City Health Information
September 2012 New York City Department of Health and Mental Hygiene Vol.31(4):25-32
 

IN THIS ISSUE

 

Influenza Prevention and Control, 2012-2013
  • Vaccinate everyone aged 6 months and older against influenza.

  • Vaccinate day care and school-aged children, who are key transmitters of disease, as early as possible.

  • Give inactivated vaccine to all pregnant women in any trimester.

  • Vaccinate all health care workers against influenza.

  • New health care worker vaccination reporting requirements for acute-care facilities will take effect in January 2013.


INFLUENZA IN ADULTS

CDC recommends annual influenza vaccination for all adults, especially for people at higher risk (Boxes 1 and 2).

Pregnant women are an important priority group for vaccination (Box 3) (11,17). Educate pregnant patients about vaccination to prevent influenza in themselves and their infants (see Resources for free patient educational materials) (17). Women who are known to be pregnant should be immunized with inactivated vaccine containing no more than 1.25 μg of mercury per 0.5-mL dose. Use single-dose vials of vaccine and prefilled syringes because multidose vials contain the mercury-based preservative thimerosal (22). There is no need to test for pregnancy before vaccinating. Postpartum women can receive either trivalent inactivated (TIV) or live attenuated influenza vaccine (LAIV), even if they are breastfeeding (20).

Health care workers are at increased risk for acquiring influenza infection and transmitting disease to their patients, colleagues, and families. All health care workers should receive annual influenza vaccination with either TIV or LAIV. Health care workers younger than 50 years old may receive LAIV unless they are pregnant or have chronic medical conditions (Box 2) (23,24). TIV is recommended for health care workers who are in close contact with severely immunocompromised patients being cared for in a protective environment (eg, bone marrow or stem cell transplant unit) (11,33).

All medical facilities employing health care workers should provide vaccine to their staff in line with standards from the Joint Commission on the Accreditation of Healthcare Organizations as well as recommendations of numerous professional organizations, including the Association for Professionals in Infection Control and the Society for Healthcare Epidemiology of America. Evidence-based approaches such as mobile carts, vaccination of senior staff, and gaining support of institutional leaders can help facilities increase vaccination coverage (25). To accommodate health care workers, vaccination should be provided during all shifts and on weekends. In the absence of an employer requirement, significantly higher vaccination coverage can be achieved among health care personnel who are offered vaccination onsite, free of charge, and for more than 1 day (34). For more information on improving vaccination rates in health care workers, see Resources--National Foundation for Infectious Diseases.

In January 2013, new national reporting requirements for health care worker vaccination rates will go into effect for acute-care facilities (Box 4). Facilities should immediately begin to familiarize themselves with the requirements and collaborate with appropriate departments in their institution to assist in data collection. Refer to www.nyc.gov/flu for more information.

BOX 3. INFLUENZA IN PREGNANCY

Women are 5 times more likely to be vaccinated if their providers offer or recommend influenza vaccination during pregnancy (17).

The American College of Obstetricians and Gynecologists, American Academy of Family Physicians, Advisory Committee on Immunization Practices, and many other professional organizations strongly encourage providers to urge their pregnant patients to get vaccinated against influenza. Women should be vaccinated in any trimester with a single dose of trivalent inactivated vaccine (TIV) as soon as vaccine is available.

  • During pregnancy, women are more susceptible to severe illness from influenza (18) and have a 4-fold greater risk of influenza-related hospitalization than nonpregnant women (19).
  • Pregnant women with influenza have an increased risk of premature labor and delivery (20,21).
  • Pregnant women who are vaccinated protect themselves and their infants younger than 6 months; these infants are not old enough to receive vaccine and are at high risk for influenza-related hospitalization (17,20).
  • Vaccination in pregnancy is safe. In the last decade, influenza vaccine has been given to millions of pregnant women without causing harm (18).

PDF version of Box 3

BOX 4. VACCINATION OF HEALTH CARE WORKERS
  • High influenza vaccination coverage protects staff and patients and reduces disease burden, health care costs, and absenteeism (25-27).
  • In 2011-2012 in New York State, only 44% of health care workers received influenza vaccination (28), far below the 90% target set by Healthy People 2020.
  • According to the 2009 NYC Community Health Survey, only about 42% of health care workers in NYC reported receiving an influenza vaccination within the preceding 12 months (29).
  • The National Vaccine Advisory Committee recommends that health care employers and facilities educate providers about influenza vaccination, integrate vaccination into existing programs, and consider mandatory immunization (30).
  • The American College of Physicians, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and other groups recommend mandatory vaccination of all health care workers (barring medical contraindications) as the best way to achieve targeted immunization rates (31).
  • As of January 2013, the Centers for Medicare and Medicaid Services (CMS) will require acute-care facilities to monitor and report summary counts of health care worker influenza vaccinations through CDCís National Healthcare Safety Network (NHSN) (7). Facilities failing to comply with the reporting requirements will be subject to payment reduction, and quality data will be made publicly available on the Hospital Compare Web site (www.hospitalcompare.hhs.gov) starting in the 2013-14 season (7). CMS has also finalized reporting requirements for ambulatory surgical centers to begin in 2014 (32).

PDF version of Box 4