City Health Information
Volume 32 (2013) New York City Department of Health and Mental Hygiene No. 3; 11-18
 

IN THIS ISSUE

 

Influenza Prevention and Control, 2013-2014
  • Vaccinate everyone aged 6 months and older against influenza as early as possible.
  • Give inactivated vaccine to all pregnant women in any trimester.
  • Get your flu vaccination as soon as vaccine becomes available and ensure that your staff does the same.

 

INFLUENZA IN ADULTS

Nationally in 2012-2013, half of all reported influenza hospitalizations occurred in adults aged 65 and older (10). In NYS, almost 50% of influenza hospitalizations occurred in people aged 65 and older and were highest in adults with cardiovascular disease, metabolic disorders, chronic lung disease, and obesity (12). In NYC, preliminary data from September 2012 through May 2013 indicate that most of the 2,085 influenza- and pneumonia-related deaths were in people aged 65 and older (unpublished data). In long-term care facilities, there were 95 outbreaks of influenza, 1,060 confirmed cases, 69 hospitalizations, and 16 deaths (unpublished data).

Less than 40% of NYC adults reported receiving influenza vaccine in the 2011-2012 season (unpublished data). Be sure to vaccinate all of your adult patients, especially those at higher risk, including people who live with or care for anyone at higher risk for severe influenza-related complications (Boxes 1 and 2).

Pregnant women are a high-risk group that should be vaccinated as early as possible (Box 4). Advise pregnant patients about the importance of vaccination for themselves and their infants (see Resources—NYC DOHMH and CDC for free patient educational materials).

Health care workers are another group at higher risk for acquiring influenza infection and transmitting disease to their patients, colleagues, and families. Vaccination of health care workers is of critical importance in reducing the burden of nosocomial influenza, especially in high-risk groups such as older adults, immunocompromised persons, and pregnant women. High influenza vaccination coverage protects staff and patients and reduces disease burden, health care costs, and absenteeism (18,19). 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 (20). Box 5 includes suggestions for improving vaccination rates in your office or facility. Health care workers should receive annual vaccination with either inactivated (IIV) or live attenuated influenza vaccine (LAIV) as early as possible. Those younger than age 50 may receive LAIV unless they are pregnant or have chronic medical conditions (Box 2), or work with patients in a protected environment (ie, bone marrow transplant unit) (1,21).

Beginning in the 2013-14 influenza season, new regulations require NYS-licensed, Article 28, 36, and 40 health care and residential facilities and agencies to document the influenza vaccination status of all health care personnel, and ensure that unvaccinated personnel wear masks in areas where patients or residents may be present when the NYS Health Department declares that influenza is prevalent. Employers must provide masks, implement policies to ensure compliance, and document that unvaccinated personnel are wearing masks in the presence of patients. Upon request from the NYS Department of Health, facilities are required to report the number and percentage of personnel vaccinated in the current season (25). For more information, see FluMaskReg. In addition to these new NYS regulations, hospitals are required to continue reporting health care personnel vaccination coverage to the Centers for Medicare and Medicaid Services (CMS) using the National Healthcare Safety Network Platform. This season, data collection began on October 1. As of October 2014, CMS will also require ambulatory surgical centers to report health care worker influenza vaccination coverage (26).

BOX 4. INFLUENZA IN PREGNANCY
Pregnant women are an important priority group for vaccination and should receive a single dose of inactivated influenza vaccine in any trimester as soon as vaccine becomes available (5).
  • Pregnant women are more susceptible to severe illness from influenza (15) and have a 4-fold-greater risk of influenza-related hospitalization than nonpregnant women (16).
  • When pregnant women are vaccinated, they protect themselves and their infants younger than 6 months, who are at high risk for influenza-related hospitalization but not old enough to receive vaccine (5,17). Vaccination during pregnancy is safe. In the last decade, influenza vaccine has been given to millions of pregnant women without causing harm (16). Pregnant women are 5 times more likely to be vaccinated if their providers offer or recommend influenza vaccination (5).
  • The American Congress 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 be vaccinated against influenza.
  • Providers should also use this opportunity to administer Tdap vaccine, which is recommended during every pregnancy. Vaccination of pregnant females allows for direct transfer of antibodies to a newborn infant, which may provide protection against the disease during the infant's first few months of life, the period of highest vulnerability. Vaccination protects the mother from transmitting pertussis to her newborn infant as well. Complete recommendations for Tdap vaccination during pregnancy.

PDF version of Box 4

BOX 5. IMPROVING VACCINATION OF HEALTH CARE WORKERS
  • Get vaccinated as early as possible and ensure that your staff does the same.
  • Evidence-based strategies to improve staff vaccination rates include offering extended vaccination hours on weekends and evenings; use of mobile carts; vaccination of senior staff; and support of institutional leaders (19), as well as offering free onsite vaccination for more than 1 day (22).
  • Educate providers and staff in contact with patients about influenza vaccination and integrate vaccination into existing programs.
  • Implement policies to enforce new New York State regulations requiring that licensed health care and residential facilities and agencies document vaccination status of health care personnel and that unvaccinated staff wear masks while in patient areas.
For facilities not subject to these regulations, consider mandatory immunization of staff, as recommended by the National Vaccine Advisory Committee. The American College of Physicians, American Congress of Obstetricians and Gynecologists, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and many other professional groups agree that it is the best way to achieve targeted immunization rates of health care workers (23,24).

PDF version of Box 5

Continue to VACCINE EFFECTIVENESS on the next page >