Influenza Vaccination of Healthcare Personnel HCP

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Influenza Vaccination of Health-care Personnel
(HCP)

• National Influenza Vaccination Week (NIVW)
• Andrew Kroger

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Which HCP Need Vaccination?

• Includes physicians, nurses, nursing assistants,
  therapists, technicians, EMTs, dental,
  pharmacists, laboratory personnel, autopsy,
  students, trainees, contract staff, persons
  potentially exposed to infectious agents that can
  be transmitted to and from HCP.
• Settings include hospitals, nursing homes,
  skilled nursing facilities, physicians offices,
  urgent care centers, outpatient clinics, home
  healthcare, and emergency medical services

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Overview

• Nosocomial influenza epidemiology
• Health-care personnel influenza vaccine coverage
• Strategies to improve health-care personnel
  vaccination

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Nosocomial Influenza

• Transmission that occurs in a health-care setting
• Can result from under-vaccination of health-care
  personnel

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Nosocomial Influenza

• In a tertiary care facility 1987-2000
• Staff influenza vaccination coverage
• 4 gtgtgt 67
• Staff influenza disease
• 42 gtgtgt 9
• Nosocomial Disease
• 32 gtgtgt 0 cases

• Salgado CD, Infection Control Hospital
  Epidemiology, 2004

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Influenza in Nursing Homes

• Influenza Attack Rates
• 25-60
• Case-fatality 10-20

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Influenza in Nursing Homes

• Randomized control study
• Staff vaccination led to an 43 decrease in ILI
• 44 decrease in mortality

• Potter J, et. Al. J Infect Dis. 1997

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Nosocomial Influenza

• Health-care personnel can be infected by their
  patients
• Prospective study vaccinated health-care
  personnel
• 30 fewer ILI
• 63 fewer illnesses with fever and cough

• Wilde, JA, JAMA 1999

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• Prepared by Michele L. Pearson, MD1 Carolyn B.
  Bridges, MD2 Scott A. Harper, MD3

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Health-care Personnel Vaccination Coverage

• In the 2006 National Health Interview Survey,
  only 42 of HCP reported receiving influenza
  vaccine in the previous 12 months

• MMWR 2007, 56(RR-6) 1-54

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Health-care Personnel Vaccination Strategies

• Education/campaigns
• Vaccination of role models
• Improving vaccine access
• Measurement and feedback
• Legislation and regulation

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Influenza Vaccination Barriers Amenable to
Education

• Fear of side effects
• Perceived ineffectiveness
• Perception of low risk
• Fear of needles

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Inactivated Influenza Vaccine (TIV) Adverse
Reactions

• Local reactions 15-20
• Fever, malaise not common
• Allergic reactions rare

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Live Attenuated Influenza Vaccine (LAIV) Adverse
Reactions

• Children
• Increased risk of asthma or reactive airways
  disease in children 12-59 months of age
• Adults
• Increased rate of cough, runny nose, nasal
  congestion, sore throat, and chills reported
  among vaccine recipients

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• TIV contains only noninfectious fragments of
  influenza virus
• LAIV cannot replicate in the lower respiratory
  track
• Neither vaccine can cause influenza disease

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TIV Efficacy

• 70 - 90 effective among healthy persons younger
  than 65 years of age
• 30 - 40 effective among elderly persons
• 50 - 60 effective in preventing hospitalization
• 80 effective in preventing death

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LAIV Efficacy

• 85 effective following experimental challenge
• Effective against complications of influenza
• Children otitis media 27 effective
• Adults febrile respiratory illness 27

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Influenza Disease Risk Perception

• HCP influenza infection rates
• Sero-surveys 23
• Placebo recipients 13
• Cross-sectional surveys (ILI) 37

• Wilde JA, et. Al. JAMA 1999
• Lester RT, et. Al. Infect Control Hosp Epidemiol
  2003

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Improving Influenza Vaccine Access

• Clinics
• Conferences
• Mobile Carts

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Measurement and Feedback

• Posting vaccination rates in selected areas of
  the hospital
• HICPAC recommends influenza vaccination rates as
  a quality-measure

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Legislation and Regulation

• Official health agencies should take necessary
  steps, including, when appropriate, developing
  and enforcing child care and school vaccination
  requirements, to ensure that students at all
  grade levels (including college) and children in
  day care centers are protected against
  vaccine-preventable diseases

• Centers for Disease Control and Prevention.
  General Recommendations on Immunization. MMWR
  200655(No. RR-15)38.