Shortage doesn’t sway HCWs on flu vaccine

Feds vow to emphasize need for shots

This year’s flu vaccine shortage failed to budge the nation’s health care workers from their typically dismal rate of vaccination. About 43% of health care workers with direct patient care responsibilities received the vaccine, which is similar to that of prior years, the Centers for Disease Control and Prevention (CDC) reported.

Meanwhile, if a shortage recurs, health care workers will remain among the top priority groups for vaccination. But in the most severe shortage, the shots would go first to the elderly, pregnant women, children 6-23 months old, and people with conditions that put them at risk for serious complications. Health care workers are in the third tier of the top priority groups, or 1C, according to a plan approved by the Advisory Committee on Immunization Practices (ACIP).

"For all practical purposes, groups 1A to 1C can be covered in all shortage situations," says Keiji Fukuda, MD, chief of the epidemiology section of CDC’s influenza branch. "It was clear in some of the local situations where they had a very great shortage of vaccine that they had to decide who would get the vaccine."

The top tier group (1A) encompasses the elderly with health conditions that put them at risk for complications. This group suffers the greatest deaths and hospitalizations from influenza, he says. "The whole prioritization activity is difficult. We don’t want to send the message that some people are important and others are not."

Public health officials are struggling continually to convince health care workers to get the annual vaccine. While some people scramble for their chance to get priority during a shortage, health care workers may have responded differently.

"There’s the potential that some health care providers actually wanted to save vaccine for their frail patients," says Jeanne Santoli, MD, MPH, associate director for science in the Immunization Services Division of the National Immunization Program. "The message we want to get out is they are protecting their frail patients by getting the vaccine themselves."

The failure of health care workers to receive the vaccine is an ongoing frustration for public health officials. Influenza recommendations for the 2005-2006 season are likely to emphasize the need for health care workers to get vaccinated — and the message that they can safely use the new FluMist, a live attenuated virus administered nasally.

"I believe it does go beyond [just] saying what you should do," Fukuda explains. "There has to be a coordinated effort, looking at why health care workers don’t want to get vaccinated and what the institutional barriers are to vaccination. Until we address those in a fairly large-scale way, it will be difficult to move it from where it is now."

Nurses and other health care workers still believe myths about the flu vaccine, says William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University in Nashville, TN, and a representative of the Infectious Diseases Society of America to ACIP.

For example, they believe that they can get influenza from the flu vaccine — especially from the live attenuated vaccine. While people vaccinated with FluMist may have some mild side effects, such as a low-grade fever or sore throat, they do not become infected with influenza.

"[Nurses say] they can’t afford to get sick," Schaffner continues. "They have too many responsibilities, both at work and in the family. We need to provide them with education and reassurance."

Hospitals should come up with a system to make vaccination of health care workers as easy as possible, explains Greg Poland, MD, director of the Mayo Vaccine Research Group at the Mayo Medical School of the Mayo Clinic and Foundation in Rochester, MN, and a member of ACIP.

For example, Mayo sends doses of flu vaccine to each unit, and the nurses vaccinate each other.

But Poland also supports making influenza a mandatory vaccine for health care workers, with a declination similar to the one used for hepatitis B vaccination.

"There is no amount of education, no amount of information, that is going to work on increasing those rates on a voluntary basis," he adds. "Isn’t that unbelievable that only four out of 10 health care workers do this? We can’t blame it on any shortage because that’s what it’s been year after year."

Health care facilities, professional organizations, and even state legislatures should become involved in promoting influenza vaccination of health care workers, Poland says. "I hope we will finally solve this problem and protect our patients."