Protect HCWs and patients with early flu vaccines
Protect HCWs and patients with early flu vaccines
Additional H1N1 vaccines may be necessary
Amid uncertainties about the novel H1N1 virus (swine flu), there's one clear edict: Vaccinate early and often for seasonal influenza.
Public health authorities advise hospitals and other health care providers to get an early start on the annual flu vaccine campaigns, which would provide more time for additional H1N1 vaccines, if necessary. "If possible, we do want to try to have an earlier roll-out of the seasonal influenza vaccine simply for that reason, to make it easier for an additional vaccine, if that's the ultimate policy," says Daniel Jernigan, MD, PhD, deputy director of the influenza division at the Centers for Disease Control and Prevention in Atlanta.
If CDC asks health care workers to protect themselves from the novel H1N1 with immunization, they will probably need to have two separate vaccines - and may even require two doses of the "swine flu" version, says vaccine expert John Treanor, MD, professor of medicine and of microbiology and immunology at the University of Rochester (NY). That could create logistic issues for both vaccine manufacturers and health care providers.
"We are aggressively taking the very early steps that are necessary for vaccine manufacture, should a decision be made to go ahead and ramp up to full-scale production," Nancy Cox, PhD, director of CDC's influenza division, explained at a press briefing in early May. "If a vaccine for this new virus is prepared, it would be prepared either in parallel with or after the seasonal vaccine is already produced, so that we would be able to have the seasonal vaccine, and then if necessary, a supplemental vaccine with this new H1N1 virus."
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Sick calls help track H1N1 spread Done in 90 seconds When the first cases of a novel H1N1 flu strain emerged in the United States, Ken Michaels, DO, MPH, medical director of Orlando (FL) Health Occupational Health, braced for the worst. With all the travelers streaming through Orlando, home of Walt Disney World, it only was a matter of time before local cases would appear. Michaels wanted to stay ahead of the problem with careful surveillance. Prior flu vaccine campaigns gave him a potential tool: A database for tracking employee health responses. Michaels wanted to standardize the employee call-in procedure so that sick employees could be monitored for flu-like symptoms. He first gained the support of infection control and then asked information services to develop an easy-to-use system. Orlando Health, which has 14,000 employees in seven hospitals and numerous clinics and outpatient sites across three counties, adapted a tracking system to monitor the consent and declination for flu vaccines. When an employee calls in to his or her manager or the unit secretary, the person taking the call clicks on an icon on the hospital's intranet system and enters the employee's ID. The system automatically logs the time and basic information, such as the employee's department, shift, and job title. Questions then pop up with a field of possible answers, making it simple to log the responses. The first question: Is the employee sick, or staying home because of a sick family member, unexpected child care issues, or another reason? If the employee is sick, do the symptoms include: Fever, cough, muscle ache, sore throat, nausea, vomiting, headache, fatigue, diarrhea? (They check all that apply.) Have you been in close proximity or contact with anyone who has these symptoms? If yes, was that person a co-worker? A patient the employee was caring for? A family member or other close household contact? Friend or neighbor? Other? How many days have you been sick: 1, 2, 3, 4, or 5 or more? Have you been seen for your current symptoms at: a physician's office, urgent care center, emergency department, or received no medical treatment? The system also prompts a reminder to employees not to return to work until they've been fever-free (less than 100°F) for at least 24 hours. "This takes 90 seconds or less. That's our goal. It's got to be quick," says Michaels. During a pandemic, employee health could run daily reports on absences due to illness and could look for patterns, such as a larger number of absences in a particular department. |
Employee health services may need to garner more resources for an expanded flu vaccination program, says William Schaffner, MD, professor and chairman of the Department of Preventive Medicine and professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, TN. Schaffner also is a liaison member of the Advisory Committee on Immunization Practices, an expert panel that advises CDC.
"It would be very well for people to rehearse scenarios and to inform their administrations that if this is indeed the case [that additional vaccines will be recommended], they're going to need more resources," he says.
By May, flu vaccine manufacturers had produced much of the bulk seasonal flu vaccine. The three strains in the vaccine are selected based on surveillance of prevailing influenza disease in Asia. Yet public health authorities were closely watching the emergence of winter in the Southern Hemisphere and the continued spread of the novel H1N1.
"I'd make two different plans [to protect hospital employees]," suggests Treanor. "What am I going to do if an outbreak of flu occurs over the summer? That planning is about how to cover employee absenteeism, personal protective equipment, how to staff situations where there may be a lot of illnesses and a run on capacity."
"I'd also have a plan for what happens if we need to vaccinate people and be prepared for a larger-than-usual outbreak of flu early in the fall or winter. Those are all completely reasonable scenarios."
Build on annual flu programs
Hospitals have made huge strides in improving annual flu vaccination of employees, and the improved structure of delivering and tracking vaccinations will be beneficial in this fluid situation.
Yet Schaffner notes that hospitals would need to become even more efficient at vaccinating employees if the novel virus triggers more severe disease and extra doses are required. "Making the vaccine is the easy part [by comparison]," he says. "Then you have to create a delivery system."
Recordkeeping and documentation will be more important than ever. "I can [imagine] a patient coming into Nashville who last month visited her daughter in Evansville, IN, where she got an influenza vaccine. Which one did she get?" says Schaffner. "It can be confusion on top of turmoil."
Hospitals and health care workers should not become complacent if the novel H1N1 continues to be no more virulent than seasonal flu, cautions Treanor. If more people are susceptible to this virus, then we can expect a greater magnitude of complications, hospitalizations, and deaths, just by the numbers alone, he notes. "Because a lot of people are susceptible, the attack rates would be large," he says.
"Another scenario that would be absolutely in line with what happened in the past is to be focused on H1N1, and have [avian flu] H5N1 [emerge as a transmissible virus]," he says. "You just have to be prepared for the unexpected, which is what people in public health try to do."
If we have a new H1N1 vaccine, will health care workers embrace it or shun it? The answer depends largely on the perception of the novel flu virus, says Treanor.
"If there is substantial indication that the virus is going to spread and cause an outbreak in the U.S., then I think there will be a demand," he says. "If there's a vaccine that is expected to be protective, I think most health care workers are going to want to get it, although there would be concern about side effects."
However, if the novel flu seems relatively mild, health care workers may avoid the additional vaccine, he predicts.
Education is the best way to boost health care worker vaccination, says Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU) in Washington, DC.
"There are a lot of myths around the flu vaccine. We are gratified to see that where there is comprehensive education, more people can have their questions answered, people get vaccinated at much higher rates," he says.
Health care workers also need to be protected if a novel vaccine causes unexpected complications, he says. "If this is an experimental vaccine, then we would want to have assurances that if people did get sick or die, there would be some level of compensation provided to them or their family members," says Borwegen, although he notes that traditional flu vaccines do not use a live virus and therefore don't carry the risks of some other vaccines, such as the smallpox vaccine.
Amid uncertainties about the novel H1N1 virus (swine flu), there's one clear edict: Vaccinate early and often for seasonal influenza.Subscribe Now for Access
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