Vaccination nation: Pressure mounting to improve HCW flu immunization rate
Feds call for hospitals to reach 2010 HCW goal
Pressure to vaccinate more health care workers against influenza will grow even more intense this year, as public health officials seek to reach the Healthy People 2010 goal of immunizing 60% of all health care workers.
In 2006, just 42% of the nation's health care workers got their flu shot, according to the National Health Interview Survey. Vaccination rates may be somewhat higher among hospital employees, but many hospitals are struggling to raise their rates. Immunization coverage of 80% is considered adequate for "herd immunity," which means enough people are vaccinated to prevent spread of disease.
The U.S. Department of Health and Human Services is launching an initiative that targets nursing homes and health care professional schools, such as nursing and medical schools. HHS also will track its own clinical employees, such as those at the National Institutes of Health.
Public health officials also are urging hospitals and other health care employers to extend their flu immunizations beyond the usual September-to-November time frame. About 150 million doses will be distributed this fall.
"With this record amount of vaccine available, it should be abundant, it should be on time. There's no excuse not to vaccinate health care workers," says Raymond Strikas, MD, medical officer with the National Vaccine Program Office.
Flu experts stressed that although last season's vaccine was a poor match with the prevailing strains, it still provided protection and overall was 44% effective. The flu season was more severe than the previous three seasons; there were reports of 53 influenza-associated deaths among children, according to the Centers for Disease Control and Prevention.
Hospitals often reach a plateau in their efforts to raise immunization rates, says William Schaffner, MD, chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine in Nashville and vice president of the board of directors of the National Foundation for Infectious Diseases (NFID).
"In our own institution, the occupational health service, infection control and administration have been working hard, and we're stuck at 55% to 67%," he reports. "We can't seem to get to the next level."
Strong, visible support from executive, nursing and medical leadership is vital to move the influenza vaccination programs forward, says Schaffner. "If there are important people in the institution who are skeptics, they have to be addressed and their concerns have to be answered before they cease to be barriers," he says.
Declination statements may be helpful, but often they make it too easy for health care workers to opt out particularly if the employee simply clicks on a "no" button in an online form. Even collecting written declinations can be an exercise in paperwork. What reluctant health care workers really need is someone to talk to them about their concerns, Schaffner says.
"The myth that the influenza vaccine causes the flu is profoundly imbedded, especially among nurses," he says. "It's a tenacious myth."
The myth may have developed from the flu vaccines of several decades ago, which were less pure and more likely or produce side effects that included fever, says Schaffner. And if someone gets a cold or other respiratory illness within a few days of getting the flu vaccine, they often wrongly attribute it to the vaccine, he says.
NFID promotes education of health care workers that directly addresses misconceptions about the vaccine.
Vaccinate through February
The low point for vaccination of health care workers came in 2004, when there was a severe shortage of vaccine. With six vaccine manufacturers and a record quantity this year, public health officials want to see a record demand.
In fact, they want to get out the word that flu vaccination isn't just a fall event. "The hope is that we'll continue to see a trend toward more vaccination in the December, January, and February time frame," says Anthony Fiore, MD, MPH, a medical epidemiologist with CDC. Last season, influenza outbreaks peaked in February.
Vaccination may be especially important as flu strains gain resistance to common antiviral medications. The CDC reported that 11% of the H1N1 strains tested were resistant for oseltamivir (Tamiflu). "This season represents a great increase in resistance to oseltamivir," Fiore says.
All strains remain to zanamivir, he said.
Hospitals will need to adapt their flu vaccination campaigns as supply remains high and the pressure stays on for higher vaccination rates, says Schaffner. "There is this desire to do it in a blast fashion," he says. "If we want to vaccinate more people, we have to do it for a longer period of time."
Pressure to vaccinate more health care workers against influenza will grow even more intense this year, as public health officials seek to reach the Healthy People 2010 goal of immunizing 60% of all health care workers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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