Title: Seasonal Influenza Vaccination and Health Care Workers (HCWs)
1Seasonal Influenza Vaccination and Health Care
Workers (HCWs)
- 2015-2016 Influenza Season
-
Health Protection Surveillance Centre
National Immunisation Office
2Protect yourselfProtect others
3Format 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
4Influenza (Flu)
- The flu is an infection that is caused by a flu
virus. There are many different types of flu
viruses. - 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.
5In healthy adults symptoms of flu can range from
classic influenza to mild illness or asymptomatic
infection
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
6Influenza complications
- Bacterial superinfections
- bacterial pneumonia
- croup
- respiratory disorders
- Decompensation of chronic diseases
- pulmonary disease
- heart disease
- renal insufficiency
- metabolic disease
7How 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
8Who 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
50-64 - 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
9Flu 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//www.eurosurveillance.org/View
Article.aspx?ArticleId21065 - HPSC ICU influenza surveillance
10Risk 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
11Influenza 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
303945.
12Risk 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.
13Everyone 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//www.eswi.org/library/bulletins
/0499-4.html. CDC. MMWR. 200150(RR-04)1-46.
14Transmission 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
vaccinated - In long-term facility3
- 65 residents developed influenza
- Over half developed pneumonia, 19 hospitalized, 2
died - 10 of HCW were vaccinated
Influenza infection can remain asymptomatic but
infectious4
1Cunney et al. Infect Control Hosp Epidemiol.
20002144951 2Malavaud S, et al.
Transplantation. 2001725357 3CDC. MMWR
19914129-131 4Elder G, et al. BMJ.
199631312412
15Characteristics of Influenza Hospitalisations in
Ireland over 6 influenza seasons
2014/2015 data provisional, further reported
cases expected.
16Characteristics of Influenza ICU admissions,
Ireland, over 6 influenza seasons
2014/2015 data provisional, further reported
cases expected.
17Summary 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
18Summary 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
19ILI consultation rate, positive influenza A and B
specimens (NVRL), by week and year
(2012/13-2013/14)
Data for 2014-2015 not available at time of
presentation 1/10/2015
20But I dont get the flu
21Actually
- 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
infection
Elder G, et al. BMJ. 199631312412. Kuster SP
et al 2011. PLoS ONE 6(10)e26239.
doi10.1371/journal.pone.0026239
22How 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
sick. - Flu is also spread through tiny droplets spread
into the air when people cough or sneeze. - The best protection is VACCINATION.
23Good News!!
- YOU can help protect your family, friends,
patients, and yourself from the flu.
24Since 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.
25Influenza 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
organisations - 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
26The 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
virus - Influenza A/Switzerland/9715293/2013 (H3N2)-like
virus - 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
27Influenza 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
(LAIV) - 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.
http//www.hse.ie/eng/health/immunisation/hcpinfo/
guidelines/chapter11.pdf
28Administration 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
29European 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
2014/2015 - To mitigate the impact of seasonal influenza
among health care workers - For 2014/2015 Ireland (provisional data
PCRS/HPSC) - Uptake among elderly gt 65 years of age
(medical/GP only card holders) was 63 (source
PCRS)
30HCW 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
influenza - Unvaccinated workers who are not sick can still
spread the virus - Benefits of influenza vaccination of HCWs
- Reduce risk of outbreaks in health care
facilities - Decrease staff illness and absenteeism
- Reduce costs resulting from loss of productivity
31Yet still HCW vaccination rates remain low
32VENICE studySeasonal influenza vaccination
uptake among HCWs in 15 EU/EEA Member States,
2008/09-2012/13
Health care workers in GPs practice Source
VENICE survey http//venice.cineca.org/
33Uptake 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
34Uptake 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
35Reasons 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
vaccine
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
anyway
36Reasons for not getting influenza vaccine among
Irish HCWs (n 92), 2006
Mereckiene J et al. Euro Surveill. 200712(12).
37Does 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 - .
38Factors 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
individuals - 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
response
39Effectiveness of inactivated influenza vaccine in
adults
- Effectiveness dependent on match with circulating
virus - 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
18-65 - 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.
40Is 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
vaccine
41Does 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.
42Vaccine 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
weakness - usually begin soon after vaccination and last 1-2
days - Frequency
- local reactions 15-20 recipients
- Fever, malaise not common, resolve
- Allergic reactions rare
- Neurological reactions very rare
-
43Debunking the Myths I got sicker from the
vaccine than when I actually got the fluN Engl
J Med 20013451529-36.)
SYMPTOMS VACCINE PLACEBO
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
44What 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
45If I get vaccinated, will it really make a
difference to my patients?
46Does Vaccinating Health Care Workers (HCWs)
Really Help?
YES !
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
vaccination.
Carman WF GD, et al. Lancet 2000355937.
47Vaccination of HCW reducesnosocomial influenza
cases
- 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
200425923-928
48Patient 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.
49Vaccinating 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.
50Benefits of Influenza Vaccination in Health Care
Workers
- 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
51Does getting vaccinated really keep the workforce
more healthy?
52Absenteeism of HCW
- Double blind, randomised, placebo controlled
trial - 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.
53Vaccination 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
infections - 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.
19991877983.
54What 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
complications - 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
vaccination
Stowe J et al. Am J Epidemiol. 2009 Feb
1169(3)382-8.
55Cost-effectiveness for healthy adults
- Healthy adults (lt65 years of age) savings
include - 13-44 fewer health-care provider visits
- 18-45 fewer lost workdays
- 18-28 fewer days working with reduced
effectiveness - 25 decrease in antibiotic use for ILI
- Savings categories
- Reduction in direct medical costs
- Decreased indirect costs from lost work
productivity - 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.
56Influenza 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
expenditure
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.
2001224724.
57Strategies to increase uptake
- Organised vaccination programmmes
- Emphasis on Duty-of-Care
- Education and debunking the myths
- Support from senior staff
- Mandatory vaccination/declination
- Provision of free, easily accessible vaccines in
a convenient matter
58Rates 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
59If 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
visits. - 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
60Since Ive Been in the Health Care Field for a
Long Time, am I Already Protected Against the
Flu?
- 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
it. - A different vaccine is needed every year.
- You need to get a flu vaccine every year.
61Why 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!
62Why annual vaccination?
- Influenza viruses always changing.
- Strains monitored by WHO surveillance
laboratories - WHO recommends strains for inclusion in seasonal
flu vaccine every year - Seasonal flu vaccine formulated to match
circulating strains
632 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,
2013
64Accompanying 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
recommendation
65HCW 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
66What can be done to improve the situation?
- Develop strong position on HCWs influenza
immunisation - 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/
absenteeism - Educate early and often and avoid confusion among
HCWs - 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
67Improve Influenza Immunisation
- Make it attractive
- Convenient and comfortable (site and time)
- Incentives and rewards (raffles, spot prizes,
chocolates) - Inter-departmental/team competition uptake by
units published - Identify key person on each unit/ward/team
- responsible for encouraging vaccination,
vaccinating - Make it accessible
- Multiple opportunities (during day/night, week,
month) - 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)
68Monitoring 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
vaccination
69Protect your patients, your self, colleagues,
family and friends
70More information on influenza 2015-2016 season
- HPSC
- http//www.hpsc.ie/A-Z/Respiratory/Influenza/Seaso
nalInfluenza/ - National immunisation Office
- http//www.immunisation.ie/en/HotTopics/Text_17465
_en.html