Healthcare worker influenza immunization-San Diego

2006-2007 national HCW influenza vaccine coverage rate 44%

Significant effort by Occupational Health and Infection Control groups in recent years to maximize influenza vaccination

SB 739 and declination statements SDHIIP project H1N1!

0%

25%

50%

75%

100%

MD/AdvancedPt. Care

Nursing/NursingAsst.

Allied Health Non-HCSupportServices

Administrative

2006 2007 2008

Percent of hospital-based respondents vaccinated 06-08 by job category. The sample size for each category is too small to detect significant

difference.

Source: 2006, 2007 & 2008 RDD HCW Telephone Survey

n = 509 (2006)

n = 533 (2007)

n= 192 (2008)

Job categories recoded from self-reported job description, coding varied slightly between 3 years

S:\PHS\Immun\Evaluation\RDD2008\HCW_ADULT 2008\Presentations\2008 RDD Highlights for Eval.ppt

Influenza Coverage Rates RDD Telephone Surveys 2005, 2008, and 2009

12%

21%

26.3%

31%

47%50.8%

13%

25%29.8% 31%

44%48.7%

72%72%76.5%

61% 61%

55.3%

0%

20%

40%

60%

80%

Per

cen

t U

TD

18-49 Healthy 18-64 High RiskCondition

18-49 HouseholdContact Only

50-64 65+ HCW

2005 2008 2009

(n for each category on next slide)

HCW shows 2007 coverage rate instead of 2005

HCWs not excluded from other categories

S:\PHS\Immun\Evaluation\Results\Adults and Seniors\Highlights in PowerPoint Presentations\2009\Adult Influenza RDD Survey Results 2009.ppt

National HCW flu coverage rates

MMWR 2010;59(12):357-62

San Diego HCW Influenza VaccineRDD Survey 2006-2008 – All HCWs

Received Influenza vaccine last year 70% Have never received flu vaccine 19.8% Reasons why not

Not in priority group 41.7%Vaccine side effects 16.7%Vaccine doesn’t work 13.2%I never get sick

Rationale for Mandatory Infuenza Immunization for Healthcare Workers

There is precedent for requiring immunizations for employment in healthcare settings (measles, varicella, hepatitis B)

Multiple studies implicate healthcare workers in the transmission of influenza to patients

Maximum efforts over many years to reach the goal that >90% of HCW be immunized for influenza have failed

People are infectious before they have symptoms so steps to avoid transmission come too late

BJC Healthcare/Washington University experience

Large system with 11 acute care hospitals Mandated influenza vaccination and made it a

condition of employment in 2008 Medical and religious exemptions allowed In 2009 25,561/25,980 (98.4%) employees

vaccinated 321 medical exemptions 90 religious exemptions

Babcock et al, Clin Infect Dis 2010; 50:459-64

BJC Healthcare/Washington University experience

Babcock et al, Clin Infect Dis 2010; 50:459-64

Hospitals with Mandatory Influenza Policies

Virginia Mason Health System, 2004 UC Davis Medical Center, 2009 University of Iowa Medical Center, 2009 BJC Healthcare/Washington University, St. Louis 2008 U Penn/CHOP 2009 All New York State Hospitals and long-term care

facilities, 2009 Naval Medical Center San Diego (Civilians) 2009 UCSD Medical Center, Rady Children’s Hospital San

Diego 2009