Health care workers target of flu shot push

Supply disruptions in past years have derailed efforts to immunize this group, but a prediction of ample vaccine is getting them back on track.

By Victoria Stagg Elliott — Posted Aug. 7, 2006

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Because more flu vaccine than ever before is expected this season, activities to increase the number of health care workers who receive it are being dusted off and put in motion.

American Medical Association policy states that hospitals and skilled nursing facilities should have a system for measuring and maximizing the number of health care workers who receive the vaccine annually. The AMA is planning to restart its campaign -- put aside in the fall of 2004 because of severe supply shortfalls -- targeting this group. Health care workers will also be among those targeted by the National Influenza Vaccine Summit, which is co-sponsored by the Association and the Centers for Disease Control and Prevention.

"There are so many reasons why targeting this group makes sense," said Raymond Strikas, MD, seasonal and pandemic influenza coordinator for the Dept. of Health and Human Services' National Vaccine Program Office.

Also, to supplement February recommendations from the CDC's Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices aimed at health workers, the Joint Commission on Accreditation of Healthcare Organizations last month issued new standards. These require hospitals and long-term care facilities to offer the flu shot to employees and volunteers with close patient contact as of Jan. 1, 2007.

Health professionals have long been a focus of vaccination efforts but have also traditionally had a low immunization rate -- hovering around 40%. Experts say that while they comprise one of the smaller segments prioritized to receive vaccine, health professionals are particularly important because they can transmit the virus to patients.

"Preventing the spread of the flu protects patients and saves lives. Encouraging health care workers to be vaccinated can play a vital role in stopping the transmission of this potentially fatal infection," said Robert Wise, MD, JCAHO's vice president of the Division of Standards and Survey Methods.

Vaccination advocates also suspect that increasing rates among health care workers may have a domino effect in the general population. Several studies have suggested that a vaccinated health care worker is more likely to recommend flu shots to patients.

"When a doctor or nurse says they don't get [the influenza vaccine] that is absolutely the wrong message," said Andrew Eisenberg, MD, a family physician from Madisonville, Texas, who represented the Texas Medical Assn. at the summit.

In some ways, it should be an easy target. Health care workers are simple to find and identify in the workplace. Most can receive either the injectable or the live attenuated nasal version. A desire to not harm patients is a potent motivator.

"That health care workers get it because they don't want to make their patients sick is still underappreciated," said William Schaffner, MD, vice president of the National Foundation for Infectious Diseases.

Experts note, however, that unique challenges are still in play. Most health professionals view themselves at low personal risk and may not be aware that transmission from them to vulnerable patients is a significant risk. Many are concerned about side effects and, like many patients, may still hold the misperception that the flu vaccine causes the flu.

"The myth that you can get the flu from the flu vaccine is alive and well, and it's one thing that we still need to address," said Dr. Schaffner.

Advocates also say that efforts made so far are only the beginning. Additional action will be needed to make it even more likely that health care workers will get vaccinated.

"We hope in the future this standard will be expanded to encompass various strategies to increase health care worker vaccine uptake," Dr. Schaffner.

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To get vaccinated or not

Health professionals cite their concerns, both for and against getting a flu shot.

Reasons for not receiving influenza vaccine

  • Concerns about side effects or vaccine safety, including the misperception that the injectable vaccine could cause the flu
  • Perception of a low personal risk of contracting influenza
  • Inconvenience
  • Lack of awareness of the CDC recommendations
  • Dislike of needles

Reasons for deciding to receive the vaccine

  • Personal protection
  • Previous firsthand experience with having the flu
  • Convenience; free vaccine
  • Concerns about missing work
  • Protection of patients

Source: "Improving Influenza Vaccination Rates in Health Care Workers," National Foundation for Infectious Diseases, 2004

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Flu shots for health care workers

64% go unvaccinated, which is a key cause of influenza outbreaks in health care settings

36% are vaccinated, which is associated with reduced absenteeism and fewer patient deaths

Note: Annual average

Sources: National Foundation for Infectious Diseases, "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices," MMWR, 2003.

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External links

National Influenza Vaccine Summit, sponsored by the American Medical Association and the Centers for Disease Control and Prevention (link)

National Foundation for Infectious Diseases on health care workers and influenza (link)

"Influenza Vaccination of Health-Care Personnel," Morbidity and Mortality Weekly Report, Feb. 9 (link)

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