Don't let the flu start with you it's not too late to get your flu shot this season!

This year between 5%-20% of the population will be infected with influenza virus resulting in an estimated 200,000 hospital admissions and 36,000 deaths. Although whether or not you choose to get an annual influenza vaccination is a personal decision, it really is a patient safety and quality of care issue. There are multiple reports in the literature of healthcare worker (HCW) to patient transmission of influenza, and subsequent hospital-based or long term care-based outbreaks leading to increased patient morbidity and mortality and difficulty in safely staffing those facilities. Influenza immunization of HCWs has been shown to not only decrease influenza illness and absenteeism in HCWs, but to also decrease mortality in patients they care for. Two randomized clinical trials have demonstrated statistically decreased mortality rates in patients cared for by HCWs who are immunized against influenza.

The American Nurses Association has called annual influenza immunization of nurses "an ethical responsibility." Their web site states the ANA is "adamant about nurses receiving flu vaccine ..." Several other professional organizations (the Society of Hospital Epidemiologists of America and the Infectious Diseases Society of America) as well as the Centers for Disease Control and Prevention not only recommend yearly influenza vaccinations for all HCWs with direct patient contact but also recommend obtaining a signed declination (informed refusal form) from HCWs who decline influenza vaccination for reasons other than medical contraindications. Vaccination or a signed declination is now considered the standard of care.

JCAHO has added influenza vaccination as a new Infection Control standard in 2007. Healthcare organizations must not only offer a robust vaccination program but must also evaluate its efficacy and implement enhancements to increase participation. JCAHO has not yet adopted the requirement of signing an informed refusal form, but many think this will be included in the standard in the next year or two. Nationwide, compliance with influenza vaccine among HCWs is abysmally low; estimates from the CDC put it in the range of 35%-40%, leaving ample room for improvement!

Historically, nurses have a much lower compliance rate with annual influenza vaccination than physicians, and yet no one would argue the fact that nurses have far more direct patient contact (with potential for transmission) than physicians! Nurses can act as "disease amplifiers" and vectors for influenza. We can protect our patients, and provide a "cocoon" around our vulnerable patients, by making sure that each and every one of us is protected from influenza. Like many other infectious diseases, we are capable of transmitting the infection to our patients for at least 24 hours before we become symptomatic. And some studies suggest that as many as 25% of HCWs show serological evidence of influenza during peak flu times, but may have either very mild, or even no symptoms yet still be shedding virus!

Some common myths about flu shots include: they don't work, they will give you the flu, they have many side effects and if you missed getting vaccinated in November, it's too late for this year. Although protection is not 100% (no vaccine can make that claim!) and it will vary from year to year (depending on how closely the vaccine strain matches the circulating strains for the season), it does offer significant protection for the majority of people. It takes approximately two weeks before a vaccine recipient will have produced enough antibody to be protected. The vaccine is made of sub-units of the influenza virus which are not capable of causing infection. While it's preferable to get vaccinated early in the season (October is ideal), January is not too late. Flu season in Vermont typically doesn't peak until mid-winter so getting vaccinated in January or even February may offer significant protection. And a recent placebo-controlled trial showed convincingly that the only significant side effect seen with influenza vaccine when compared with a placebo was a sore arm. This seems a small price to pay for providing safe patient care!

Although previous years have seen shortages in the influenza vaccine, this year's supply is plentiful. Between 110-115 million doses will be available by the end of 2006. Vaccine was distributed in a phased manner early in the season but by year's end, all providers should have received their full orders. CDC is also helping facilitate distribution of vaccine from distributors who may still have available influenza vaccine. In addition to HCWs, the groups recommended for annual influenza vaccination this year include:

* Persons at high risk for influenza-related complications and severe disease including:

* Children aged 6-59 months

* Pregnant women

* Persons > 50 years of age

* Persons with certain chronic medical conditions

* Persons who live with, or have household contact with, persons at high risk.

The 36,000 deaths associated with influenza each year in this country make it the sixth leading cause of death among adults. More people die of complications from influenza than any other vaccine-preventable disease in the United States. One significant step you can take to help protect your patients is to get your flu shot. It is a moral and ethical imperative. Don't let the flu start with you; if you haven't gotten your flu shot yet, it's not too late!

by: Susan Page, MT, MS

Infection Control Practitioner