INFLUENZA VACCINATION IN AGED

CARE

11 May 2018

INFLUENZA VACCINATION

Influenza Vaccination

• 5 quadrivalent influenza vaccines

• 2 enhanced trivalent influenza vaccines (> 65 years)

• 2018 influenza vaccine strains:– A(H1N1): an A/Michigan/45/2015/(H1N1)pdm09 like virus

– A(H3N2): an A/Singapore/INFIMH-16-0019/2016(H3N2) like virus#

– B: a B/Phuket/3073/2013 like virus

– B: a B/Brisbane/60/2008 like virus*

#New strain (differs from the strain in 2017 vaccine)

*Not included in the enhanced TIVs

Influenza Vaccination

https://beta.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2018

Funded Groups

• In 2018 influenza vaccination is funded for:– All adults > 65 years

– All persons aged > 6 months who have certain medical conditions which increase the risk of influenza disease complications

– Aboriginal and/or Torres Strait Islander persons aged 6 months to < 5 years or > 15 years

– Pregnant women (during any stage of pregnancy)

– All children aged 6 months to < 5 years

Influenza Vaccination for > 65 years

• Increased risk of serious complications

• Reduced immune response to vaccine

• 2 new funded enhanced trivalent vaccines:– Fluzone High-Dose (4 x amount of antigen)

– Fluad (includes adjuvant)

• Similar effectiveness

• Preferentially recommended

• Staff and residents

Influenza Vaccination for > 65 years

• Injection site reactions more common – 30% vs 20%

• Systemic reactions similar

• No expected increase in severe/serious AEFIs

• One or the other!

• Dose of QIV not needed

• Report adverse events associated with vaccination

Staff Influenza Vaccination

• Annual vaccination for ALL staff of aged care facilities

• > 95% vaccination coverage of staff prior to flu season

• HCWs are at significantly increased risk of getting influenza

• Staff vaccination reduces ILI and deaths during high flu activity

• 88% estimated effectiveness in HCWs

STAFF INFLUENZA VACCINATION

PROGRAM – BEST PRACTICE

COMPONENTS

What are we doing now?

• Package for ACFs

– Declination form

– Promotional posters

– 4-page FAQ addressing barriers

– Brochure

– Checklist for facilities

Checklist – Best Practice Vaccination Program

Components

• Based on evidence

• No “one size fits all” approach

• Understand enablers and barriers in your facility

• Multi-component approach is best

• Requires sustained effort

Declination Form

• Good evidence

• Benefits of a declination form:– Prompts staff to consider their reasons

– Acknowledge risk

– Identify staff who could benefit from education

– Understand barriers to uptake

– Assist with the management of staff during outbreaks

Promotion

• Posters

• Brochures

• Screensavers

• Emails, newsletters

• Program kick-off event

• Stickers/badges for vaccinated staff

Feedback on Vaccination Target

• Set a vaccination target and promote it– > 95% recommended

• Regular updates

• Confidentially follow-up staff who haven’t declared intention

Vaccination Champions

• Actively organise and promote program

• Senior, influential or other relevant staff

• Champions could:– Run education sessions

– Distribute materials

– Distribute coverage updates

– Use word of mouth

– Counsel staff

– Publicise their own vaccination

Access

• Free vaccine for all staff

• On-site vaccination– Time-limited sessions

– Mobile cart

– Vaccination day

• Offer as many sessions as possible

• Schedule at times that maximise uptake

• Off-site access as adjunct

Education

• Tailor messages to identified barriers/misconceptions

• Presentations

• Videos

• Written Material

Source: www.isg.org.au

Incentives

• Personal incentives

• Group incentives – For reaching target

– For having the highest coverage

Commitment and Support by Management

• Can be demonstrated by:– Documented influenza vaccination policy

for all staff

– Providing a recommendation

– Accepting the vaccination

– Participating in the program in visible ways

Source: www.health.qld.gov.au

Data Collection

• Accurate data will assist your program

• Register recommended

• Collect data on staff who receive the vaccine outside of your facility

Summary

• Vaccination is the best protection

• > 65 years – higher-immunogenicity trivalent vaccines

• Staff Influenza vaccination programs:– ACT Health Resources

– Multi-component program

– Consider your enablers, barriers and resources

– Accurate data collection

Questions

References

• Australian Technical Advisory Group on Immunisation (ATAGI). The Australian immunisation handbook 10th ed(2017 update). Canberra: Australian Government Department of Health, 2017.

• National Centre for Immunisation Research & Surveillance (NCIRS). Influenza vaccines frequently asked questions. May 2018. Available from: http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/Influenza-FAQs.pdf(accessed May 2018).

• Australian Technical Advisory Group on Immunisation (ATAGI). Statement on the administration of seasonal influenza vaccines in 2018. 19 Feb 2018. Available from: https://beta.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2018 (accessed Apr 2018).

• Lytras T, Kopsachilis F, Mouratidou E et al. Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis. Human Vaccines and Immunotherapeutics2016;12(3):671-681.

• Hollmeyer H, Hayden F, Mounts A et al. Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and other respiratory viruses 2012;7(4):604-621.

• Stuart M. Review of strategies to enhance the uptake of seasonal influenza vaccination by Australian healthcare workers. Communicable Diseases Intelligence 2012; 36(3):268-276.

• Lam P, Chambers L, MacDougall D et al. Seasonal influenza vaccination campaigns for health care personnel: systematic review. CMAJ 2010;182(12):542-548.

• Heinrich-Morrison K, McLellan S, McGinnes U et al. An effective strategy for influenza vaccination of healthcare workers in Australia: experience at a large health service without a mandatory policy. BMC Infectious Diseases 2015;15(42). DOI 10.1186/s12879-015-0765-7

References

• Halliday L, Thomson J, Roberts L et al. Influenza vaccination of staff in aged care facilities in the ACT: how can we improve the uptake of influenza vaccine? Australian and New Zealand Journal of Public Health 2003;27(1):70-75.

• Hayward A, Harling R, Wetten S et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised control trial. BMJ 2006. DOI:10.1136/bmj.39010.581354.55

• Lemaitre M, Meret T, Rothan-Tondeur M. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomised trial. JAGS 2009;57:1580-1586. DOI: 10.1111/j.1532-5415.2009.02402.x

• Rothan-Tondeur M, Filali-Zegzouti Y, Golmard J et al. Randomised active programs on healthcare workers’ flu vaccination in geriatric health care settings in France: the VESTA study. The Journal of Nutrition, Health & Aging 2011;15(2):126-132.

• Hill J, Smith B, Evans C et al. Implementing a declination form programme to improve influenza vaccine uptake by staff in Department of Veterans Affairs spinal cord injury centres: a pilot study. Journal of Hospital Infection 2015;91:158-165.

• Jung Y, Kwon M, Song J. Stepwise intervention including 1-on-1 counselling is highly effective in increasing influenza vaccination among health care workers. American Journal of Infection Control 2017;45:635-41.

• Tannenbaum T, Thomas D, Baumgarten M et al. Evaluation of an influenza vaccination program for nursing home staff. Canadian Journal of Public Health 1993;84(1):60-62.

• Thomas D, Winsted B, Koontz C. Improving neglected influenza vaccination among healthcare workers in long-term care. JAGS 1993;41:928-930.

• Ofstead C, Amelang M, Wetzler H et al. Moving the needle on nursing staff influenza vaccination in long-term care: Results of an evidence-based intervention. Vaccine 2017;35:2390-2395.

• Kimura A, Nguyen C, Higa J et al. The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities. American Journal of Public Health 2007;97(4):684-690.