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.


IMPROVING VACCINATION RATES

Use a variety of strategies to help improve vaccination coverage in your facility. Provider recommendation has a strong effect on patient acceptance of vaccination. Offer influenza vaccine (and pneumococcal vaccine, if appropriate) at every patient visit from the time vaccine becomes available until it expires. Educate patients and staff about influenza vaccination and dispel any misconceptions that may hinder efforts to increase vaccination in your practice (Box 5). Do not limit influenza vaccination for patients to specified hours or weekend clinics. Keep a flexible schedule if possible, and offer patients a variety of options to help fit their needs.

Reminding patients via phone calls or postcard mailings may improve vaccination coverage. Many electronic medical record systems, as well as the Citywide Immunization Registry (CIR), offer reminder/recall features to contact patients due for influenza immunization (Box 6).

Pharmacy-based vaccination can serve as an important adjunct to increase vaccination coverage in the community (Box 7). Be sure to ask patients aged 18 and older if they have received an influenza vaccination this season in a pharmacy or other venue and document this in the patient’s medical record.

BOX 5. COMMON MISCONCEPTIONS ABOUT INFLUENZA AND VACCINATION (37,38)

Myth 1. Influenza is no worse than a very bad cold and is only dangerous in older people.
Fact. Influenza is a severe respiratory illness that can cause misery for patients. Symptoms include congestion, fever, cough, body aches, and complete exhaustion, and can last for 2 to 3 weeks. While most people who become seriously ill or die from influenza complications are older than 65 years, influenza can be dangerous for very young children, healthy younger adults, and people of any age with chronic health conditions. People at lower risk for complications can still transmit influenza to others who are susceptible, including children less than 6 months old, who cannot be vaccinated.

Myth 2. Chronic health conditions such as cardiac disease or asthma are contraindications to influenza vaccination.
Fact. Patients with chronic health conditions are at higher risk for complications from influenza and should be vaccinated annually with a trivalent inactivated vaccine (TIV).

Myth 3. Pregnancy is a contraindication to influenza vaccination.
Fact. Pregnant women are at higher risk for severe complications from influenza (see Box 3). Vaccination protects both women and their newborns. Thimerosal-free preparations of TIV may be used during all stages of pregnancy.

Myth 4. Close contact with immunosuppressed patients is a contraindication to influenza vaccination.
Fact. Immunosuppressed patients may be at increased risk of contracting influenza disease and its complications even if vaccinated, so it is especially important for close contacts, including health care workers, to be vaccinated, preferably with inactivated vaccine. See Available Vaccines for information on live attenuated influenza vaccine.

Myth 5. Influenza vaccination will cause a mild version of the flu.
Fact. Inactivated influenza vaccine contains killed viruses that cannot cause infection. Live attenuated influenza vaccine contains only weakened viruses that replicate at cooler temperatures within the nose and may therefore cause postvaccination nasal congestion. The viruses cannot infect the lungs or other areas where the temperature is warmer. Occasionally, people may report mild transient reactions, including fever, muscle pain, chills, tiredness/weakness, or headache. These reactions generally last only 1 or 2 days as the immune system produces antibodies (39).

Myth 6. It's too early to get vaccinated in August and too late after the end of November.
Fact. Influenza vaccination should begin as soon as vaccine becomes available and continue until vaccine expires. Protection will last all season, into the following year. Furthermore, influenza activity is unpredictable; outbreaks can occur as late as May.

Myth 7. Influenza vaccine contains mercury, which is unsafe.
Fact. Multidose vials of influenza vaccine contain a small amount of thimerosal, a preservative used to protect against bacterial contamination. Ethylmercury is a metabolite of thimerosal and differs from methylmercury, which is a neurotoxic agent (40). Numerous studies have found no association between thimerosal and developmental disorders. Thimerosal is usually only associated with minor local injection site reactions such as redness and swelling (41).

Myth 8. It's better not to get vaccinated and become "naturally" immune to influenza.
Fact. Influenza is a debilitating preventable illness with potentially severe complications. Vaccination is the best method of protection against the morbidity and mortality associated with influenza.

PDF version of Box 5

BOX 6. HEALTH DEPARTMENT TOOLS TO INCREASE IMMUNIZATION
  • The Citywide Immunization Registry (CIR) is an electronic central recordkeeping system that tracks immunizations of people vaccinated in New York City and securely maintains immunization records. The CIR offers guidance on immunizations that are due and can generate reminder/recall lists of patients due for immunizations, including children aged 6 months through 8 years who may require a second dose of influenza vaccine. The CIR can also print letters and address labels for patient reminders.
    You must report all vaccinations administered to children <19 years of age to the CIR within 2 weeks of administration. You may report vaccinations given to people aged 19 years and older if you have the patient's written consent. Encourage your adult patients to participate in the CIR to ensure future availability of vaccination records.
    For further information or to register
    with the CIR, visit the CIR Web site, www.nyc.gov/health/cir, or call
    347-396-2400
    .

  • The Primary Care Information Project (PCIP) helps providers adopt electronic health records and use them to identify patients who are due for follow-up or routine preventive care appointments, track immunization coverage in their practice, and report immunizations to the CIR. For more information, contact PCIP at 347-396-4888 or by e-mail at pcip@health.nyc.gov.

  • NYC Health Department publications on influenza and pneumococcal disease:

PDF version of Box 6

BOX 7. PHARMACISTS AND INFLUENZA VACCINATION

New York State-licensed pharmacists who are certified by the New York State Education Department can administer influenza and pneumococcal vaccines to adults aged 18 years and older if they obtain a non-patient-specific standing order from a New York State-licensed physician or nurse practitioner. Starting in 2012, pharmacists may also administer herpes zoster vaccine if they receive a patient-specific order from a prescribing health care provider. Pharmacists who are interested in offering influenza and pneumococcal vaccination but are unable to obtain a standing order should contact the New York City Health Department at www.nyc.gov/html/doh/flu/html/public/pharma.shtml for further information.

PDF version of Box 7



 

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