Influenza Immunization

8/6/2019 Influenza Immunization

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Henry H. Bernstein, Jeffrey R. Starke and Committeeon Infectious Diseases

Pediatrics 2010;126;809-815; originally publishedonline Sep 13, 2010;



Health care²associated influenza outbreaks commonand serious public health problem patient morbidityand mortality and creates a financial burden on health

care systems.Annual immunization of health care personnel (HCP)

is a matter of patient safety and necessary tosignificantly reduce health care²associated influenza

infections.



Immunization rates of 80% or higher areessential for providing the ´herd immunityµneeded, but overall immunization rates forHCP remain near 40%.Mandatory programs for all HCP should be

implemented nationwide



� Each year , United States > 36 000 deaths 200000hospitalizations associated with the influenza virus

major public health concern.�

Serious morbidity and mortality can resultfrom influenza infection in any person of any age� Immunization is the most effective way to prevent

influenza outbreaks,



� Many individuals at high risk of influenza andits associated complications close contactwith HCP need to seek inpatient and

outpatient medical service.� immunization of HCP is a critically importantstep for protecting those at risk from healthcare² associated influenza



Advisory Committee on ImmunizationPractices of the Centers for Disease Controland Prevention (CDC) recommend influenza

immunization for HCP in the early 1980simmunization rates for HCP remain near40% prompted the US Department of Healthand Human Services to make increasing HCP

immunization rates to 60%, a part of theirHealthy People 2010 objectives failed



� During the 2009 ²2010 influenza season

recommended vaccines against seasonal influenzastrains and the 2009 pandemic H1N1 influenza Avirus.

� In January 2010, the CDC estimated that the

percentage of HCP receiving influenza vaccine61.9% for seasonal influenza vaccine37.1% for 2009 H1N1 monovalent vaccine

34.7% for both vaccines.



� influenza coverage among US HCP remainsunacceptably low at a rate of 44.4% between2006 and 2007

�

fewer receiving both seasonal and H1N1vaccines during the 2009 ²2010 season.� Voluntary programs have proven to be

ineffective� HCP have misconceptions regarding the risks

and benefits of the vaccines believe thatseasonal influenza vaccine was safe whencompared with the 2009 H1N1 vaccine (80.9%vs 66.6%),



� It is well known that HCP can transmit influenza virus topatients and co workers before the onset of symptoms orduring symptomatic illness.

� In a NICU, 19 of 54 (35%) infants were infected withinfluenza A as a result of health care²associatedtransmission; 6 became ill, and 1 died. Only

15% of staff had received influenza vaccine³67% ofphysicians and 9% of nurses.

14% of the employees reported taking time off from workbecause of illnessthese symptomatic personnel had a role in transmission



� During an outbreak of influenza in a bonemarrow transplant unit 7 cases of healthcare² associated influenza- 6 patients

developed pneumonia, and 2 patients died.� 5 staff members developed influenza-like

illness during the outbreak. Surveys revealeda vaccination rate of 12% among unit staff.

� The hospital implement a multifacetedvoluntary education program 42% of thestaff remained unimmunized the followingyear.



� healthy adults who receive the influenzaimmunization have 25% fewer upperrespiratory infections, 44% fewer physician

visits, and 43% fewer sick days off, saving anaverage of $47 per person annually andhighlighting the cost-effectiveness ofimmunization against influenza.



� The US Supreme Court ruled in 1905 in Jacobson v Massachusetts that states havethe power to enforce immunization

requirements or other public healthinitiatives is constitutionally permissiblewhen the intervention:is a public health necessity;

has proven to be effective;is not ´gratuitously onerous or unfairµ; and

does not pose a health risk to the subject.



� BJC Health care- has26 000 employees,implemented a mandatory influenzaimmunization program in 2008 after

voluntary models failed to increase ratesabove 80%.immunization rate of 98.4% for theorganization of 25 980 employees. Only 8

employees refused to be vaccinated, andtheir employment was terminated.



� Seattle·s Virginia Mason Medical Centerimplemented a mandatory influenzaimmunization program in 2005. The medical

center reported a 99% immunizationcompliance rate among its employees.



� The National Institutes of Health ClinicalCenter passed a mandatory influenzaimmunization policy in 2008.

The policy achieved 100% participation inthat all 2754 employees. Compared withvaccination rates of 40% to 60% fromprevious years, the organization achieved animmunization rate of 88% (2424) amongemployees with patient contact.



� Hospital Corporation of America, whichincludes 163 hospitals, 112 outpatientcenters, and 368 physician practices in 20

states, put a mandatory policy into effect inlate 2009.. Before the policy, vaccinationrates in Hospital Corporation of Americafacilities varied from 20% to 70%.

This mandatory policy offered influenzavaccine to 140 599 HCP; 96% of theseemployees complied.



Three criteria that a public health interventionmust meet to justify mandatory status havebeen proposed.

1. There should be clear medical value fromthe intervention to the individual

2. The public health benefit of themandatory intervention must beclear to

justify the infringement on personalliberties

3. A mandate must be considered the onlyoption



Having full support of health care leadership.

Customizing the plan for each institution; thepolicy must be tailored tothe geographic setting,educational resources, financial assets, localculture, and potential language barriers.

Making vaccine free to all HCP.



Publicizing the program to HCP at all levelsOffering convenient times and locations for

education and immunization administration,

preferably within the institution; vaccinatorsshould adapt to accommodate HCPschedules,



Using a universal form with defined acceptablemedical and religious exemptions, which will bemore effective, concrete, and uniform than

requiring a physician·s note.Creating a clear institutional policy for

management of employees who are exemptedfrom immunization



Voluntary programs have failed to increaseimmunization ratesMandatory influenza immunization programs for HCP

will benefit the health of employees, their patients,and members of the community. The influenzavaccine is safe, effective, and cost-effective.



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Influenza Immunization