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Vaccination, especially to protect against the flu, is one of the key interventions in occupational health. Influenza in health care staff can lead to lost workdays and spread to other workers and to patients at high risk for serious complications of influenza. Influenza vaccination of HCPs has been shown to reduce the risk of influenza and absenteeism among vaccinated HCPs and reduce the risk of respiratory illness and death.
Although we do not know what will be the coverage of health workers for 2018 until next year, the Centers for Disease Control and Prevention (CDC) reported that 67.6% of HCPs received influenza vaccine last season. The agency found that during the previous two seasons, flu vaccination coverage had increased by 10 to 12 percentage points from the start of the season to the end of the season.
Early-season influenza vaccine coverage for 2017-2018 was highest among pharmacists (86.4%), physicians (82.7%), nurses (80.9%), nurse practitioners / medical assistants (79.7%) and other clinical staff (75.1%). percent). Immunization coverage against influenza was lowest among administrative and non-clinical support staff (61.0%) and assistants and aides (56.2%).
In the workplace, early-season influenza vaccine coverage was highest among health professionals working in hospitals (82.6%). Influenza immunization coverage remains low among health professionals working in long-term care facilities (LTC) (58.5%) compared to those working in hospitals and ambulatory care facilities (68.7%). %).
Influenza immunization coverage at the beginning of the season was higher among health professionals whose employers required (88.4%) or recommended (65.1%) to be vaccinated compared to health professionals whose Employer neither required nor recommended vaccination against the flu (29.8%). Among unvaccinated health professionals who did not plan to be vaccinated against influenza during this influenza season, the main reason given for not being vaccinated was the fear of experiencing adverse effects. or getting sick of the vaccine (22.1%).
The Advisory Committee on Immunization Practices (ACIP) recommends that all health professionals be vaccinated annually. Interventions to promote influenza immunization among health professionals each season include employers who offer workplace influenza immunization for several days and shifts, at no charge and with active promotion. Educational materials must be provided to answer questions and misperceptions about the benefits and risks of influenza vaccination.
Measurement and feedback of immunization coverage is recommended to increase the number of recommended immunizations. Measures such as the requirements imposed by Medicare Centers and Medicaid Services (CMS) at acute care hospitals, outpatient surgery centers and ambulatory dialysis centers to report coverage rates through HCP vaccination against Influenza in their establishments may be useful for this purpose.
To better guide best practices in the immunization of health professionals, the Association of Health Professionals in the Health Sector (AOHP) has published a position paper on best practices in immunization of health professionals. personal health. The AOHP recommends that employers in the health sector adopt practices that ensure that health care workers are evaluated based on their immunization status and properly immunized against vaccine-preventable diseases.
The AOHP statement is based on a thorough review of ACIP's recommendations, which includes experts in medicine and public health who develop recommendations on the use of vaccines in the US civilian population . These recommendations constitute a public health guide for the safe use of vaccines and related biologicals.
"The AOHP is committed to promoting the recommended vaccinations for health care workers and the standards for the practice of adult immunization in health organizations represented by the members of the AOHP. ", says Mary Bliss, RN, COHN, executive chair of the AOHP. "These vaccines, which protect both health care workers and their patients, must be provided free of charge and must comply with national and federal regulations."
Specific vaccine recommendations included in the AOHP Position Statement include:
• Hepatitis B
• MMR – measles, mumps, rubella
• Varicella – Varicella
• Tdap / Td – Tetanus, Diphtheria, whooping cough
• flu
• Neisseria Meningitidis – Meningococcal (Meningitis)
In many cases, AOHP recommends that health care workers who refuse recommended vaccinations be required to provide a declination statement and not participate directly in the indirect care of patients. With respect to influenza, the AOHP advocates that health care workers be vaccinated each year and asks health care administrators to adopt a policy mandating annual influenza vaccination (with medical waivers). ) or offering alternatives to vaccination, such as the use of surgical masks for patient care. who refuses the vaccine.
The World Health Organization (WHO), which holds a consultation, usually in February of each year, makes recommendations on the composition of influenza vaccines in the Northern Hemisphere. Surveillance data is reviewed and vaccine candidate viruses are discussed. The WHO Advisory Committee on Vaccines and Related Biologicals (VRBPAC) reviews the WHO recommendations, reviews and reviews similar data and makes a final decision regarding the virus composition of licensed influenza vaccines and marketed in the United States.
With respect to the current influenza season, Grohskopf, et al. (2018) summarize ACIP 2018-2019 recommendations regarding the use of seasonal influenza vaccines in the United States: "Routine annual vaccination against influenza is recommended for all ≥ elderly people. 6 months with no contraindications Allowed, recommended, and age Inactivated influenza vaccines (VII), recombinant influenza vaccines (RIV) and live attenuated vaccines (LAIV) should be available for the 2018 season – 19. Inactivated non-adjuvanted standard-dose influenza vaccines will be available in quadrivalent (IVV4) and trivalent (IIV3) formulations. Recombinant influenza vaccine (RIV4) and live attenuated vaccine (LAIV4) will be available in quadrivalent formulations High-dose inactivated influenza vaccine ( HD-IIV3) and inactivated with adjuvant influenza vaccine (aIIV3) will be available in trivalent formulations. "
Grohskopf et al. (2018) explain the main changes of this influenza season:
• The annual flu vaccination of all persons ≥ 6 months of age without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for people for whom more than one registered, recommended and appropriate product is available. The information and tips updated in this report include the following:
• The vaccine viruses included in the US 2018-2019 trivalent flu vaccines will be a type A / Michigan / 45/2015 (H1N1) virus pdm09, a type A / Singapore / INFIMH-16-0019 / 2016 (H3N2) virus, and a virus similar to B / Colorado / 06/2017 (Victoria lineage). The quadrivalent influenza vaccines will contain these three viruses and an additional virus B virus, a type B / Phuket / 3073/2013 virus (Yamagata lineage).
• After two seasons (2016-17 and 2017-18) in which ACIP recommended not to use the VVAv4, ACIP voted in February 2018 to recommend that, for the 2018-19 season, immunization providers be able to choose between Administer any license that is licensed and age-appropriate. influenza vaccine (IIV, RIV4 or LAIV4). LAIV4 is an option for those for whom this is appropriate.
• Egg-allergic individuals, regardless of severity, may receive any approved, age-appropriate influenza vaccine (IIV, RIV4 or LAIV4). IIV and RIV4 have already been recommended. The use of LAIV4 in people with allergies to eggs was approved by the ACIP in February 2016. Additional recommendations regarding vaccination of those allergic to eggs are discussed.
References:
Association of Occupational Health Professionals in Health Care (AOHP). Position Statement on Best Practices for the Immunization of Health Care Workers. May 2018.
Centers for Disease Control and Prevention (CDC). Vaccination of Health Personnel and Influenza, Internet Panel Survey, United States, November 2017.
Grohskopf LA, Sokolow LZ, Embroider KR, Emmanuel B. Walter EB, Fry AM and Jernigan DB. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, Recommendations and Reports on the 2018-2019 Influenza Season. August 24, 2018; 67 (3); 1-20.
Vaccine Offer for the 2018-2019 Season
The CDC provides the following questions / answers on vaccine supply for the 2018-19 season:
Q: How much influenza vaccine should be available for the 2018-2019 influenza season?
A: The influenza vaccine is produced by private manufacturers. The supply therefore depends on the manufacturers. Vaccine manufacturers have planned to provide 163 to 168 million doses of influenza vaccine for the 2018-19 season.
Q: How much thimerosal-free flu shot should be available for the 2018-19 season?
A: For the 2018-19 season, manufacturers will produce influenza vaccines containing thimerosal and some vaccines that do not contain thimerosal. For the 2018-19 season, only multi-dose presentations of influenza vaccines contain thimerosal. More than 80% of the projected vaccine supply for the 2018-2019 influenza season will be without thimerosal (ie, no preservatives).
Q: How much quadrivalent vaccine should be available for the 2018-19 season?
A: For the 2018-19 season, manufacturers will produce trivalent (tri-component) and quadrivalent (four-component) influenza vaccines. More than 80% of the projected vaccine supply for the 2018-2019 influenza season will be quadrivalent (4-component) vaccines. The remaining vaccine will be trivalent, including the high-dose, adjuvanted influenza vaccines, as well as one brand of inactivated standard-dose vaccine.
Q: How much supply of US vaccine for 2018-2019 will be produced from eggs?
A: About 85% of the projected vaccine supply for the 2018-2019 influenza season will be produced using an egg-based manufacturing technology. The remaining vaccine will be produced using cell-based and recombinant technologies.
Q: Can I still buy the influenza vaccine for the 2018-19 season?
A: Pre-booking of the flu vaccine usually takes place between January and March, although most vaccine preparations should still be available for purchase. Suppliers should contact local distributors and suppliers for the remaining offer. In addition, beginning in early October of each year, information on manufacturers and distributors who still have influenza vaccine available for sale is available at http://www.preventinfluenza.org/ivats/ . Updates on the distribution of influenza vaccine doses for the 2018-19 season will be provided as the season progresses.
Q: What can we expect in terms of vaccine availability for the 2018-2019 season?
A: The timing of vaccine availability depends on when production is complete. Anti-influenza vaccine shipments will continue until October and November until all vaccine is distributed.
Q: Are all influenza vaccines the same?
A: All influenza vaccines contain an antigen derived from the same viruses, with the difference that trivalent vaccines contain three different antigens and that quadrivalent vaccines contain four different antigens (the same three in trivalent vaccines plus one). However, apart from the antigen composition, the different influenza vaccine preparations have different indications, as authorized by the FDA. Each is allowed for a specific age range. All recipients must receive a vaccine that is appropriate for their age. In addition, the use of LAIV is not recommended in some populations.
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