Title: Enough is Enough – Improving Influenza Vaccination Rates among Healthcare workers
Authors: Owen Simwale; Brandyn Powers – Pennsylvania Department of Health
Every winter, influenza (the flu) causes a substantial burden of illness in Pennsylvania. Approximately, 1-5% of all out-patient doctor-visits during the winter are related to influenza1. A majority of people with influenza and influenza-like illnesses (ILI) seek primary care in primary care and as many may be seen by Nurse Practitioners as Physicians. Focusing only on lab-confirmed reports, during the 2010/11 flu season over 18, 000 cases were reported to the Pennsylvania Department of Health (PADOH), involving 1, 527 hospitalizations and 90 deaths, A total of 179 flu outbreaks in 158 long term care facilities (LTCF) were also reported last flu season1,2.
Nurse Practitioners are an important piece of the jigsaw puzzle that constitutes influenza. CRNPs encourage their patients to receive annual immunization and administer much of Pennsylvania’s annual supply of vaccine. They also form a high-risk group for influenza infection and can transmit the virus to their co-workers, their families, and their patients. There is a great deal of evidence showing illness among unvaccinated Health Care Workers (HCWs) may contribute to influenza outbreaks in both acute and long term care settings4. An assessment of nursing home outbreaks in Pennsylvania during the 2007/08 influenza season showed that among 92 flu outbreaks in 91 LTCFs, a majority of outbreaks and hospitalizations occurred in facilities where less than 60% of employees were vaccinated and in facilities with ill employees 1, 2.
Vaccination is the single most effective measure to prevent influenza. Vaccination of HCWs reduces influenza infection and employee absenteeism, prevents mortality in their patients, and results in cost savings to sponsoring health institutions4-6. In spite of the clear benefits of HCW vaccination, shamefully almost half (40-50%) of HCWs still do not get a flu shot every year6-8. Decades of encouraging HCWs to voluntarily receive flu vaccination has yielded only marginal gains in vaccine uptake. Most healthcare facilities have reached a plateau at or below the 60% mark7,8.
The Healthy People 2020 goal for influenza vaccination among HCWs is 90%. Therefore we have a long way to go to attain that sort of coverage. At present, PADOH is only aware of 8 hospitals (of about 250 licensed) and 4 LCTFs (out of over 700) that have attained a 90% or greater vaccination rate among their healthcare workforce.
Evidence to date shows the only way to achieve near universal vaccine coverage of HCWs is to implement mandatory programs (influenza vaccination as a condition of employment) at the institutional level6. Therefore, the Pennsylvania Department of Health, has joined a growing list of health care organizations that support and promote mandatory influenza vaccinations policies for HCWs. This flu season (2011/12), PADOH has joined into a partnership with the Hospital and Health System Association of Pennsylvania (HAP), the Pennsylvania Immunization Coalition and the Center for Vaccine Ethics at the University of Pennsylvania to actively encourage implementation of mandatory influenza vaccination at the institutional level. Healthcare facilities that vaccinate over 90 percent of staff will be recognized by the state with a certificate of excellence and inducted into the patient safety and employee health honor roll. Cases studies of hospitals and long term care facilities that have achieved near universal coverage can be found at www.pahcwfluvax.org, www.flufreepa.com and at http://www.haponline.org/quality/resources/flu-campaign/.
Given the overwhelming benefit of healthcare worker vaccination, the status quo with HCW vaccination rates in Pennsylvania cannot go unchallenged. Enough is enough and our current approaches are unlikely to produce meaningful changes in coverage. Therefore, PADOH encourages all facilities in the Commonwealth to reexamine their current policies and make the pledge to achieve universal vaccination of their workforce to keep their workers safe and healthy. And we all owe it to our patients to keep them as safe and healthy as possible. Corresponding author:
References
1. Pennsylvania Department of Health, 2010/11 flu surveillance data (unpublished).
2. Smith E., Simwale O., Ostroff, S. (2010). Outbreaks of Influenza in long term care facilities and influenza vaccination. Abstract, presented at the 2010 American Public Health Association Annual Conference. Accessed on 10/18/2011 from, http://www.cste.org/webpdfs/ac/abstractbook2011.pdf
3. Flood EM and others. (2011). Parents' decision-making regarding vaccinating their children against influenza: A web-based survey. Clinical Therapeutics. 2010 August; 32(8):1448-67.
4. Horcajada JP, Pumarola T, Martinez JA. (2003). A nosocomial outbreak of influenza during a period without influenza epidemic activity. Eur Respir J 2003; 21(2):303-307.
5. Centers for Disease Control and Prevention (CDC). Place of influenza vaccination among adults --- United States, 2010-11 influenza season. MMWR Morb Mortal Wkly Rep. 2011 Jun 17; 60(23):781-5. Accessed on 11/10/11 from, http://www.ncbi.nlm.nih.gov/pubmed?term=%22Centers%20for%20Disease%20Control%20and%20Prevention%20(CDC)%22%5BCorporate%20Author%5D
6. Katherine M. Harris and others. (2011). Influenza Vaccination Coverage among Health-Care Personnel --- United States, 2010--11 Influenza Season. Morbidity and Mortality Weekly Report (MMWR). August 19, 2011 / 60(32); 1073-1077. Accessed on 10/11/11from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6032a1.htm?s_cid=mm6032a1_w
7. Belshe RB, Edwards KM, Vesikari T, Black SV, Walker RE, Hultquist M, Kemble G, Connor EM; CAIV-T Comparative Efficacy Study Group. Live attenuated versus inactivated influenza vaccine in infants and young children. N Engl J Med. 2007;356(7):685-96
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