Immunization

Benefits and Risks of Influenza Immunization and Anti-Viral Medications

The Flu and You What does the research show?

La grippe et vous Qu'indiquent les recherches?

Why should Healthcare Workers be Immunized?

Keeping nurses, physicians and allied health professionals working during seasonal influenza epidemics is essential. Annual influenza immunization has been shown to mitigate the adverse health outcomes associated with influenza in the community. When provided to healthcare workers (HCW), influenza vaccine reduces the frequency and severity of nosocomial influenza outbreaks and reduces influenza-associated morbidity and mortality among patients by reducing the transmission of influenza from HCW to their vulnerable patients [2].

Influenza is one of the leading causes of acute respiratory infection and results in significant increases in average life-years lost, hospital lengths of stay and outpatient clinic visits (3-5), representing an enormous economic burden for many countries (6). Healthcare workers (HCW) are at particularly high risk of exposure to influenza as they are exposed in both the community and in the workplace (7). Influenza vaccination for HCW has been shown to reduce patient mortality in long-term care facilities as well as employee absenteeism and financial costs in acute care settings (8-13). The Canadian National Advisory Committee on Immunization (NACI) recommends that influenza immunization programs strive to immunize at least 90% of eligible recipients (14). In fact, NACI regards influenza immunization of HCW with direct patient care responsibilities as an essential component of the standard of care for the protection of patients and the refusal of HCW without contraindications to receive influenza vaccine as a failure in their duty of care to patients (14). Despite national recommendations and proven effectiveness, influenza immunization coverage rates among HCW remain below targeted levels.

Poor Uptake of Influenza Vaccine by Healthcare Workers

Despite abundant evidence of the safety and efficacy of the influenza vaccine, immunization rates among HCW in hospital and long term settings remain well below the public health target of 90%. Current initiatives targeted at increasing HCW immunization rates are having limited success with HCW immunization rates as low as 2% but averaging 40% - 60% in most acute care facilities being reported [2, 3, 13].The decision to accept or refuse influenza vaccine each year may be a difficult one for many HCW. Decisional conflict, a term used to describe the difficulty experienced by an individual who simultaneously tends to both accept and reject a given course of action, occurs in many medical decisions where the best choice often differs depending on how individuals weigh the risks and benefits and has been shown to contribute to poor vaccine uptake (15, 16). In a review of literature from 1985 to 2004 it was found that HCW experience decisional conflict related to misperceptions about influenza, its risks, the role of HCW in its transmission to patients, and the importance and risks of vaccination (7,10,17-21). In a cross-sectional survey study assessing HCW general knowledge regarding influenza vaccination, vaccination status, and reasons for vaccine declination, deficits in general influenza vaccine knowledge were identified as a significant barrier to immunization (22).

References

1. CCHSA Patient Safety Required Operational Procedures (ROPs): New ROPs for 2008 Accreditation Surveys. Available at: www.cchsa-ccass.ca/default.aspx?page=355&cat=30. Accessed August 26, 2008.
2. Harper SA, Fukuda K, Uyeki TM, Cox NJ, Bridges CB, Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2004 May 28;53(RR-6):1-40.
3. Cunney RJ, Bialachowski A, Thornley D, Smaill FM, Pennie RA. An outbreak of influenza A in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2000 Jul;21(7):449-454.
4. Maltezou HC, Drancourt M. Nosocomial influenza in children. J Hosp Infect. 2003 Oct;55(2):83-91.
5. Sartor C, Zandotti C, Romain F, Jacomo V, Simon S, Atlan-Gepner C, et al. Disruption of services in an internal medicine unit due to a nosocomial influenza outbreak. Infect Control Hosp Epidemiol. 2002 Oct;23(10):615-619.
6. Molinari NA, Ortega-Sanchez IR, Messonnier ML, Thompson WW, Wortley PM, Weintraub E, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007 Jun 28;25(27):5086-5096.
7. Hofmann F, Ferracin C, Marsh G, Dumas R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection 2006 Jun;34(3):142-147.
8. Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000 Jan 8;355(9198):93-97.
9. Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, et al. The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med 1995 Oct 5;333(14):889-893.
10. Lester RT, McGeer A, Tomlinson G, Detsky AS. Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol 2003 Nov;24(11):839-844.
11. Weinstock DM, Eagan J, Malak SA, Rogers M, Wallace H, Kiehn TE, et al. Control of influenza A on a bone marrow transplant unit. Infect Control Hosp Epidemiol 2000 Nov;21(11):730-732.
12. Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006 Dec 16;333(7581):1241.
13. (otter J, Stott DJ, Roberts MA, Elder AG, O'Donnell B, Knight PV, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997 Jan;175(1):1-6.
14. National Advisory Committee on Immunization. Canadian Immunization Guide 7th Edition. 2006.
15. Sullivan SM, Pierrynowski-Gallant D, Chambers L, O'Connor A, Bowman S, McNeil S, et al. Influenza vaccination and decisional conflict among regulated and unregulated direct nursing care providers in long-term-care homes. AAOHN J. 2008 Feb;56(2):77-84.
16. O'Connor AM. Using decision aids to help patients navigate the "grey zone" of medical decision-making. CMAJ 2007 May 22;176(11):1597-1598.
17. Song JY, Park CW, Jeong HW, Cheong HJ, Kim WJ, Kim SR. Effect of a hospital campaign for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2006 Jun;27(6):612-617.
18. LaVela SL, Smith B, Weaver FM, Legro MW, Goldstein B, Nichol K. Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders. Infect Control Hosp Epidemiol 2004 Nov;25(11):933-940.
19. Takayanagi IJ, Cardoso MR, Costa SF, Araya ME, Machado CM. Attitudes of health care workers to influenza vaccination: why are they not vaccinated? Am J Infect Control 2007 Feb;35(1):56-61.
20. Christini AB, Shutt KA, Byers KE. Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol 2007 Feb;28(2):171-177.
21. Canning HS, Phillips J, Allsup S. Health care worker beliefs about influenza vaccine and reasons for non-vaccination--a cross-sectional survey. J Clin Nurs 2005 Sep;14(8):922-925.
22. Martinello RA, Jones L, Topal JE. Correlation between healthcare workers' knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol 2003 Nov;24(11):845-847.