Protecting Your Patients From Influenza

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Protecting Your Patients From Influenza

• Immunization Program
• New York State Department of Health (NYSDOH)
• 2007

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Immunization of Health Care Personnel (HCP)

• The Problem-The Impact of Influenza
• The Role of Health Care Personnel (HCP)
• The Importance of Immunization
• National Recommendations
• Current New York State (NYS) Status
• Immunizing in Health Care Facilities

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Influenza-the Problem

• Influenza is a highly infectious viral illness
• Also known as The Flu
• Influenza can be a serious illness associated
  with significant complications which can lead to
  hospitalization and death

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Influenza Virus

• 3 types of influenza virus A,B,C
• Type A and B are the ones that affect humans
• Virus mutates and changes every year to create
  different strains
• These changes are called antigenic drifts and
  shifts
• Different strains have different effects re
  severity of influenza illness produced

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Influenza Virus
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2007-2008 Influenza Vaccine

• A/Wisconsin/67/2005 (H3N2)-like virus
• A/Solomon Islands/3/2006 (H1N1) like virus
• B/Malaysia/2506/2004-like virus.

new
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Influenza Epidemiology

• Highly contagious respiratory disease transmitted
  by droplets.
• Individuals are contagious for 1-4 days before
  the onset of symptoms and approx. 5 days after
  first symptoms.
• Approximately 30-50 of infected people are
  asymptomatic or have mild disease.

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Influenza Occurrence

• Occurs throughout the world
• Peaks from December to March in temperate
  climates such as in North America
• Can occur as early as the beginning of November
  and as late as the end of April
• In the southern hemisphere flu occurs primarily
  in their winter (our summer)

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Month of Peak Influenza Activity United States,
1976-2002
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Influenza Complications

• Pneumonia
• primary influenza
• secondary bacterial
• Worsening of chronic conditions
• Myocarditis
• Death 0.5-1 per 1000 cases

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Influenza Transmission

• Influenza is primarily spread from person to
  person
• Droplets containing the influenza virus are
  released during coughing and sneezing
• Influenza may also be spread through direct
  contact with respiratory secretions (mucous) from
  infected persons.

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Transmission
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Influenza Symptoms

• Classic symptoms come on abruptly
• Fever, usually 101-102 as high as 104
• Chills and sweats
• Body aches muscles and joints
• Dry cough
• Runny nose, sore throat, headache

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Influenza Impact

• Hospitalizations
• Highest rates among adults gt65yo and children
  lt2yo
• During the influenza seasons from 1979-80 through
  2000-01, an average of 226,000 influenza-related
  hospitalizations occurred per year
• 63 of all of these hospitalizations occurred in
  persons gt65yo

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Influenza Impact contd

• Deaths
• Influenza and pneumonia, together, are the 7th
  leading cause of death in the U.S. (2003 death
  certificates)
• The 6th leading cause in persons gt65yo
• During the influenza seasons from 1990-1999, an
  average of 36,000 influenza-related deaths
  occurred per year
• gt90 of influenza-related deaths were among
  persons gt65yo

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Impact on Healthcare Facilities

• Influenza is highly contagious.
• Can spread rapidly through a healthcare facility
• Influenza is transmitted to patients by other
  patients, visitors, and healthcare personnel.
• Patients in healthcare facilities are at high
  risk of complications from influenza due to their
  age and chronic medical conditions.

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Impact on Acute Care

• Influenza has a substantial impact on acute care
  services.
• A CDC survey of hospitals conducted during a peak
  influenza season revealed
• 35 reported staffing shortages
• 28 reported bed shortages
• 43 reported ICU bed shortages
• 9 reported diversion of patients to other
  facilities

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Impact on Long-Term Care

• In nursing homes, an influenza outbreak can cause
  illness in up to 60 of residents.
• Of those who become sick with influenza
• Up to 25 may need to be hospitalized
• Up to 30 may die from influenza-related
  complications

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Economic Impact of Influenza

• Unimmunized HCP spend nearly 50 more in medical
  costs than immunized workers.
• Healthy HCP who receive flu shot have about 44
  few doctor visits
• Current nursing shortage seasonal absenteeism
  contribute to domino effect

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Roll of HCP in Disease Transmission

• HCP are frequently implicated as the source of
  influenza transmission in health care settings
• Employees continue to work while sick with
  influenza
• Unvaccinated workers who are infected but not
  sick can still spread the virus
• Up to ¼ of HCP contract influenza during the
  winter

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HCP Role in Transmission contd

• Up to half of individuals who become infected
  with the influenza virus never develop symptoms
• But they can still transmit influenza to others

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Influenza Prevention

• Influenza vaccination is the primary means to
  prevent influenza, its transmission, and
  associated complications.

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Vaccination of Healthcare Personnel

• Healthy healthcare personnel who receive
  influenza vaccine have
• Fewer upper respiratory infections
• Fewer health care visits
• Fewer sick days
• Less use of medication
• Lower total health care costs (i.e., save money)

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Vaccination of Healthcare Personnel contd

• Vaccination of healthcare personnel has been
  shown to
• Decrease transmission of influenza in healthcare
  facilities
• Healthcare facilities with higher rates of
  influenza vaccination among their staff have been
  shown to have lower rates of influenza in their
  patients
• Decrease the risk of complications and deaths
  related to influenza among patients at those
  facilities

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Influenza Vaccine

• Given once a year in the fall (October November)
  but can be given as late as March.

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Types of Influenza Vaccine

• Killed (inactivated)
• Intramuscular injection
• The flu shot
• Live, but attenuated influenza vaccine (LAIV),
  weakened so that it cannot multiply
• Intranasal spray
• FluMist

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Inactivated Influenza Vaccine Efficacy

• Depends of vaccine match, age, and health status
• 70-90 effective among healthy persons lt65 years
  of age
• 30-40 effective among frail elderly persons
• 50-60 effective in preventing hospitalization
• 80 effective in preventing death

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LAIV Efficacy in Healthy Adults

• 20 fewer severe febrile illness episodes
• 24 fewer febrile upper respiratory illness
  episodes
• 27 fewer lost work days due to febrile upper
  respiratory illness
• 18-37 fewer days of healthcare provider visits
  due to febrile illness
• 41-45 fewer days of antibiotic use

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Inactivated Vaccine Safety (Injection)

• Inactivated influenza vaccine injection
• The flu shot
• Contains noninfectious killed viruses
• LAIV has never been transmitted to a patient in a
  health care setting
• LAIV should not be used by those working with
  severely immunocompromised patients such as those
  is a bone marrow transplant unit

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Influenza Vaccine Injection Adverse Reactions

• Local reactions 15-20
• Generalized reactions not common
• Allergic reactions rare
• Neurological reactions very rare

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• A flu shot cannot cause the flu!

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Why might you get sick after a flu shot?

• It takes two weeks for the vaccine to become
  protective
• Flu shots are given during flu season
• It is possible to be infected with influenza
  virus after vaccination
• Therefore, people can develop influenza disease
  after being vaccinated
• Other microbes besides influenza cause
  influenza-like illness

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Influenza Intranasal Spray (FluMist, LAIV)

• Recommended for healthy children, adolescents and
  adults 2-49 years old.
• Avoid if in close contact with severely
  immunosuppressed persons for 7 days after
  vaccination.
• Separate VIS available.

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Live Vaccine Safety(Intranasal Spray)

• Live influenza vaccine is contraindicated in
• Anyone with a chronic medical condition
• Immunocompromised individuals
• Pregnant women

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Influenza VaccineContraindications and
Precautions-TIV and LAIV

• Severe allergic reaction to a vaccine component
  (including egg) or following a prior dose of
  vaccine
• Moderate or severe acute illness

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Influenza Vaccination of Health-Care Personnel
Recommendations of ACIP and HICPAC-MMWR 2/06

• Strengthened and broadened recommendations for
  influenza vaccination of health-care personnel
  (HCP).
• HICPAC and ACIP recommend that all HCP be
  vaccinated annually against influenza.
• Facilities that employ health HCP are strongly
  encouraged to provide vaccine to their staff by
  using evidence-based approaches that maximize
  vaccination rates.
• HCP all paid and unpaid persons working in
  health care settings who have the potential for
  exposure to infectious materials

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Definition of Health Care Personnel and Facility

• Those with direct patient care MDs, RNs, nursing
  assistants, therapists, technicians, emergency
  personnel, dental personnel, pharmacists, lab
  personnel, autopsy personnel, students, trainees,
  volunteers,
• Those not directly involved with patient care
  but potentially exposed to infectious agents
  that can be transmitted to and from HCP. Such as
  clerical, dietary, housekeeping, and maintenance
  staff.
• Facilities include acute care hospitals, nursing
  homes, skilled nursing facilities, physicians
  offices, urgent care centers, and outpatient
  clinics, and to persons who provide home health
  care and emergency medical services.

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Summary of Recommendations

• Educate HCP regarding the benefits of influenza
  vaccination, the potential health consequences of
  influenza illness, influenza disease
  epidemiology, modes of transmission, diagnosis,
  treatment, infections control etc.
• Offer influenza vaccine annually to all eligible
  HCP
• Provide influenza vaccine at the work site and at
  no cost
• Use strategies that have been shown to increase
  influenza vaccine rates such as mobile carts,
  access during all work shifts, support by
  leaders, incentives,
• Obtain a signed declination from those HCP who
  decline vaccination for reasons other than
  medical exemption

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Summary Continued

• Monitor HCP influenza vaccination coverage and
  declination at regular intervals during the
  influenza season and provide feedback of ward-,
  unit-, and specialty-specific rates to staff and
  administration.
• Use the level of HCP influenza vaccination
  coverage as one measure of a patient safety
  quality program.

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The Role of Healthcare Personnel in Prevention of
Influenza

• In a 2003 National Health Interview Survey, only
  40 of healthcare personnel reported receiving
  the influenza vaccine in the previous 12 months.

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Average Influenza Rate in HCPs
64 Unvaccinated Key cause of Influenza Outbreaks
in health care settings
36 Vaccinated
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Healthy People 2010 Goal

• 90 of individuals in LTCFs be immunized against
  influenza and pneumococcal disease

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NYSDOH Commissioners Letter

• To health care providers, informing them of the
  standard of care in NYS
• Available on the NYSDOH public website and the
  HIN/HPN

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(NYS)
Median institutional vaccine coverage (
residents vaccinated)
Healthy People 2010 goal 90
Nursing Home (NH) Adult Care Facility
(ACF) Adult Day Health Care Program (ADHC)
Season
Source NYS DOH
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(NYS)
Healthy People 2010 goal 90
Percentage of facilities
Resident Vaccine Coverage
Nursing Home (NH) Adult Care Facility (ACF)
Adult Day Health Care Program (ADHC)
Source NYS DOH
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(NYS)
Healthy People 2010 goal 90
Median institutional vaccine coverage (
residents vaccinated)
Nursing Home (NH) Adult Care Facility (ACF)
Adult Day Health Care Program (ADHC)
Source NYS DOH
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(NYS)
Median institutional vaccine coverage (
employees vaccinated)
Nursing Home (NH) Adult Care Facility
(ACF) Adult Day Health Care Program (ADHC)
Season
Source NYS DOH
49
(NYS)
Median institutional vaccine coverage (
employees vaccinated)
Nursing Home (NH) Adult Care Facility
(ACF) Adult Day Health Care Program (ADHC)
Source NYS DOH
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2007 Anticipated Influenza Vaccine Production
Total Anticipated 130 million doses
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Other Immunizations for Health Care Personnel

• Pneumococcal Vaccine
• Tdap (tetanus, diphtheria, pertussis)
• Hepatitis B
• MMR (measles, mumps, and rubella)
• Varicella (chicken pox)
• And others

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Summary

• Influenza is a serious infection that causes a
  significant number of complications and deaths
• Influenza-infected healthcare personnel can
  transmit the virus to their patients
• Influenza vaccination of healthcare personnel
  reduces the risk of influenza illness and its
  complications among their patients
• Influenza vaccination of healthcare personnel is
  recommended by the Centers for Disease Control
  and Prevention
• Healthcare personnel have an ethical and moral
  duty to protect their patients from serious and
  transmissible diseases
• Adapted from Poland, Tosh Jacobsen (2005).
  Vaccine 232251-2255

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Sources

• Advisory Committee on Immunization Practices
  (ACIP) www.cdc.gov/nip/acip
• Centers for Disease Control and Prevention (CDC)
  www.cdc.gov/nip
• CDC Epidemiology and Prevention of Vaccine
  Preventable Vaccine (Pink Book)
• National Center for Health Statistics

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Sources Continued

• MMWR
• Prevention and Control of Influenza,
  Recommendations of the Advisory Committee on
  Immunization Practices (ACIP) July 28, 2006
  55No. RR-10.
• Influenza Vaccination of Health Care Personnel,
  Recommendations of the Healthcare Infection
  Control Practices Advisory Committee (HICPAC) and
  the ACIP February 24, 2006 55No. RR-2
• NYSDOH Long Term Care Employee Immunization Act
  Report, 2000-2004.