Transcript Slide 1

2014-2015 Influenza Season
Health Protection Surveillance Centre &
National Immunisation Office
17-Jul-15
1
17-Jul-15
2

Influenza
◦ Symptoms and burden in general and in HCWs
◦ Risk groups







Vaccine uptake / HCWs in Ireland
Reasons why HCWs decline
Effectiveness in HCWs
Safety of the vaccine
Effectiveness in protecting patients
Strategies to improve uptake
Controversy in relation to influenza systematic
reviews from Cochrane
17-Jul-15
3
•
The flu is an infection that is caused by a flu virus.
There are many different types of flu viruses.
•
The flu affects the lungs, throat, nose, and other parts
of the body.
•
Unlike the common cold, the flu comes on suddenly,
makes you very sick for a week or longer, and you may
end up in hospital.
17-Jul-15
4
Symptoms
Cold
Classic Flu
Fever
Rare , except in very
young children
Usual (≥ 38oC 100.4° F)
lasts 3-4 days, reduced
in elderly
Headache
Rare
Prominent
General aches/ pains
Slight
Often severe
Fatigue/ Weakness
Mild
Sudden onset and can
last up to 3 weeks
Extreme exhaustion
Never
Early and prominent
Stuffy nose
Common
Sometimes
Sneezing
Usual
Sometimes
Sore throat
Common
Sometimes
Cough, Chest discomfort Mild to moderate
Common and can
become severe
17-Jul-15
5

Bacterial superinfections
◦ bacterial pneumonia
◦ croup
◦ respiratory disorders

Decompensation of chronic diseases
◦ pulmonary disease
◦ heart disease
◦ renal insufficiency
◦ metabolic disease
17-Jul-15
6
•
Flu is spread through tiny droplets sprayed into the air
when a sick person coughs, sneezes, or even talks.
•
You can get sick from the droplets if they land in your
nose, eyes, or mouth.
•
You can also get the flu by touching a surface like a
table or a doorknob that has the virus on it, then
touching your mouth or nose.
Courtesy: CDC/ Brian Judd
•
.
17-Jul-15
7
•
Diseases
• Those with chronic medical conditions e.g. Chronic respiratory, cardiac
etc., Diabetes Mellitus, neurological disorders, immunosuppressed
either through disease or treatment including those with asplenia or
splenic dysfunction, morbid obesity-BMI ≥ 40
•
Vulnerable age
• Young children < 5 years
• hospitalisation rates comparable to those aged 50-64
• those under 6 months have highest hospitalisation rate of any age
• > 65 years
• Account for 90% deaths from seasonal flu
•
•
Pregnancy
SAGE WHO background paper on Influenza vaccines and Immunization
17-Jul-15
8
When some people get the flu it may be mild, but for many others it
could be fatal.
•
Death 0.5-1/1000 cases (1/10,000 pop per year). Approximately,
200-500 Irish people will die each year because of flu. In a bad
year this can be up to 1000 people (2008-2009)*
•
•
•
Most of these excess deaths are in the elderly or in those with underlying illness
BUT
Of the 276 people admitted to ICU in Ireland with lab confirmed flu
since 2009, 10-25% each year were healthy people with no underlying
illness and 85% of those admitted to ICU were under 65 years**
*( HPSC Euromomo study – awaiting publication)
** HPSC ICU influenza surveillance
17-Jul-15
9

There was no increase in the risk of myocardial infarction or stroke
in the period after influenza, tetanus, or pneumococcal vaccination.

However, the risks of both events were substantially higher after a
diagnosis of systemic respiratory tract infection (incidence ratio for
myocardial infarction, 4.95; 95 percent confidence interval, 4.43 to
5.53; incidence ratio for stroke, 3.19; 95%CI, 2.81 to 3.62).

Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk
of Myocardial Infarction and Stroke after Acute Infection or Vaccination. N
Engl J Med 2004 Dec 16;351(25):2611-8
17-Jul-15
10
• Case control study of 218 patients with coronary heart disease (CHD)
during the 1997–98 influenza season in the USA
• Efficacy of influenza vaccine in reducing the risk of recurrent
myocardial infarction (MI) in patients with CHD
Correlation between different factors and the
risk of recurrent MI
OR
Correlation
Current hypertension
4.96
++
Hypercholesterolemia
4.08
++
Smoking
3.75
++
Influenza vaccination
0.33
--
Vaccination
associated
with a
reduced risk
of recurrent
MI
Past and current influenza vaccination reduces
the risk of recurrent MI in CHD patients
Naghavi M et al. Circulation 2000; 102: 3039–45.
17-Jul-15
11
Risk
Risk to die within one year due to
1:200
Smoking more than 10 cigarettes/day
1:5000
Influenza
1:8000
Street accident
1:12,000
Leukaemia
1:500,000
Accident on railway
1:10,000,000
Lightning strike
Calman KC. BMJ. 1996;313:799-802.
17-Jul-15
12
100 million people infected every year
in Northern Hemisphere*
1:10 adults
1:3 children
*In North America, Europe, and Japan.
10,000-40,000
deaths in the USA
ESWI. Available at: http//www.eswi.org/library/bulletins/0499-4.html.
CDC. MMWR. 2001;50(RR-04)1-46.
17-Jul-15
13

In a neonatal intensive care unit1
◦ 19/54 infants were infected and one died
◦ 15% of staff were vaccinated against influenza
◦ Only 29% of staff who reported influenza-like illness took time off work

In an organ transplant unit: attack rate 33%2
◦ Each patient was in an individual room and 3/4 had no visitors to account
for the spread
◦ 3/27 (11%) HCWs on the ward had influenza; not vaccinated

In long-term facility3
◦ 65 residents developed influenza
◦ Over half developed pneumonia, 19 hospitalized, 2 died
◦ 10% of HCW were vaccinated
Influenza infection can remain asymptomatic but infectious4
1Cunney
et al. Infect Control Hosp Epidemiol. 2000;21:449–51
S, et al. Transplantation. 2001;72:535–7
3CDC. MMWR 1991;4:129-131
4Elder G, et al. BMJ. 1996;313:1241–2
2Malavaud
17-Jul-15
14
Summary influenza/ILI general outbreaks in health care
facilities/residential institutions by unit type; 2013/2014 flu season
Location
Comm. Hosp/Longstay unit
Hospital
Nursing home
Residential
institution
Total
Total
Total
Total
Total
No. of
number
number Number number lab
outbreaks
ill
hospitalised dead confirmed
21
298
35
13
61
4
37
17
0
10
26
506
47
15
98
7
58
4
0
15
58
899
103
28
184
17-Jul-15
15
Summary influenza/ILI general outbreaks in health care
facilities/residential institutions by HSE area; 2013/2014 flu season
HSE-area
East
Midlands
Midwest
Northeast
Northwest
Southeast
South
West
No. of
Total no. Total no. Total no. Total no. lab Total no. lab
outbreaks
ill
hospitalised dead
confirmed investigated
23
2
4
6
4
7
9
3
58
431
10
41
90
30
154
103
40
899
26
0
23
12
11
11
18
2
103
*Source CIDR data
13
1
0
0
0
6
7
1
28
94
5
13
18
14
26
2
12
184
167
6
4
28
17
43
5
19
289
17-Jul-15
16
Community hospital/Long-stay unit/Residential institution
Hospital
Educational setting
Other outbreak
ILI consultation rate per 100,000 population
30
2010/2011=14
Pandemic=109
200
20
150
15
2012/2013=72
100
10
50
2011/2012=17
5
0
ILI consutlation rate per 100,000 population
Number of ILI/influenza outbreaks
25
250
0
17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17
Summer
2009
2009/2010
Summer
2010
2010/2011
Summer
2011
2011/2012
Summer
2012
2012/2013
Week number & season
* Data for 2013-2014 not available at time of presentation 3/10/2014
17-Jul-15
17
17-Jul-15
18
One serosurvey*
showed 23% of HCW
had serologic
evidence of influenza
virus infection during
a single influenza
season
…the majority had mild
illness
or subclinical infection
*Elder G, et al. BMJ. 1996;313:1241–2.
Kuster SP et al 2011. PLoS ONE 6(10):e26239. doi:10.1371/journal.pone.0026239
17-Jul-15
19
1.
2.
Stay home from work when you feel sick.
Wash your hands or use hand sanitisers, sneeze in your
sleeve or a tissue.
But this is not enough……
•
People can still spread the flu even when they DON’T feel sick.
 Up to 50% of infected people don’t have symptoms when they are infected.
 People can spread flu germs before they feel sick.
•
Flu is also spread through tiny droplets spread into the air when
people cough or sneeze.
•
The best protection is
VACCINATION.
17-Jul-15
20
YOU can help protect your family, friends,
patients, and yourself from the flu.
17-Jul-15
21
YES.
•
When you get the flu it may be mild, but for those at
high risk it could be fatal.
• Patients.
• Family Members and Friends.
•
Getting the flu vaccine helps to protect the people
you work so hard to keep healthy.
17-Jul-15
22

Recommended annually since 1999*
◦ Increased risk of exposure
 Reduce staff illness and absenteeism
◦ Known to spread from workers to patients
 Vital to care of high risk patients

Recent emphasis on influenza vaccine to ensure
patient safety and as quality measure for
organisations
*RCPI National Immunisation Guidelines for Ireland. (editions 1999/2202/2008/2013)
HCWs: all staff (including ancillary staff, such as cleaners, porters, kitchen
staff) working in health care setting or health related activities in acute and
non acute health care settings, including those working in health related
activities in the community settings
17-Jul-15
23





This year’s (2014-2015) seasonal
flu vaccine contains 3 strains of flu
viruses as recommended by the
World Health Organization (WHO)
as the strains most likely to be
circulating this season. The three
strains are
an A/California/7/2009
(H1N1)pdm09-like virus
an A/Texas/50/2012 (H3N2)-like
virus
a B/Massachusetts/2/2012-like
virus.
This vaccine is an inactivated split
virion vaccine, does not contain
any adjuvant. It does not contain
thiomerosal.






Is there anyone who cannot get
flu vaccine?
Most people can get flu vaccine.
It is not recommended for those
who have:
a history of anaphylaxis
following a previous dose of flu
vaccine or any part of the
vaccine.
What about people with egg
allergy?
People with egg allergy can get
seasonal flu vaccine. This may be
given by your occupational health
unit or GP or you may need
referral to a hospital specialist.
See RCPI NIAC guidelines
17-Jul-15
24

Member States are recommended
◦ To achieve vaccination coverage in older age groups
and risk groups of individuals suffering from chronic
diseases and conditions
 75% by the winter season of 2014/2015
◦ To mitigate the impact of seasonal influenza among
health care workers
17-Jul-15
25


HCWs frequently implicated as the source of influenza
transmission in health care settings

Employees continue to work while sick with influenza

Unvaccinated workers who are not sick can still spread the
virus
Benefits of influenza vaccination of HCWs:

Reduce risk of outbreaks in health care facilities

Decrease staff illness and absenteeism

Reduce costs resulting from loss of productivity
17-Jul-15
26
17-Jul-15
27
100
90
Vaccination coverage (%)
80
70
60
50
40
30
20
10
0
United Kingdom
2008-09
2009-10
2010-11
2011-12
*Health care workers in GPs practice
Source VENICE survey ; http://venice.cineca.org/
17-Jul-15
28
100
90
Vaccination coverage (%)
80
70
60
50
40
30
20
10
0
Residents
Staff
Residents
Portugal*
Residents
Slovakia
2008-09
2009-10
Staff
Ireland
2010-11
Staff
England
2011-12
*Source VENICE survey ; http://venice.cineca.org
17-Jul-15
29
24.4
17.4
18.0
24.2
21.7
18.4
12.5
12.2
19.6
33.6
23.5
20.9
21.9
26.6
30.2
20.0
18.5
20
22.1
21.6
% Uptake
30
25.1
26.6
40
10
0
General
Health & Social Management &
Support Staff
Care
Admin
Professionals
Medical &
Dental
Nursing
Other Patient &
Client Care
All Staff
HSE Staff Category
2011-2012
2012-2013
2013-2014
Note: numbers of hospitals participating varied by season,
2011-2012 (n= 41), 2012-2013 (n=35) and 2013-2014 (n=46)
17-Jul-15
*HPSC;http://www.hpsc.ie/A-Z/Respiratory/Influenza/SeasonalInfluenza/Vaccination/
30
10
17.4
15.6
10.7
11.3
10.1
18.0
24.4
27.8
17.7
22.0
9.2
20
19.7
% Staff Uptake
30
25.5
26.3
35.2
40
0
DML
DNE
South
West
All Regions
HSE Region
2011-2012
2012-2013
2013-2014
Note: numbers of hospitals participating varied by season,
2011-2012 (n= 41), 2012-2013 (n=35) and 2013-2014 (n=46)
17-Jul-15
*HPSC;http://www.hpsc.ie/A-Z/Respiratory/Influenza/SeasonalInfluenza/Vaccination/
31
Reason for non-vaccination
Other reason
8
Problems with awareness / access
10
Problems with Vaccine / Injection /
Side-effects
13
I don’t need it
35
I don’t get the flu/rarely sick
21
Only good for elderly people
14
Perceived low risk
70
0
10 20 30 40 50 60 70 80
Percentage (%)
Mereckiene J et al. Euro Surveill. 2007;12(12).
17-Jul-15
33
YES!
Systematic reviews have shown that flu
vaccine has reduced the flu incidence rate
from 18.7 % in unvaccinated HCWs to 6.5%
in vaccinated HCWs
Kuster SP et al. Incidence of Influenza in Health adults and Health
Care Workers: A systematic review and Meta –Analysis 2011
PLoS ONE 6(10):e26239. doi:10.1371/journal.pone.0026239
17-Jul-15
34





Closeness of the match between the vaccine strain and
the circulating virus
Age of vaccinee: older people do not respond as well
Health of the vaccinee: people with chronic illnesses and
immune system disorders do not respond as well as
healthy individuals
Number of vaccinations: in children under 9 two doses
are required in the first year of use
Type of vaccine used ; adjuvanted vaccines can give
better immune response
17-Jul-15
35


Effectiveness dependent on match with
circulating virus
Seasonal
◦ Vaccine closely matched to circulating strain
 73% effective in healthy adults <65 years of age against
influenza symptoms, whereas 44% when not well matched
 Jefferson T et al Vaccines for preventing influenza in healthy
adults Cochrane Database Syst Rev 2010:CD001269
Pooled efficacy results of 59% in adults aged 18-65

◦
Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza
.
vaccines: a systematic review and meta‐analysis. Lancet Infect Dis. Jan 2012;12(1):36‐44
17-Jul-15
36
YES! The flu vaccine is very safe.
The benefits far
outweigh any possible side effects.
•
Some people may have redness and soreness where they received
the vaccine
•
Serious side effects are rare.
• Guillain Barré recent studies show reduced after vaccine but increased after
influenza
• Narcolepsy has not been linked to seasonal flu vaccine
17-Jul-15
37
◦ It cannot cause flu
 influenza viruses in vaccine are inactivated (killed) during
manufacturing process
 cannot cause infection
 batches of vaccine are tested to ensure safety
 Randomised placebo (saline *, vaccine diluent**) controlled
studies have demonstrated safety
 only differences in symptoms between vaccinated and nonvaccinated was increased soreness in the arm and redness at
the injection site
 no differences in terms of body aches, fever, cough, runny nose
or sore throat.
*Carolyn Bridges et al. (2000). JAMA. 284(13):1655–1663.
**Kristin Nichol et al. (1995). NEJM. 333(14): 889-893.
17-Jul-15
38

Most common side effect of seasonal flu vaccine
◦ soreness at injection site, usually < 2 days

Rare symptoms
◦ fever, muscle pain, and feelings of discomfort or
weakness
◦ usually begin soon after vaccination and last 1-2 days

Frequency




◦
local reactions
Fever, malaise
Allergic reactions
Neurological reactions
15-20% recipients
not common, resolve
rare
very rare
17-Jul-15
39
17-Jul-15
SYMPTOMS
VACCINE
PLACEBO
Rhinitis
44.8%
45%
Sore throat
28.3
28.7
Cough
46.1
45.7
Headache
39.6
37.8
Myalgia
25.1
20.8
Chills
12.2
11.1
Fever
5.1
5.0
Fatigue
27.9
28.6
40
 a rare neurological disease that causes temporary
weakness or paralysis of the muscles
 Frequently preceded by a viral or bacterial illness
(campylobacter)

In the literature
◦ 1976 influenza vaccine associated with increased risk –
vaccine was discontinued
◦ Since then no clear association between GBS and
influenza vaccines
◦ If risk exists, estimated at ~ 1 - 2 cases per million people
vaccinated
◦ Risk of GBS after vaccination is lower than the risk of
GBS after influenza
Stowe J et al. Am J Epidemiol 2009;169:382-8
17-Jul-15
41
17-Jul-15
42
YES !
Many studies have shown that increasing the
vaccination rates of HCWs decreases patient illness
and death.
40% reduction
One study showed a
of
influenza related deaths in hospitals with higher rates
of HCP influenza vaccination.
Carman WF GD, et al. Lancet 2000;355:93–7.
17-Jul-15
43



Monitored for 12 years
(‘87-99)
Coverage rate increased
from 4% to 67%
Lab confirmed cases-staff
◦ Dropped from 42% (199093) to 9% (1997-2000)

Nosocomial cases
among hospitalized
patients
◦ Decreased 32% to 0
(p<0.0001)
Salgado et al. Infect Control Hosp Epidemiol 2004;25:923-928
17-Jul-15
44
Most reported trials in nursing homes
 Studies of staff vaccination have shown decrease
mortality of residents 1, 2
 One cluster randomised clinical trial3 with 44 nursing
homes’ residents
 When staff offered vaccine (48% coverage) vs. not
offered (6% coverage), impact on residents:
◦ Decrease mortality
◦ Decrease in ILI
◦ Decrease in medical visits for ILI
1. Carman WF, et al. Lancet 2000;355:93--7.
2. Potter J, et al. J Infect Dis 1997;175:1--6.
3. Hayward AC, et al.BMJ 2006;333:1241.
17-Jul-15
45
Increased vaccination rates of HCWs working in long-term care geriatric
hospitals have been associated with a reduction in patient mortality
20 long-term care geriatric hospitals in Scotland randomised and
followed for 6 months during the 1996–97 season
(1217 HCWs, 1437 patients)
HCWs
HCWs in
in 10
10 hospitals
hospitals offered
offered
vaccination
vaccination
HCWs
HCWs in
in 10
10 hospitals
hospitals not
not offered
offered
vaccination
vaccination
50%
50% of
of HCWs
HCWs vaccinated
vaccinated
5%
5% of
of HCWs
HCWs vaccinated
vaccinated
749
749 patients
patients monitored
monitored
688 patients monitored
Crude
Crude patient
patient mortality:
mortality: 14%
14%
Crude patient mortality: 22%
Carman WF, et al. Lancet. 2000;355:93–7.
17-Jul-15
46
◦ 1) protects HCW against influenza
◦ 2) provides indirect protection against influenza to the
high-risk patients
◦ 3) reduces absenteeism from work
◦ 4) is cost-effective and probably cost-saving
17-Jul-15
47
17-Jul-15
48



Double blind, randomised, placebo controlled trial*
2 large teaching hospitals over 3 years
Vaccinated vs. controls
◦ Vaccinated group with lower incidence of influenza (1.7%)
compared to controls (13.4%)
◦ Estimated vaccine efficacy against serologically defined
influenza A and influenza B infection of 88% and 89%
◦ Trend toward
 fewer total respiratory illnesses (28.7 per 100 persons) vs.
controls (40.6 per 100 persons)
 Fewer days of lost work (9.9 per 100 persons) vs. 21.1 per
100 persons for controls
*Wilde JA, McMillan JA, Serwint J, Butta J, O'Riordan MA, Steinhoff MC. Effectiveness of influenza
vaccine in health care professionals: a randomized trial. JAMA 1999;281:908--13.
17-Jul-15
49
427 HCWs in two Finnish paediatric hospitals randomized to
influenza vaccine or placebo and followed (double blind) for
4 months during 1996–97 season
211 received placebo
216 vaccinated against influenza
218 days sick leave
due to respiratory infections


301 days sick leave
due to respiratory infections
Vaccination was associated with a 28% decrease (p = 0.02) in
absenteeism related to respiratory infections
No effect on the total number of days with respiratory infections (with
or without sick leave) nor on antibiotic use
Saxen H, et al. Pediatr Infect Dis J. 1999;18:779–83.

Does
◦ protect against influenza from 2 weeks after vaccination
up to a year later
◦ Decreases risk of influenza disease and complications
 Hospitalisation and severe illness incl. Guillain Barre after
influenza-like illness

Does not
◦ Prevent “influenza-like” illnesses caused by other viruses
◦ Increase risk of Guillain Barré syndrome after vaccination
Stowe J et al. Am J Epidemiol. 2009 Feb 1;169(3):382-8.
17-Jul-15
51
Healthy adults (<65 years of age) savings include*:
 13%-44% fewer health-care provider visits
 18%-45% fewer lost workdays
 18%-28% fewer days working with reduced
effectiveness
 25% decrease in antibiotic use for ILI
 Savings categories
◦ Reduction in direct medical costs
◦ Decreased indirect costs from lost work productivity
 >70% of cost savings
*Molinari NA, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in
the US: measuring disease burden and costs. Vaccine 2007;25:5086--96.
17-Jul-15
52

University Hospital of Zurich, 1999–2000 season:
◦ 200 employees
◦ 4.3 days off work per employee presenting with an
influenza-like illness
◦ 29.5% attack rate

Overall economic impact on the hospital (including
5,525 employees):
Influenza-like illness
Laboratory-confirmed influenza

Productivity loss
(days)
Annual personnel
expenditure (US$)
3,096–9,079
0.42–1.2 million
646–1,943
102,500–300,000
Cost of lost productivity for influenza represented 0.05–
0.1% of overall personnel expenditure
Szucs TD, et al. Infect Control Hosp
Epidemiol. 2001;22:472–4.
17-Jul-15
53
1.
2.
3.
4.
5.
6.
Organised vaccination programmmes
Emphasis on Duty-of-Care
Education and debunking the myths
Support from senior staff
Mandatory vaccination/declination
Provision of free, easily accessible vaccines in a
convenient matter
17-Jul-15
54
Factor
Vaccination rate in
Programmes with
Vaccination rate in
Programmmes without
Weekend provision of
vaccine
58.8%
43.9%
Train-the-trainer
programs
59.5%
46.5%
Report of vaccination
rates to administrators
57.2%
48.1%
Letter sent to employees 59.3%
emphasizing the
importance of vaccination
47%
Any form of visible
leadership support
57.9%
36.9%
Required declination
56.9%
55%
Talbot TR. Dellit TH. Hebden J. Sama D. Cuny J. Factors associated with increased healthcare worker influenza vaccination rates:
results from a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol. 31(5):456-62, 2010 May
17-Jul-15
55
You won’t need to take time off from work
because you are sick with the flu.
•
•
HCWs who receive flu vaccine take about 50% fewer sick days.
*Wilde JA, et al . Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281:908--13.
You won’t need to pay for doctor visits and
medication to treat the flu.
•
• Immunised HCWs have about 44% fewer doctor visits.
Nichol KL, M, et al. The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med 1995;333:889–93.
•
.
You won’t need to cancel activities with friends
and family because you are sick with the flu.
• Immunized HCWs have a 59% reduction in illness during
vacation time.
Influenza Vaccination of Health-Care Personnel Recommendations of ACIP and HICPAC-MMWR 2006
17-Jul-15
56
No, this is not possible.
•
Flu virus changes every year.
•
Your body cannot protect itself from new types
of flu because your immune system does not
recognise it.
•
A different vaccine is needed every year.
•
You need to get a flu vaccine every year.
17-Jul-15
57
•
•
•
•
Protect yourself.
Protect your patients.
Protect your family and friends.
Flu vaccination:
•
•
•
•
is FREE.
is safe.
is quick and easy.
can save you time and money.
Vaccination is the BEST protection
you have against the flu!
17-Jul-15
58

Influenza viruses always changing.
◦ Strains monitored by WHO surveillance laboratories
◦ WHO recommends strains for inclusion in seasonal flu
vaccine every year
◦ Seasonal flu vaccine formulated to ‘match’ circulating
strains
17-Jul-15
59
 Thomas RE et al reported on 3 randomised controlled trials and found no
reasonable evidence that vaccination of HCWs protected residents in
LTCF. They did not look at all cause deaths and restricted outcomes to lab
confirmed influenza or hospitalisation or death due to a lower respiratory
tract illness

Ahmed et al from CDC identified four cluster‐randomised trials and four
observational studies conducted in long‐term care or hospital settings. They
estimated that all cause death was reduced by 29% and ILI by 42%.

Thomas RE et al. Influenza vaccination for healthcare workers who care for people aged 60 or
older living in long‐term care institutions. Cochrane Database Syst Rev.2013;7:CD005187
Faruque Ahmed et al. Effect of Influenza Vaccination of Health Care Personnel on Morbidity and
Mortality among Patients: Systematic Review and Grading of Evidence Clinical Infectious
Diseases Advance Access published September 17, 2013

17-Jul-15
60
Sir Austin Bradford Hill
“All scientific work is incomplete—whether it be observational or
experimental. All scientific work is liable to be upset or modified by
advancing knowledge. That does not confer upon us a freedom to
ignore the knowledge we already have, or postpone the action that it
appears to demand at a given time.”


The meta‐analysis by Ahmed et al. offers additional reassurance
that the threshold for action has been reached or surpassed.
Vaccination of healthcare workers to protect vulnerable patients and
residents of long term
facilities should be viewed as an
evidence‐based recommendation
17-Jul-15
61

Poor uptake of immunisation among Irish HCWs
 Historically poor but improving
 Inter-hospital variation



High risk of transmission in health care setting to vulnerable
groups
High risk of complications in risk groups
Human and economic impact of influenza
 employee absenteeism, disease among patients, burden on health
services

Poor knowledge
 Low perception of self risk or risk to others among HCWs
 Myths and inaccurate information common
17-Jul-15
62

Develop strong position on HCWs influenza immunisation



leadership and department/institution support
Aim high (uptake > 40%)
Highlight benefits of HCW immunisation
 Personal/ patient /family
 Decreased transmission among staff and patients;
deaths/complications/prolonged hospital stays/ absenteeism

Educate early and often and avoid confusion among HCWs
 dangers of influenza transmission from HCWs to patients, patient care
responsibility
 Highlight vaccine safety and efficacy- and years of safe usage
 Dispel myths: You cannot get influenza from the injectable vaccine, side
effects minimum

Communication tools
◦
posters, leaflets, newsletter articles, e-mails, text messaging
17-Jul-15
63

Make it attractive
 Convenient and comfortable (site and time)
 Incentives and rewards (raffles, spot prizes, chocolates)
 Inter-departmental/team competition – uptake by units published
 Identify key person on each unit/ward/team
 responsible for encouraging vaccination, vaccinating

Make it accessible
 Multiple opportunities (during day/night, week, month)
 Continuous programme October-March
 Avoid “missed opportunities”
 offer immunisation during any contact
 Bring vaccine to staff
 mobile teams, multiple sites, target group gatherings, team meetings
 Throughout work day (and night)
17-Jul-15
64

Monitor
 Uptake by units and professional group
 Health care-associated illness during season

Evaluate


Differences between groups and units – investigate reasons for
differences
Report and share information

Demonstrate high performing areas
 Introduce competition
 Demonstrate safety and uptake
 Information may stimulate HCWs to seek vaccination
17-Jul-15
65
17-Jul-15
66




HPSC
http://www.hpsc.ie/AZ/Respiratory/Influenza/SeasonalInfluenza/
National immunisation Office
http://www.immunisation.ie/en/HotTopics/Text_174
65_en.html
17-Jul-15
67