Healthcare Personnel

1. Some Findings

Influenza is a common nosocomial infection. Serious outbreaks occur typically in elderly long-term patients, but have also been reported in renal transplant and oncology units, neonatal intensive care and paediatrics. It is likely that staff-patient cross-infection is common.

• Vaccination of health care workers (HCW) has been shown to be effective in protecting elderly patients in long-term care. For instance, in 20 long-term elderly-care hospitals vaccination of healthcare workers (HCW) was associated with a substantial decrease in mortality among patients.
• A mobile cart vaccination program and an increased emphasis on healthcare workers to receive the vaccine were associated with a significant increase in vaccine acceptance (4 --> 67%) and a significant decrease in the rate of nosocomial influenza among patients.
• In recipients of vaccine, the numbers of febrile illness, severe illness, and febrile upper respiratory tract illness were significantly reduced compared with HCW without vaccination.
• Influenza-like illness was common among house staff. They tended to work through their illnesses, potentially putting patients at risk. They were motivated mostly by self-protection and did report a benefit. Despite busy schedules and an unfounded fear of getting influenza symptoms from the vaccine, many thought the vaccine should be mandatory.

2. Some Opinions

First do no harm

• Healthcare workers should adhere to the dictum: “First do no harm”. In addition to being immunized themselves, healthcare workers should also ensure that their high risk patients are immunized
• Health professionals have the professional responsibility to prevent risks for the residents in their institutions. This responsibility might have moral reasons to accept influenza immunization.
• As a member of the collective, health professionals have the professional responsibility not to frustrate the collective effort in institutions that aim at herd immunity by refusing vaccination.

Efficacy and Effectiveness of Inactivated Influenza Vaccine

The effectiveness of inactivated influenza vaccine depends primarily on the condition of the immune system of the vaccine recipient and the degree of similarity between the viruses in the vaccine and those in circulation. Adults of 65 years or older and persons with certain chronic diseases might develop lower post-vaccination antibody titres than healthy younger adults and thus can remain susceptible to influenza-related upper respiratory tract infection.

Elderly

1. Among persons older than 60 years a vaccine efficacy of 58% against influenza respiratory illness was found.
2. Among elderly persons not living in nursing homes or similar chronic-care facilities, influenza vaccine is 30 – 70% effective in preventing hospitalization for pneumonia and influenza
3. Among older persons who do reside in nursing homes influenza vaccine can be 50 – 60% effective in preventing hospitalization or pneumonia and 80% effective in preventing death, although the effectiveness in preventing influenza illness often ranges from 30 – 40%.

Growing evidence suggests that influenza illness may play a causal role in the development of atherosclerosis and its complications. To increase influenza vaccination of patients at high risk for CHD, an intense public health effort is needed. In the elderly, vaccination against influenza is associated with a reduction in the risk of hospitalization for heart disease by 19% and cerebro-vascular disease by 16 – 23%.

Healthy adults aged <65 years
Influenza vaccine prevents influenza illness among approximately 70 – 90% of healthy adults younger than 65 years, when the vaccine and circulating viruses are a good match. In addition among healthy working adults influenza vaccination reduces episodes of upper respiratory or influenza-like illnesses from all causes by 25 – 34%, associated work loss by 32 – 43%, physician visits by 34 – 44%, and antibiotic use for influenza-associated illnesses by 25%.

Children
In children aged 1 – 15 years inactivated influenza vaccine is up to 91% effective in preventing influenza respiratory illness and it reduced day-care absenteeism on average by 2.3 days. Acute otitis media is an important complication of influenza among young children. Vaccination reduces influenza related otitis media among young children by approximately 30%. Vaccination of children may also reduce the risk of secondary transmission of influenza within families as well as within communities.