Training Module Influenza Vaccination

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Training Module Influenza Vaccination

• 2006 2007

What you need to know to provide influenza
vaccination in your health care setting or
community.
Developed by Suzanne Wowk and Donna Klutz
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Please visit the East Central Health Intranet for
important resources

• All individuals providing influenza vaccination
  are to be familiar with the ECH Guideline
  (CDC-05-40/IPC-05-30) Influenza Immunization
  Program
• You are also encouraged to review other client
  and professional resources available on the ECH
  Intranet
• If you do not have access to the ECH Intranet, a
  paper copy of these resources can be accessed
  through your local Public Health Nurse.

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Influenza The Flu

• Influenza known more commonly as the flu is a
  highly contagious, acute viral infection that can
  cause severe illness and death.
• Severe complications are often due to pneumonia
  or secondary infections.

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Symptoms of Influenza

• Symptoms include fever, headache, general
  aches/pains, fatigue and weakness, runny/stuffy
  nose, sneezing, sore throat, chest discomfort and
  cough it can truly feel like youve been run
  over by a Mac Truck!

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Comparing Influenza and Cold Symptoms
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Statistics

• In Canada
• 10 25 of population is infected
• 500-1500 deaths annually
• 45.6 of lab confirmed influenza infections were
  reported in children lt 15 years of age
• Of the influenza-related hospitalizations
  occurring in the 2005-2006 season, 40 were
  children lt 2 years of age.

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How Is Influenza Spread?
Person to person by direct contact Air Viruses
can travel 1-2 metres in the air
from coughing, sneezing and
talking, and
enter the body through the eyes, nose and
mouth. Contaminated surfaces The virus can
live on hard surfaces for 1-2 days, on cloth,
tissue and paper for 8 12 hours and on hands
for 5 minutes. The virus may remain infective
for up to 48 hours
on a smooth surface.
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Infectivity

• Adults may spread influenza to others during a
  period ranging from 1 day before to 7 days after
  the onset of symptoms.
• Infected children may be contagious for a longer
  time period than adults.
• 2006 CCDR NACI, 15 June 2006 pg 2

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adapted from Standard Ed (2002)
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How Do We Protect Ourselves Others Against
Influenza?

• The most effective way to reduce the impact of
  influenza
• VACCINATION!

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NACI Statement

• The National Advisory Committee on
  Immunization recommends an annual flu vaccination
  for
• All persons at high risk of developing
  complications of influenza
• Those who are capable of transmitting influenza
  to those at high risk

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Vaccine is offered at no charge to those at high
risk for influenza-related complications,
including

• Continuing Care, facility and lodge residents
• People 65 years and older
• Anyone with chronic lung or heart disorders
  requiring medical care
• Those with conditions that may affect the immune
  system
• People at increased risk of aspiration.
• Anyone with chronic conditions requiring medical
  care diabetes, cancer, renal disease,
  immunodeficiency, metabolic disease,
  immunosuppression, hemoglobinopathy, HIV
  positive.
• Children 6 months to 23 months old
• Age 6 months 18 years taking ASA for long
  periods.
• People living in chronically disadvantaged
  situations.

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Influenza Vaccine is offered at no charge to
people who can transmit Influenza to those At
Risk

• Health Care Workers
• Ambulance Staff
• Facility Support Staff
• Volunteers
• Clergy
• Household contacts
• Pregnant women in their third trimester
• Regular child care providers for children less
  than 24 months old

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Health Care Workers Influenza
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First do no harm

• Protect your patients/clients/residents by making
  sure staff receive the yearly influenza vaccine!
• Health Care Workers who are not immunized can be
  a danger to the health of those who are entrusted
  to their care.
• CCDR NACI 15 June 2006 p. 16 The advice of
• a health care provider is a very important
• factor affecting whether a person
• accepts immunization.

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Never Sick?

• 59 of health care workers tested had evidence
  of recent influenza infection but could not
  recall having symptoms.
• ( CCDR NACI 15 June 2005 pg. 14
  British Study)

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Health Care Workers

• Many people may experience influenza infection
  with no symptoms, and may then unintentionally
  pass the disease on to others.
• This information has huge implications for
  healthcare workers. I never get sick reason
  for not getting immunized is not accurate for the
  infectivity that may occur with clients and other
  staffunintentionally.
• It is also important for visitors of those at
  risk, such as lodge/nursing home residents.
• CCDR NACI 15 June 2005 pg. 17, British Study

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2006 - 2007 Influenza Vaccine

• Type A New Caledonia
• Type A Wisconsin
• Type B Malaysia

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Informed Consent

• Verbal and/or written information must
• be provided regarding
• ?Benefits and risk of vaccine
• ?Possible adverse reactions

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Informed Consent for Immunization

• Each vaccine provider is responsible for ensuring
  informed consent is received prior to vaccine
  delivery.
• Refer to your facility guidelines for current
  direction on consent for treatment/service.

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Administration - Adult

• Site Deltoid Muscle
• Influenza vaccine is provided in the deltoid
  muscle for adults. There have been requests for
  the vaccine to be administered elsewhere but the
  vaccine insert recommends the deltoid site.

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Administration - Adult

• Vaccine providers should be familiar with the
  vaccine insert which outlines administration
  procedures.
• Route Deep IM Deltoid Muscle
• Needle 25 g, 1 1 ½
• Dosage 0.5 ml

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Administration - Child

• Site Deltoid Muscle (gt 12 months)
• Vastus Lateralis Muscle (lt
  12 months)
• Route Deep IM
• Needle
• 25 g, 5/8 1

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Hemorrhage Risk

• If there is a risk of hemorrhage
• Immunization should be carried out using a fine
  gauge needle of appropriate length, followed by
  application of firm pressure, without rubbing, to
  the injection site for at least 5 minutes
• (Alberta Immunization Manual p. 24)
• The vaccine provider needs to assess for the use
  of anticoagulant therapy and whether client
  bruises easily.
• Provide aftercare advice especially if bleeding
  is noted after the client leaves the
  administration area.

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Contraindications to Influenza Vaccination

• Influenza Vaccine should not be administered to
• People less than 6 months of age
• People with an allergy to any component of the
  vaccine
• Those with previous allergic reaction to
  influenza vaccine
• People with an anaphylactic hypersensitivity to
  eggs or chicken, manifested as hives, swelling of
  the mouth and throat, difficulty breathing,
  hypotension and shock.
• Vaccine may be deferred until later in the
  following situations.
• For individuals with a newly diagnosed or
  unstable neurological disorder, discussion with,
  or information from the physician is recommended
  prior to immunizing.
• Those with serious acute febrile illness usually
  should not be vaccinated until symptoms have
  abated.
• People who are receiving cancer treatments should
  speak with their doctor to determine when the
  influenza vaccine should be given.
• Vaccine can safely be given to the following
  individuals
• Those with mild acute illness, with or without
  fever.
• Individuals who are recovering from illness or
  are taking antibiotics.

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Pregnancy Breastfeeding

• Influenza vaccine is safe for pregnant women at
  all stages of pregnancy and for breastfeeding
  mothers. (CCDR NACI 15 June 2005 pg. 9)

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Anaphylaxis

• Extremely severe and life threatening form of
  allergic reaction
• Usually occurs within 1 to 15 minutes
• Involves more than one body system, such as skin,
  respiratory, gastrointestinal
• Advise all clients to wait/ observe client
• for 15 minutes after vaccination

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Recognition Treatment

• The vaccine provider must be able to identify
  allergic reactions and anaphylaxis, and to know
  how to respond appropriately.
• Refer to your sites protocols
  for such an event.

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Faint

• Similar to anaphylactic responses, but do not
  progress to shock
• Sudden pale skin
• Loss of consciousness
• Collapse
• Possible brief clonic seizure activity

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Reactions

• Most people have NO reaction!
• Redness, swelling or soreness at the injection
  site for up to 2 days
• Fever, feeling unwell, headache muscle pains
  starting 6-12 hours after the injection, lasting
  1-2 days

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Adverse Reactions

• REPORT unusual reactions to a Public Health
  Nurse, such as
• Severe pain and/or swelling
• Rash
• Oculorespiratory Syndrome (ORS)

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Guillian-Barre Syndrome

• GBS risk following influenza immunization is
  approximately 1 case per 1,000,000 doses
• It is not known whether influenza vaccine is
  associated with an increased risk of recurrent
  GBS in those with a previous history of GBS
• Avoid vaccinating people with a known history
  of GBS, or who have developed GBS within 8 weeks
  of a previous influenza vaccination.
• NACI 2006 pg. 14

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Oculorespiratory SyndromeORS

• Background In 2000/2001, Health Canada received
  an increased number of vaccine-associated
  symptoms and signs subsequently described as
  Oculorespiratory Syndrome (ORS).
• Symptoms included the onset of bilateral red
  eyes and/or respiratory symptoms (cough, wheeze,
  chest tightness, difficulty breathing, difficulty
  swallowing, hoarseness or sore throat) and/or
  facial swelling occurring within 24 hours of
  influenza immunization.

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ORS and Influenza Vaccination

• Vaccinate individuals who previously experienced
  mild to moderate ORS symptoms , with no lower
  respiratory symptoms.
• For individuals who previously experienced severe
  ORS that included lower respiratory symptoms
  within 24 hours of receiving the influenza
  vaccine (e.g. wheezing, chest tightness,
  difficulty breathing), the Medical Officer of
  Health should be consulted to review the risks
  and benefits of further influenza vaccination.
• Individuals who experienced severe difficulty
  swallowing or other severe symptoms not included
  in the ORS case definition (I.e. severe throat
  constriction) should be reported through the
  Alberta Adverse Event Reporting process contact
  a Public Health Nurse.

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Vaccine Storage Temperature

• Please Refer to your facility guidelines on
  vaccine storage and handling.
• As a brief overview
• Vaccine should be placed on the middle shelves of
  the fridge.
• Store vaccine between 2 and 8 degrees Celsius at
  all times.
• Monitor and record fridge temperatures daily
• Be sure not to freeze the vaccine

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Vaccine Transport

• Use insulated containers with temperature
  monitoring device and appropriate cooling agents
• Avoid vehicle trunks, heaters, air conditioning
  vents, and direct sunlight
• Keep vaccine in insulated bags

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Removing Vaccine from Fridge

• Vaccine should only be removed from the fridge or
  insulated bags during drawing up of vaccine for
  immediate administration, and then immediately
  returned to the fridge or insulated bag.
• When drawing up, use the following guidelines
• Groups of people remove only one vial from the
• fridge and carry in insulated cooler bag
• Draw up vaccine immediately prior to
• administration. Do not pre-draw multiple
• syringes of vaccine ahead of time.

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Packing Cooler Bag

• Remove frozen ice pack from freezer and allow it
  to sweat for 15 minutes at room temperature.
• Place ice pack in cooler bag and cover with a
  face cloth or single layer of bubble wrap so
  vaccine is not in direct contact with the ice
  pack (it may FREEZE).
• Place vaccine on top of towel/bubble wrap.

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Cold Chain Break

• A Cold Chain break has occurred if vaccine is
  found outside 2-8 degrees Celsius
• If this occurs, Label it Cold Chain Break. Do
  not use the vaccine, but continue to store it in
  the fridge between 2 8 degrees.
• Please then consult with a Public Health Nurse
  before using any of the affected product.

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Minimize Wastage

• Write the date on vials when they are first
  opened. Use Fluviral vaccine within 30 days, and
  Vaxigrip within 7 days.
• Communicate use of near expiry vials to other
  staff members, so the vaccine can be used before
  it expires.
• Maintain cold chain at all times.

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Do Not Use Vaccine If . . .

• It is involved in a cold chain break
• Vaccine is discolored, or extraneous particulate
  matter is present
• The vial is defective.

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Data Collection

• Complete an Immunization Data Record for each
• person immunized.
• Submit completed forms to Public Health by fax or
  
• mail.
• Include the vaccination reason code start at
  the top of the reason code list, and
  choose the first code that applies (i.e. if
  the client is a health care worker,
  and has asthma, choose health
  care worker because it is higher on the list)

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Questions
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Can the Flu Shot Give Me the Flu?

• Influenza vaccination cannot cause influenza
  because the vaccine does not contain live virus.

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I Received the Flu Shot Last Year Got the
Flu. Is that Possible?

• Yes.
• The influenza vaccine provides protection against
  3 specific influenza viruses. Those vaccinated
  are not protected against other viruses and
  bacteria.
• The vaccine is about 70 to 90 effective. If
  immunized individuals become infected with
  influenza, the illness if usually much less
  severe.

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Do clergy qualify?

• Yes!
• If they regularly visit people in acute or
  continuing care facilities.

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Do EMS qualify?

• Yes!
• Only if they share a confined air space and work
  closely with high risk individuals

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Do dental staff qualify for free vaccine?

• Yes
• All individuals who work in community settings
  where health care is provided and are either
• employees/employers/volunteers, or
• Students who will have practical experience
• And
• Will be working within one meter of a high risk
  person on a regular basis for 2 or more days
  per week, for 6 hours or more per day (with or
  without protective equipment).
• Note This is a change from previous years.

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Do firefighters police officers qualify?

• No!
• They provide essential services but do not
  qualify for free vaccine.
• These individuals may purchase vaccine

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Should I Get an Influenza Shot Every Year?

• YES!
• A new vaccine is developed every year, which
  includes protection against the 3 strains of
  influenza virus that are predicted to be
  circulating in the coming influenza season.
• Protection lasts for about 6 months

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How Effective Is the Vaccine in Preventing
Influenza?

• 70-90 effective

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Self Care

• If you are ill, stay home from work so you do not
  spread illness to others. Children who are ill
  should stay home from school and daycare.
• Cover your cough with a tissue, or cough or
  sneeze into your upper sleeve, not your hands.
• Stay well. Exercise, drink plenty of water, eat
  well and do not smoke.
• Avoid crowds when flu season hits your area.
• Get the influenza vaccine every fall

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Wash your hands often!
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Conclusion

• You have a key role in reducing influenza this
  season!
• Immunizations against influenza promote health
• Contact a Public Health Nurse if you have any
  questions.

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Where To Find Credible Information

• Health Canada
• http//www.hc-sc.gc.ca
• Centers of Disease Control
• Canadian Pediatric Society
• Canadian Immunization Awareness Program
• http//www.immunize.cpha.ca
• Health Link 1-866-408-5465