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Delays in delivery of influenza vaccine have created new challenges for employee health professionals as they try to boost their vaccination rates of health care workers. But as one hospital found, misconceptions about the influenza vaccine create long-standing obstacles to vaccination. Health care workers often harbor myths about the vaccine’s effectiveness and possible side effects, says Mary Lou Solliday, RN, MPH, CIC, director of infection control at St. Francis Hospital — The Heart Center in Roslyn, NY.
Solliday identified the reasons health care workers fail to receive the vaccine through a survey of hospital staff, conducted with assistance from the Centers for Disease Control and Prevention in Atlanta. A significant number of employees believed they could contract influenza from the vaccine — even though it uses a dead virus, says Solliday. Others worried that the vaccine could be harmful. (For list of reasons, see table, below.)
|Reasons for Not Getting Vaccinated|
|Avoid all medications whenever possible||People of any age can get influenza. Most people are ill with influenza for only a few days, but some get much sicker and may need to be hospitalized. Influenza causes thousands of deaths each year, mostly among the elderly. Influenza vaccine can prevent influenza.|
|Worried about side effects||Randomized trials in healthy adults have reported that the only side effects seen more commonly in those vaccinated with influenza vaccine vs. placebo is sore arm.|
|Concerned about getting the flu from vaccine||The viruses in the vaccine are killed, so you cannot get influenza from the vaccine.|
|Forgot, too busy, inconvenient||Employee health services will set up an area on each floor to make vaccinations convenient for all employees.|
|Pregnant, breast-feeding, or trying to get pregnant||Pregnancy tests are available in employee health services. Influenza vaccine is safe for nursing mothers and their infants and is recommended for women who will be in their second or third trimester of pregnancy during the influenza season.|
|Not recommended by their doctor||Vaccination of all health care workers has been recommended for many years.|
|Concerned about effectiveness of vaccine||Influenza vaccine is effective only against illness caused by influenza viruses, and not against other causes of fever and colds. Influenza viruses change often, and they may not be covered by the vaccine. But people who do get influenza despite vaccination often have a milder case than those who did not get the shot.|
|Vaccinated previous year||Viruses that cause influenza change often. Because of this, influenza vaccine is updated each year by replacing at least one of the vaccine viruses with a newer one. This is done to make sure the vaccine is as up-to-date as possible. Protection develops about two weeks after the shot and may last up to a year.|
|Source: St. Francis Hospital — The Heart Center, Roslyn, NY.|
Through a campaign to debunk myths, launched with highly visible top management support, St. Francis Hospital improved its vaccination rate from 11% to 60% in just one year, says Solliday, who presented information on her hospital’s vaccination program at the recent Association for Professionals in Infection Control and Epidemiology conference held in Seattle. "It’s an educational process that requires constant reinforcement," says Solliday.
Health care workers sometimes don’t realize the possible consequences of failing to get vaccinated. That came into focus at St. Francis in 1999 when the hospital identified a nosocomial spread of influenza in one cluster of patients. Despite expected delays in distribution of the flu vaccine this year, the CDC and the Advisory Committee on Immunization Practice place a high priority on vaccinating health care workers who work with patients at high risk of complications from influenza.
"During the winter, influenza can have a pretty substantial impact upon hospitals in terms of patient visits, hospitalized patients, absenteeism among health care workers, and unrecognized nosocomial transmission of influenza," says Tim Uyeki, MD, MPH, MPP, medical epidemiologist in CDC’s influenza branch.
The year after the outbreak, the chief executive officer of St. Francis sent a letter to every employee explaining the importance of getting vaccinated and emphasizing that the vaccine is safe and effective. CDC reports that the influenza vaccine, which is formulated each year to match the prevalent strains, is 70% to 90% effective. The hospital’s medical director sent a similar letter to physicians, urging them to get the vaccine.
The annual vaccination campaign began on Employee Appreciation Day, when staff gathered for a barbecue. "Administrative staff served as role models by rolling up their sleeves and getting vaccinated first," says Solliday. Meanwhile, Solliday and her colleagues were armed with an information sheet explaining the myths and facts about the vaccine. For example, women who were pregnant, trying to get pregnant, or breast-feeding were concerned about getting the vaccine. Yet CDC actually recommends that women who will be in their second or third trimester during the flu season have the vaccine, and the vaccine is considered to be safe for those who are breast-feeding.
Health care workers also need to realize that the flu vaccine won’t prevent them from all types of respiratory illnesses in the winter, notes Uyeki. "The common cold virus can cause a high fever, coughing, runny nose, and people will conclude, I have the flu. I got the flu shot in the fall, and I still have the flu,’" he says. "Most likely they didn’t get the flu, they got other upper respiratory infections."
This year, the CDC has asked manufacturers to distribute some early vaccine to all providers. Hospitals will give priority doses to the highest-risk patients and those who care for them. But education of health care workers should include information about the value of the vaccine even later in the fall or early winter, says Solliday. "It’s still going to protect them, and it’s still important."
The influenza vaccine takes one to two weeks to become fully effective. In an average year, the influenza season stretches from late December to early March, with peak activity in the early spring. Hospitals can improve influenza vaccination rates by extending the time period in which they offer the vaccine at employee health departments, says Uyeki.