains for inclusion in seasonal
    flu vaccine every year
  • Seasonal flu vaccine formulated to match
    circulating strains

2 Recent conflicting systematic reviews
  • Thomas RE et al reported on 3 randomised
    controlled trials and found no reasonable
    evidence that vaccination of HCWs protected
    residents in LTCF. They did not look at all cause
    deaths and restricted outcomes to lab confirmed
    influenza or hospitalisation or death due to a
    lower respiratory tract illness
  • Ahmed et al from CDC identified four
    cluster-randomised trials and four observational
    studies conducted in long-term care or hospital
    settings. They estimated that all cause death was
    reduced by 29 and ILI by 42.
  • Thomas RE et al. Influenza vaccination for
    healthcare workers who care for people aged 60 or
    older living in long-term care institutions.
    Cochrane Database Syst Rev.20137CD005187
  • Faruque Ahmed et al. Effect of Influenza
    Vaccination of Health Care Personnel on Morbidity
    and Mortality among Patients Systematic Review
    and Grading of Evidence Clinical Infectious
    Diseases Advance Access published September 17,

Accompanying Editorial in CID Marie Griffin
September 2013
  • Sir Austin Bradford Hill
  • All scientific work is incompletewhether it be
    observational or experimental. All scientific
    work is liable to be upset or modified by
    advancing knowledge. That does not confer upon us
    a freedom to ignore the knowledge we already
    have, or postpone the action that it appears to
    demand at a given time.
  • The meta-analysis by Ahmed et al. offers
    additional reassurance that the threshold for
    action has been reached or surpassed. Vaccination
    of healthcare workers to protect vulnerable
    patients and residents of long term facilities
    should be viewed as an evidence-based

HCW and vaccination Where are we in Ireland?
  • Poor uptake of immunisation among Irish HCWs
  • Historically poor but improving
  • Inter-hospital/facility variation
  • High risk of transmission in health care setting
    to vulnerable groups
  • High risk of complications in risk groups
  • Human and economic impact of influenza
  • employee absenteeism, disease among patients,
    burden on health services
  • Poor knowledge
  • Low perception of self risk or risk to others
    among HCWs
  • Myths and inaccurate information common

What can be done to improve the situation?
  • Develop strong position on HCWs influenza
  • leadership and department/institution support
  • Aim high (uptake gt 40)
  • Highlight benefits of HCW immunisation
  • Personal/ patient /family
  • Decreased transmission among staff and patients
    deaths/complications/prolonged hospital stays/
  • Educate early and often and avoid confusion among
  • dangers of influenza transmission from HCWs to
    patients, patient care responsibility
  • Highlight vaccine safety and efficacy- and years
    of safe usage
  • Dispel myths You cannot get influenza from the
    injectable vaccine, side effects minimum
  • Communication tools
  • posters, leaflets, newsletter articles, e-mails,
    text messaging

Improve Influenza Immunisation
  • Make it attractive
  • Convenient and comfortable (site and time)
  • Incentives and rewards (raffles, spot prizes,
  • Inter-departmental/team competition uptake by
    units published
  • Identify key person on each unit/ward/team
  • responsible for encouraging vaccination,
  • Make it accessible
  • Multiple opportunities (during day/night, week,
  • Continuous programme October-March
  • Avoid missed opportunities
  • offer immunisation during any contact
  • Bring vaccine to staff
  • mobile teams, multiple sites, target group
    gatherings, team meetings
  • Throughout work day (and night)

Monitoring and evaluation
  • Monitor
  • Uptake by units and professional group
  • Health care-associated illness during season
  • Evaluate
  • Differences between groups and units
    investigate reasons for differences
  • Report and share information
  • Demonstrate high performing areas
  • Introduce competition
  • Demonstrate safety and uptake
  • Information may stimulate HCWs to seek

Protect your patients, your self, colleagues,
family and friends
More information on influenza 2015-2016 season
  • HPSC
  • http//
  • National immunisation Office
  • http//