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Roundtable gives boost to HCW flu vaccine
Experts convene to promote vaccination
Why do so few health care workers get the flu vaccine each year? What can be done about it?
Those were the central questions as the National Foundation for Infectious Diseases held a roundtable discussion in November on improving influenza vaccination rates among health care workers.
"Many health care workers don’t think of themselves as part of the risk groups that need to be vaccinated," says William Schaffner, MD, who is on the board of the foundation. He also is chair of the department of preventive medicine at Vanderbilt University in Nashville.
The key reason health care workers need the vaccine is to prevent spread of the disease to vulnerable patients. Schaffner also notes that when flu season hits, hospitals need their employees to be healthy and working — not out sick.
That message was underscored in November when Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), cautioned that this could be a more severe flu season. She highlighted the need for health care workers to receive the vaccine.
"I think it’s really a responsibility for health care workers to provide that level of extra protection to themselves, their patients, and their families," she said. "We will be working even harder and more aggressively with the health care community to try to encourage this."
The roundtable, which included infection control and preventive medicine experts as well as representatives of major medical organizations, specifically tailored conversations around health care workers, not the at-risk patients.
According to the 2000 National Health Interview Survey, only about 38% of health care workers receive the flu vaccine.
"We talk so much about immunizing patients that this focus on the health care provider is an afterthought," Schaffner says. "This is the occasion to bring that front and center."
The roundtable will produce a white paper with a summary of major points in the discussion, including information about best practices.
"Ultimately, we hope that institutions and organizations will take these issues on and themselves become active in more effectively promoting health care worker vaccination," says Kristin Nichol, MD, MPH, MBA, chief of medicine at the Minneapolis VA Medical Center and an expert on infectious diseases and immunization.
Key issues: Education and convenience
More than 60% of health care workers receive their flu vaccines at the Minneapolis VA Medical Center, and Nichol credits education and convenience. Each fall, an infection control nurse works with clinical units to schedule a time for the mobile flu vaccine cart to visit each shift. Employees who miss the cart during its two-week period can visit infection control.
Year after year, the education becomes cumulative. But Nichol also has been active in dispelling common myths about the flu vaccine.
"We find people have misconceptions about the safety of vaccination," says Nichol. "You cannot get the flu from the flu shot.
"We actually did a placebo-controlled trial and demonstrated there is no difference in systemic symptoms between people who got the flu shot and people who got the [saline shot]."
Nichol notes that "the background rate of symptoms in the population is rather high," with as many as 20% of people feeling some symptoms, such as headache or fever, at any period of time. The only symptom clearly associated with the flu vaccine was soreness at the injection site.
FluMist, an intranasal vaccine, was recently approved by the Food and Drug Administration. Because it is a live, attenuated virus, it is not currently recommended for use by health care workers. Eventually, that recommendation could change as more data on its use becomes available. "I think it has the potential for substantially increasing the flu vaccine acceptance by health care workers," Schaffner says.
Meanwhile, Nichol emphasizes not only the need to protect patients from influenza outbreaks, but also the importance of protecting to the health care workers.
"[With the flu], you’re ill on average six days. You spend two or three or four in bed. It’s tremendously disruptive to the household," she says. "The personal benefits are not just for that person but for the entire household."
Through the roundtable, Schaffner and Nichol also intend to encourage organizations such as the American Medical Association and the American Nurses Association to promote influenza vaccination to their members.
"Many of the leading professional organizations do not specifically educate and recommend to their members that they be vaccinated," says Schaffner. "They rely on the CDC, and they know the message is out there. They have not themselves specifically spoken to their own membership on this topic. We’re going to try to enlist some of these professional organizations to just get the word out."
Higher vaccination rates will have other positive benefits, Nichol says.
"As more health care workers themselves become more sensitize to these issues and are immunized themselves, I would hope there might be a spillover effect to enhance immunization efforts for their patients, as well," she says.
Each year’s success builds on itself, she adds. "We do know that health care workers who have been previously immunized are more likely to be immunized in subsequent years," she says.