ANA Backgrounder: Seasonal Influenza 2009-2010


Introduction

The novel H1N1 influenza (H1N1) outbreak publicized since April 2009 has provided key opportunities to reinforce the importance of seasonal influenza vaccination, particularly of registered nurses and other healthcare personnel (HCP). A MMWR from the CDC stated that by May 13, 2009, they received reports of 48 HCP that tested positive for H1N1. The CDC performed case reports on 26 of the infected HCP, and concluded that 13 (50%) acquired the virus in a healthcare setting. The findings of this report confirms the risk of susceptibility of HCP, as well as the importance of proper personal protective equipment (PPE) use when caring for infectious patients.

With many unknowns regarding the 2009-2010 influenza season, ANA continues to strongly urge nurses and other HCP receive the seasonal influenza vaccine in efforts to prevent influenza transmission to themselves, as well as their patients, coworkers, families and communities.

Background

Influenza outbreaks in hospitals and long-term care facilities have been associated with low vaccination rates among registered nurses and other HCP. Concurrently, higher vaccination levels among HCP have been associated with a lower incidence of nosocomial influenza cases. Vaccination of HCP has also been associated with reduced work absenteeism. Considering that the influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications, it is vital that direct caregivers receive the vaccine. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended that health-care facilities consider the level of vaccination coverage among HCP to be one measure of a patient safety quality program and implement policies to encourage vaccination, including mandatory declination forms.

Since the influenza season varies, and the peak in the influenza season may not occur in certain communities until April or May, vaccination efforts should continue throughout the season, past the December cut off vaccination. Successful HCP vaccination programs are multifaceted, combining education and communication to combat fears, myths, and misconceptions about influenza and influenza vaccines, use of reminder call systems, efforts to remove administrative and financial barriers, role modeling, and monitoring and feedback on vaccination coverage.

Upcoming Influenza Vaccinations

The seasonal influenza virus vaccine components were selected by the United States Food and Drug Administration's Vaccine and Related Biological Products Advisory Committee on February 18, 2009. The composition is the same as the recommendation by the World Health Organization for the Northern Hemisphere for the 2009-10 influenza season. The vaccines to be used in the seasonal influenza vaccine in the United States are:

  • An A/Brisbane/59/2007 (H1N1)-like virus;
  • An A/Brisbane/10/2007 (H3N2)-like virus;
  • A B/Brisbane/60/2008-like virus.

Other seasonal influenza vaccination facts include:

  1. Annual vaccination of all children aged 6 months--18 years should begin as soon as the 2009--10 influenza vaccine is available. Annual vaccination of all children aged 6 months--4 years (59 months) and older children with conditions that place them at increased risk for complications from influenza should continue to be a primary focus of vaccination efforts as providers and programs transition to routinely vaccinating all children.

  2. Most seasonal influenza A (H1N1) virus strains tested from the United States and other countries are now resistant to oseltamivir. Recommendations for influenza diagnosis and antiviral use will be published later in 2009. CDC issued interim recommendations for antiviral treatment and chemoprophylaxis of influenza in December 2008, and these should be consulted for guidance pending recommendations from the ACIP.

Other Organization Policy and Positions

On January 1, 2007, the Joint Commission infection control standard went into effect, requiring accredited organizations to offer influenza vaccination to staff, including volunteers and licensed independent practitioners with close patient contact. Accredited organizations are required to establish annual immunization programs to educate employees about influenza and offer vaccine on site.

Some states have regulations regarding vaccination of HCP in long-term -- care facilities, and others require that health-care facilities offer influenza vaccination to HCP.

The Infectious Diseases Society of America (IDSA) recommends mandatory vaccination of HCP, with a provision for declination of vaccination based on religious or medical reasons. Similarly, a few states require vaccination of HCP, and mandate they indicate a religious, medical, or philosophical reason if they do not receive the vaccination.

The ACIP encourages the use of strategies to increase vaccination coverage rates of HCP, as well as those in training for health care professions , including an assessment plan identifying those recommended for vaccination, education and publicity, reminder/recall systems, standing order programs, scheduled immunizations throughout the influenza season, vaccination rate tracking with feedback to staff requiring the vaccine, efforts to remove administrative and financial barriers, and the use of declination forms.

ANA Position on Getting Vaccinated

Because the influenza vaccine directly affects nurses and their patients, ANA has been proactive in shaping policy and legislation that relates to it. ANA strongly recommends that nurses and all other health care providers who have direct patient contact be vaccinated against the influenza virus. ANA is especially adamant about nurses receiving an annual influenza vaccination. ANA further maintains that nurses involved in direct patient care – and particularly nurses working with persons who have HIV/AIDS, are immuno-compromised or in other high-risk groups – get vaccinated against the influenza in order to prevent any outbreaks of the virus.

Seasonal influenza vaccination coverage rates of HCP consistently remain below 50%. ANA believes this is an alarmingly low percentage, especially given health care professionals' categorization as an influenza high-risk group, their access to the vaccine and their daily contact with patients, many of whom also are in influenza high-risk categories. Because influenza annually leads to 200,000 hospitalizations, resulting from complications, and 36,000 deaths each year, nurses who are vaccinated against the virus not only safeguard themselves, but they also help protect their patients, coworkers, visitors, families and communities.

ANA Past Actions

In 2005 the ANA launched its “Everybody Deserves a Shot at Fighting Flu” Campaign. As part of this initiative a survey was conducted that revealed 86% of nurses polled are extremely or very concerned about their patients becoming infected with influenza. Also, 95% of nurses agree that all health care workers should get vaccinated against influenza each year; however only 5% of the nurses polled believed all of their co-workers received an influenza vaccination in 2004 (ANA, 2005). These startling results have been used to leverage increased awareness in nurses of the importance of influenza vaccination through press releases, dedicated web pages, and articles in ANA sponsored publications.

In 2006 the ANA House of Delegates passed the Resolution Pandemic and Seasonal Influenza, which resolved that ANA strongly urges all RNs involved in direct patient care to receive the seasonal influenza vaccine annually. In December 2006, the ANA Board of Directors approved the Consent Action Report entitled “Seasonal Influenza Vaccination for Registered Nurses”, which resolved that ANA support comprehensive influenza vaccination programs for RNs that also provides an “opt out” with the completion of an informed declination form.

ANA also conducted the successful 2006-07 and 2007-08 Best Practice in Seasonal Influenza Vaccination Campaigns. This recognition campaign elicited responses from health care organizations with effective seasonal influenza vaccination programs that resulted in increased seasonal influenza vaccination of registered nurses and other healthcare personnel. Effective strategies from the awarded programs were complied into a brochure and multiple articles to assist other organizations interested in increasing vaccination coverage rates.. Occupational health and infection control nurses in various healthcare organizations can utilize the brochure and other materials developed based on the findings in planning and implementing their respective programs.

Influenza General Facts

  • Approximately 36,000 people die each year as a result of the influenza.
  • Seasonal influenza and its related complications account for over 200,000 hospitalizations annually.
  • Rates of serious illness and death are highest among persons over age 64, children less than age 2, and persons of any age who have medical conditions that place them at increased risk for complications from influenza.
  • More than 90 percent of influenza-related deaths occur in people age 65 and older.
  • 10 percent to 20 percent of the general population gets influenza each year.
  • In the United States, annual epidemics of influenza typically occur during the fall or winter months, but the peak of influenza activity can occur as late as April or May
  • October and November are the best months in which to get vaccinated against seasonal influenza, but getting vaccinated through March can still help in preventing the spread of the influenza.
  • Scientists make a different vaccine every year because the strains of virus causing influenza change from year to year.
  • Because the strands of influenza viruses used in the trivalent influenza vaccine are “killed” following vaccination, they cannot cause infection.
  • Antibodies take about two weeks to develop after getting vaccinated.
  • Influenza viruses spread in respiratory droplets caused by coughing and sneezing. They usually spread from person to person but also can be spread from touching something with the influenza virus on it and then touching the mouth, eyes or nose.
  • Healthy adults may be able to infect others beginning one day before symptoms develop and up to five days after becoming sick.
  • Healthy persons who are clinically or asymptomatically infected can transmit influenza virus to persons at higher risk for complications from influenza.
  • Spread of the influenza virus may be prevented by using good hand-washing hygiene and respiratory etiquette (using a tissue or a handkerchief or coughing into one's elbow, for example).
  • Influenza virus can cause disease among persons in any age group, but rates of infection are highest among children.
  • The influenza-related hospitalization rates are highest among children aged zero to one year.
  • Children are two to three times more likely than adults to get sick with influenza and frequently spread the virus to others, according to the National Institute of Allergy and Infectious Diseases. In 2004, the first year all children 6-23 months were recommended for influenza vaccination, the vaccination rate among children aged 6-23 months was up sharply from 7.7 percent in 2002 to 57.3 percent, according to the CDC.

ANA Advocacy Activities

  • ANA participates in meetings of federal advisory committees on immunization including the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP).
  • ANA signed on to the Adult Immunization Call to Action of National Foundation for Infectious Diseases (NFID) .
  • ANA attended and was a participant on panels at the National Influenza Vaccine Summit in 2008 and 2009.
  • ANA Best Practices in Influenza Immunization Campaign —ANA's recognition campaign that was designed to identify organizations that have the best success stories for getting their staff vaccinated. These success stories have been compiled to represent the best practices in immunization programs that result in increased immunization acceptance and accessibility among HCP.
  • In May 2008, ANA signed on to support an open letter to Congress requesting that policy-makers support vaccination, particularly of children, to reduce the spread of vaccine-preventable diseases.
  • ANA participated in multiple work groups hosted by the National Foundation for Infectious Diseases, resulting in the publications Call to Action: Influenza Immunization Among Health Care Workers (2003), Call to Action: Influenza Immunization Among Health Care Personnel (2008), Call to Action: Improving Influenza Vaccination Rates in Adults and Children with Diabetes (2006), and Immunizing Healthcare Personnel Against Influenza: A Best Practices Report (2008).

Communications Outreach and Education

Media Outreach and Response – ANA regularly responds to media inquiries regarding vaccination preparedness from major media outlets.

Member Education/Publications – Members have been updated on the influenza issue through:

CDC Influenza Reports

Influenza Resources for Professionals

Influenza Resources for Consumers

  • CDC General Influenza Information – www.cdc.gov/flu/
  • CDC hotline: 1-800-CDCINFO

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