Vaccinate Yourself: Push Is On to Immunize Health Care Workers Against Influenza

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Public Health Feature -- October 2004  

By  Ken Ortolon  
Senior Editor
 

A killer is coming to America sometime this fall or winter. Each year around November or December influenza virus strikes hundreds of thousands of Americans, sending more than 114,000 to the hospital and killing more than 36,000, including 3,700 right here in Texas.

Public health officials are working hard to boost the number of Americans who get a flu shot every year. The Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) has long recommended flu shots for groups at high risk of complications from the flu. And this year, for the first time, ACIP formally recommends vaccination of all children aged between 6 months and 23 months.

But many public health advocates say morbidity and mortality resulting from the flu could be reduced dramatically if one group of Americans, in particular, got flu shots. That group is health care workers.

"Low influenza vaccination rates among health care workers pose a serious health threat to the patients in their care, including infants and children, the elderly, and chronically ill," said William Schaffner, MD, a member of the board of the National Foundation for Infectious Diseases (NFID) and professor and chair of the Department of Preventive Medicine at Vanderbilt School of Medicine. "Measures must be taken to ensure health care workers are provided convenient access to influenza vaccine and that employers of health care workers commit programs and resources toward institutionalizing immunization in the workplace."

NFID and other organizations say unvaccinated health care workers can be a key cause of flu outbreaks in offices, clinics, hospitals, and other settings. Yet, only about one-third get a flu vaccination each year, putting their patients at risk. In 2003, only 37 percent of health care workers were vaccinated against the disease.

"Thirty-seven percent is abysmal," said Madisonville family physician Andrew C. Eisenberg, MD, chair of Texas Medical Association's Council on Public Health. "It's the Typhoid Mary story. If you've got a carrier of disease bringing it to the people who are most likely to have a devastating effect from it, then we, in fact -- just like using dirty stethoscopes or not washing our hands -- are bringing a potential agent of death or morbidity to all of our patients."

NFID says health care-related professional organizations, a wide range of health care facilities, and government agencies recognize a problem with health care workers not being vaccinated. Among those supporting efforts to immunize health care workers are the American Medical Association, American Hospital Association, CDC, the Centers for Medicare & Medicaid Services, numerous national medical specialty societies, several hospital systems, and others.

TMA supports immunization of health care workers. To promote flu shots among Texas physicians and their families, TMA sponsored a flu shot clinic as part of the kickoff of its Be Wise - ImmunizeSM campaign at TMA Summit 2004, Oct. 1-2.           

Sticking the Right Arms  

While emphasizing health care workers this year, public health officials are not ignoring other groups who need flu shots. Lisa Davis, adult immunizations coordinator in the Texas Department of State Health Services (DSHS) Immunization Branch, says anyone who wants a flu shot should get one. But CDC recommends flu shots for several groups at highest risk for complications. They include:

  • Everyone aged 65 or older;
  • Residents of nursing homes or other facilities who are housed with people with chronic conditions;
  • Anyone over 6 months old who has chronic pulmonary disease, cardiovascular disease, diabetes, renal disease, or other chronic illnesses;
  • Anyone who is immunosuppressed;
  • Children aged between 6 months and 23 months and their household contacts; and
  • Pregnant women and children older than 2 years who are undergoing long-term aspirin therapy.

Ms. Davis says CDC "encouraged" flu shots for children last year, but in March ACIP adopted it as an official recommendation.

Tracking the Flow  

Meanwhile, public health officials are working hard to ensure that influenza impacts as few Americans as possible this year. The 2003-04 flu season was frustrating for public health officials because of two factors.

First, despite months of work monitoring influenza outbreaks around the world, infectious disease experts and vaccine manufacturers guessed wrong about the flu strain most likely to strike the United States. That meant the available vaccine only partially protected people against the strain that actually hit the country. Second, the flu outbreak struck far earlier than anticipated, catching public health officials, the medical community, and the public off guard.

"Historically, our flu season occurs at more specific times of the year -- December, January, and February, even sometimes into March," said Neil Pascoe, RN, an epidemiologist and DSHS state flu surveillance coordinator. "But the peak of our flu activity has never been as early as it was last year.  We actually peaked before Thanksgiving."

Public health officials do not expect another early flu season this year, but they urge health care professionals to begin administering vaccinations in early October for those at highest risk for influenza complications.

The problem for those trying to prevent disease is predicting which strain will hit and including it in the vaccine distributed to physicians. Each year, the influenza vaccine typically includes two strains of influenza A and one of influenza B.

Last year, much of the United States saw the Fujian strain, a strain of influenza A designated as H3N2 for the types of hemoglutinin and neuraminidase proteins it contains. Unfortunately, the vaccine supply did not contain antigens to combat that strain, but instead contained a similar strain known as Panama.

This year's vaccine contains antigens that will protect against the Fujian strain and against an influenza strain known as New Caledonia, and an influenza B strain called Shanghai.

While vaccine shortages have been a problem in past years, public health officials had expected to have between 90 and 100 million doses available this year. But roughly half of that supply came into question in late August when Chiron Corp. announced that it had found tainted doses in its factory. The company delayed shipment of nearly 50 million doses while it determined whether the vaccine was safe. It was hoping to ship between 46 and 48 million doses by early October, about a month later than usual.

Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at ken.ortolon@texmed.org .  

SIDEBAR  

The True Meaning of Terror

By Andrew C. Eisenberg, MD  

Having just weathered one of the worst storms in recent memory, being on a barrier island in the Gulf of Mexico and waiting anxiously as the erratic path of oncoming destruction headed our way, I found my attention drawn to the possibilities of the upcoming seasons. In these heated days of animosity, terror, and fear, we have often neglected those things that Mother Nature can and will spring upon us. As was the case with Hurricane Charley, we in public health often can predict an upcoming event, give warnings about its possibilities, and see that many heed our advice and remain safe. But others may not do so and will bear the brunt of their decisions.

The case in point that I allude to is the upcoming influenza season. At least here in North America, we find that the winter heralds the usual arrival of a long-time human nemesis, the flu. What might be important to remember is that the devastation of this disease is considerable, both in the toll on human life and in the economic repercussions. The swath hewn by the annual path of this disease is often far wider and more insidious than that which we witnessed in this hurricane. The death toll has exceeded the half-million mark in a single year (1918) in our country alone, and more than 4 million around the world.

This true biological terror is often downplayed as just "the flu," and often our warnings and admonishments to protect oneself and family go unheeded. I heard and read about those same human sentiments in the day prior to the arrival of Charley. "Oh, it won't hit here." "What difference do preparations make?" With extreme procrastination, some people waited until the last minute and then had no way out, stubbornly dismissing the odds.

Our world gets smaller every day. Global travel has accelerated the exposure of citizens from all walks of life to new and potentially harmful pathogens. Although many have been rare visitors to our shore, their numbers increase yearly. SARS, measles, anthrax, and avian flu are all potentially deadly, and many are potentially prevented.

Influenza vaccination can be a gift of a second chance or even the gift of life to you and your loved ones. Your patients, friends, and families all deserve at least this small amount of attention to their well-being. While the call for mandatory influenza vaccination has not yet passed from the lips of the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention, it will be here as the capacity to do so increases.

As physicians, we are in a position to set an example for our coworkers, patients, and communities. It is incumbent on us to actively promote the minimal risks and outstanding benefits of influenza vaccination for all. Current recommendations are not to prioritize delivery, but to begin early this month and vaccinate as many as you can, or refer them to a place that will. Prevention is of paramount importance. We too often deal with crisis situations and pay little heed to the preventive things that we could be doing. It does not take more than a few seconds. Have your nurses ask and give vaccine with standing orders; talk to your friends, colleagues, and staff about the importance of vaccinations. Lead by example and vaccinate yourselves.

The coming years will have an influenza pandemic. The question is not if, but when, and just like the path of Charley, we can only guess. Yet unlike that grand force of Mother Nature, we have a relatively effective weapon available for influenza. Let's keep our country safe from this biological terror.

Dr. Eisenberg is a family physician inMadisonvilleand chair of the TMA Council on Public Health.  

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