Improving Vaccination Rates For Healthcare Personnel/Module One

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  • A highly infectious viral disease which is transmitted person to person via droplet nuclei from a cough or a sneeze. Fomite transmission is also possible via touching contaminated surfaces and then touching eyes, nose or mouth. Transmission can occur from one day before symptom onset up to five days after (adult). Children can transmit influenza for up to ten days. The rates of infection are the highest among children, but risks for complications, hospitalizations and death are highest among those 65 years or older (Centers for Disease Control and Prevention [CDC], 2009). The incubation period lasts from one to four days; approximately 50% of those who contract the illness exhibit clinical symptoms which include fever, myalgia, sore throat, headache, cough (non productive); rhinorrhea, chest and eye pain may also result (Centers for Disease Control and Prevention [CDC],May 2009).

Influenza Vaccination:

  • "The most effective strategy for the prevention of influenza is annual vaccination"(CDC, 2009). Two types of influenza vaccine are available: trivalent inactivated vaccine (TIV) is administered intramuscularly and the live attenuated influenza (LAIV) is administered via the intranasal route. TIV is approved for ages 6 months to adult; (LAIV) is approved for ages 2 years to 49 years.


  • A factor that renders the administration of a drug or the carrying out of a medical procedure in advisable ( Retrieved from: Contraindications for TIV include: age under 6 months, allergy especially anaphylaxis to eggs or components of the vaccine, allergy or previous reaction to influenza vaccine, moderate to severe fever, and previous diagnosis as having Guillian-Barre syndrome is considered a precaution. Contraindications for LAIV include: age under 2 or 50 years and older, pregnancy, allergy especially anaphylaxis to eggs or components of the vaccine, allergy or previous reaction to influenza vaccine, chronic disease such as diabetes, asthma/wheezing, Guillian-Barre syndrome as mentioned, severe immunosuppression and close contacts of the severely immunosuppressed who require a protected environment (CDC, 2009).

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Introduction and Background:

  • Influenza is responsible for significant morbidity and mortality annually in the United States despite the availability of vaccines that can dramatically reduce this burden. It is estimated that 226,000 hospital admissions and 36,000 deaths occur each year directly related to influenza; epidemiologically the contribution from healthcare personnel (HCP) has been associated with various outbreaks (Talbot et al. 2005). As many as 75 million work days are missed and an additional 22 million health care visits are generated annually as a result of influenza (Nichol, 2001). Nichol also found an average of $13.66 was saved per person vaccinated with an average of 12.3 days of work absenteeism per 100 people. The annual fiscal burden has been estimated at 87.1 billion with direct medical costs equaling 10.4 billion (CDC, 2009).While 83%-85% of the United States population is recommended to receive annual influenza (flu) vaccination, there is a less than 40% adherence rate (CDC, 2009). Particularly disconcerting is that this percentage mirrors the rate for HCP; for vaccine years 2005-2006 and 2006-2007, HCP vaccination rates reached 42%-44% respectively.
  • Herd immunity is the protection afforded the susceptible--those who cannot receive vaccination--by the majority who can. By reducing the susceptible population and increasing immunity of the herd to 85% of the population, infectious disease transmission is thwarted and epidemics can be halted (Merrill& Timmreck, 2006). Vaccination of those with a high risk of transmission (children, HCP, contacts of those at risk) may convey supplementary protection to high risk populations. Some studies which include prospective trials and ecological analyses have indicated that annual flu vaccination of school aged children has lead to impressive reductions in disease burden for various population groups (Schwartz et al, 2006). Piedra et al. (2004) found that even with a 20-25% vaccination rate of a high risk for transmission group (children 1.5-18 years old) herd immunity protection was conferred upon 8% to 18% of their adult contacts aged 35 years or older during an influenza outbreak.
  • Recommendations from various agencies and accreditation bodies such as the CDC, Advisory Committee on Immunization Practices (ACIP), Health Care Infection Control Practice Advisory Committee (HICPAC), and the Joint Commission formerly known as the Joint commission of the Accreditation of Healthcare Organizations (JCAHO) all stress the importance of annual flu vaccination for HCP for the prevention of subclinical and direct transmission of influenza to patients (Lugo, 2007). An evidence-based guideline recommending vaccination for healthcare personnel suggests annual influenza vaccination should be provided to all staff for protection of others as well as to reduce absenteeism; this recommendation is category 1 A whose definition includes "strongly recommended for implementation/strongly supported by well-designed experimental, clinical, or epidemiologic studies" (Pearson, Bridges & Harper, 2006, p. 4).
  • Rationale for increasing the rates of influenza vaccination for HCP are many. The foremost being the protection of patient, self, family and the community. Increasing the rate in each unit creates the potential for herd immunity protection which will extend outward towards the community as more and more people accept vaccination. In an already financially strapped health care system, decreasing the influenza disease burden will be a welcome relief. Nursing comprises the largest group of HCP and has the most contact with patients; we are in a unique position to directly impact the severity that this disease poses to the public's health.

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Module One Questions

A. Which statement is true regarding influenza:

  1. the incubation period lasts from 1 to 10 days
  2. transmission is not possible unless clinical symptoms are visible
  3. the rates of influenza are highest among children, but complications are highest in the 65 years or older population
  4. it is a bacterial infection and may be effectively treated with antibiotics
  5. all of the above

B. Which is not a true contraindication for TIV (injection)?

  1. previous reaction to influenza vaccine
  2. a baby at 5 months of age
  3. pregnancy
  4. an allergy to eggs
  5. none of the above

C. Which is not a true contraindication for LAIV (intranasal)?

  1. a child at 11 months of age
  2. pregnancy
  3. a 51 year old adult
  4. a 3 year old healthy child
  5. all of the above

D. Herd immunity is:

  1. responsible for pandemic transmission of influenza
  2. indirect protection of susceptible individuals e.g., a newborn who cannot receive vaccine
  3. important for cows, pigs, chickens, but is not beneficial to humans
  4. protection against cowpox
  5. none of the above

E. The efficacy of herd immunity has been demonstrated in studies. Which age group is often targeted to aid in the indirect protection of various populations?

  1. children
  2. adults
  3. seniors
  4. newborns
  5. all of the above

F. Recommendations from various agencies including the Joint Commission, CDC, ACIP, are clearly in support of annual vaccination for HCP. Why?

  1. the guidelines are evidence-based
  2. subclinical/clinical transmission for HCP has been documented
  3. to decrease transmission and increase protection of patients, self, family and community
  4. all of the above

G. The rationale for increasing the influenza vaccination rates for HCP includes:

  1. protecting patients from subclinical transmission via HCP
  2. increasing the overall vaccination rates which in turn increases herd immunity
  3. decreasing absenteeism
  4. helping to quell the financial burden of influenza upon the health care system
  5. all of the above
  • Answers:

A. 3, B. 3, C. 4, D. 2, E. 1, F. 4, G. 5