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HCWs should get shots and offer to at-risk patients
If this influenza season is like many others over the last few decades in the United States, 110,000 people will be hospitalized and 20,000 will die as a result of infections that may have been prevented by an available vaccine, the Centers for Disease Control and Prevention reminds.1
During influenza epidemics, deaths can increase from influenza and pneumonia as well as from exacerbation of cardiopulmonary conditions and other chronic diseases. In addition, the number of pneumonia and influenza deaths might be increasing in part because the number of elderly people is on the rise.
What can health care workers do? First and foremost, the CDC recommends that they be immunized for influenza to decrease the risk of transmitting infection to patients at high risk of infection. "Before the influenza season, health care facilities should offer influenza vaccine to all personnel, including night and weekend staff," the CDC advises. "Particular emphasis should be placed on persons who care for members of high-risk groups." Highlights of the CDC recommendations are summarized as follows:
High risk groups: Vaccination is recommended for the following groups of persons who are at increased risk for complications from influenza:
• persons aged 65 years or older;
• residents of nursing homes and other chronic care facilities that house persons of any age who have chronic medical conditions;
• adults and children who have chronic disorders of the pulmonary or cardiovascular systems, including asthma;
• adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications);
• children and teenagers (aged six months to 18 years) who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza;
• and women who will be in the second or third trimester of pregnancy during the influenza season.
The CDC recommends that flu immunization should be particularly emphasized to high-risk populations in the following settings:
• Facilities providing ongoing medical care: Staff in these facilities (e.g., physicians’ offices, public health clinics, employee health clinics, hemodialysis centers, hospital specialty care clinics, and outpatient rehabilitation programs) should identify and label the medical records of patients who should receive vaccine. Vaccine should be offered during visits beginning in September and throughout the influenza season. The offer of vaccine and its receipt or refusal should be documented in the medical record. Patients in high-risk groups who do not have regularly scheduled visits during the fall should be reminded by mail or telephone of the need for vaccination.
• Outpatient facilities: Those providing episodic or acute care health care facilities (e.g., emergency rooms and walk-in clinics) should offer vaccine to persons in high-risk groups or provide written information on why, where, and how to obtain the vaccine. This written information should be available in languages appropriate for the populations served by the facility.
• Nursing homes and other residential long-term care facilities: Vaccination should be routinely provided to all residents of chronic-care facilities with the concurrence of attending physicians. Consent for vaccination should be obtained from the resident or a family member at the time of admission to the facility or any time afterward. All residents should be vaccinated at one time, immediately preceding the influenza season. Residents admitted during the winter months after completion of the vaccination program should be vaccinated at the time of admission.
• Acute care hospitals: All persons aged 65 years or older and younger persons (including children) with high-risk conditions who are hospitalized at any time from September through March should be offered and strongly encouraged to receive influenza vaccine before they are discharged.
• Home care: Visiting nurses and others providing home care to persons at high risk should identify patients in high-risk groups, and vaccine should be administered in the home if necessary. Caregivers and others in the household (including children) should be referred for vaccination.
1. Centers for Disease Control and Prevention. Prevention and control of influenza: Recommendations of the advisory council on immunization practices (ACIP). MMWR 1999; 48:1-30.