With thanks to the HPSC and National Immunisation Office for the slides

Transcription

1 Dr Áine McNamara Consultant in Public Health Medicine Dept. of Public Health, HSE West National Immunisation Study Day, 18th September 2017 With thanks to the HPSC and National Immunisation Office for the slides 1

2 Influenza Virus and complications Importance of Flu vaccine in HCWs Effectiveness, Safety & Side-effects Uptake Figures Benefits of vaccination

3 The flu is an infection that is caused by an influenza virus. There are many other viruses which cause flu-like illness. The flu can affect the lungs, throat, nose, and other parts of the body. Unlike the common cold, influenza comes on suddenly, makes you more sick for longer (a week or more), and you may end up in hospital. 3

4 Symptoms Cold Classic Flu Fever Rare, except in very young children Headache Rare Prominent Usual ( 38 o C F) lasts 3-4 days, reduced in elderly General aches/ pains Slight Often severe Fatigue/ Weakness Mild Sudden onset and can last up to 3 weeks Extreme exhaustion Never Early and prominent Stuffy nose Common Sometimes Sneezing Usual Sometimes Sore throat Common Sometimes Cough, Chest discomfort Mild to moderate Common and can become severe 4

5 Bacterial super-infections bacterial pneumonia Croup in children otitis media (children), sinusitis Decompensation of chronic diseases pulmonary disease heart disease renal insufficiency metabolic disease 5

6 When some people get the flu it may be mild, but for others it can be fatal Most excess deaths are among the elderly/those with underlying illness Irish people will die each year because of flu. During a severe season this can be 1000 people ( ) Of the 638 people admitted to ICU with flu in Ireland since 2009, 7-26% were previously healthy people and 73% were aged less than 65 years** Recent European study showed weeks of excess mortality coincided with medium or high influenza activity weeks* *K Mølbak et al. Excess mortality among the elderly in European countries, December 2014 to February 2015 (ttp:// ** Data extracted from HPSC ICU influenza surveillance database on 16/05/2016,data provisional - further validation required. 6

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8 Confirmed Influenza Hospitalised Cases Ireland 2009/ / pdm period 2010/ / / / / / /17 Predominant flu type AH1pdm09 AH1pdm09; B AH3 B; AH3 & AH3; AH1pdm09 AH1pdm09 AH3; B AH1pdm09; B AH3 Total cases Crude rate /100, Median age (years) Females 50% 55% 56% 57% 57% 53% 53% 52% Total deaths - all causes Case fatality rate 2% 4% 4% 5% 5% 5% 4% 5% A(H1)pdm09 A(H3) predominant predominant Data source Ireland s Computerised Infectious Disease Reporting System (CIDR) 2016/17 outcome data are provisional When interpreting these data, improved surveillance and reporting and an increase in laboratories testing for influenza in recent seasons should be noted.

9 Confirmed influenza ICU cases 2009/ /17 Admitted to ICU 2009 pdm period 2010/ / / / / / /17 Predominant flu type AH1pdm09 AH1pdm09; B AH3 B; AH3 & AH3; AH1pdm09 AH1pdm09 AH3; B AH1pdm09; B AH3 Total cases Crude rate /100, Median age (years) Females 50% 53% 80% 49% 41% 41% 42% 32% Cases with risk factor 82% 74% 93% 90% 85% 86% 83% 93% % Vaccinated NA 17% % 47% 18% 32% A(H1)pdm09 predominant A(H3) predominant 2016/17 data provisional - further outcome data pending.

10 Influenza is spread through tiny droplets sprayed into the air when a sick person coughs, sneezes, or even talks. You can pick up the infection from the droplets, particularly if they land in your nose, eyes, or mouth. You can also get the flu by touching a surface like a table or a doorknob that has the virus on it, then touching your mouth or nose. Courtesy: CDC/ Brian Judd 10

11 One serosurvey* showed 23% of HCW had serologic evidence of influenza virus infection during a single influenza season the majority had mild illness or subclinical infection *Elder G, et al. BMJ. 1996;313: Kuster SP et al PLoS ONE 6(10):e doi: /journal.pone

12 Protect yourself, your family and your patients Take responsibility for your health and wellbeing. If you are sick, you are not around to care for your patients, colleagues may be under pressure and you risk passing the illness to friends/family. The health of your family is important to you. Don t put them at risk by not getting the vaccine especially if you have children or care for someone elderly. You have a duty of care to your patients. By not getting the vaccine you risk passing on the virus to a high risk group who may not be able to recover from influenza 12

13 Recommended annually since 1999 in Ireland World Health Organisation (WHO) Center for Disease Control and Prevention (CDC) European Centre for Disease Prevention and Control (ECDC) Nursing and Medical Professional Bodies 13

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16 Influenza viruses always changing. Strains monitored by WHO surveillance laboratories influenza vaccine specifically recommended by the WHO as the strains most likely to be circulating this season A/Michigan/45/2015 (H1N1)pdm09-like virus; A/Hong Kong/4801/2014 (H3N2)-like virus; and B/Brisbane/60/2008-like virus

17 YES Effectiveness dependent on match with circulating virus Pooled analysis suggests efficacy of 40-90% in adults aged Immune systems >65 years or those with long term medical conditions less responsive to vaccine Vaccination reduces hospitalisations and deaths in elderly vaccinated patients Increasing vaccination rates among HCWs may contribute to herd immunity protecting elderly or immunocompromised patients

18 It is an inactivated vaccine Recommended for all HCWs Can be given at any stage of pregnancy Is there anyone who cannot get flu vaccine? Not recommended for those who have a history of anaphylaxis following a previous dose of flu vaccine or any part of the vaccine. 18

19 YES The seasonal flu vaccine is considered safe (CDC) Seasonal flu vaccines manufactured for over 60 years with millions of vaccines used across the world Narcolepsy has not been reported following seasonal flu vaccine Batches of vaccine are tested to ensure safety Vaccine does not contain thiomersal or adjuvants

20 NO It cannot cause flu influenza viruses in vaccine used in Ireland are inactivated (killed) during manufacturing process so cannot cause infection 20

21 Most common side effect of seasonal flu vaccine pain, swelling or redness at the injection site Less Common headache, low grade fever, malaise, shivering, fatigue, myalgia and arthralgia a small painless nodule (induration) may also form at the injection site these symptoms usually disappear within one to two days without treatment Allergic reactions occur very rarely

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24 Total Staff General Support Staff Health & Social Care Professionals Management & Admin Medical & Dental Nursing Other Patient & Client Care 24

25 HCW Influenza Vaccine % Uptake by Hospital, Saolta Group, Influenza Seasons , 2017/2017* (*Data provisional as of February 2017) % / / UHG Mayo GH Roscommon Hosp Portiuncula Hosp LUH Sligo GH Saolta 25

26 HCW Influenza Vaccine Uptake by Hospital & Staff Category, Saolta, 2016/2017* (* Data Provisional as of February 2017) % General Support Health & Social Care Management & Administration Medical & Dental Nursing 0.0 GUH Mayo Hosp Roscommon Portiuncula LUH Sligo Saolta Other Patient & Client Care 26

27 Since I am around sick people all the time, I am already immune to the flu I don t believe in it The vaccine doesn t work on me. I got the flu anyway 27

28 Reason for non-vaccination Other reason Problems with awareness / access Problems with Vaccine / Injection / Side-effects I don t need it I don t get the flu/rarely sick Only good for elderly people Perceived low risk Percentage (%) Mereckiene J et al. Euro Surveill. 2007;12(12). 28

29 YES! Systematic reviews have shown that flu vaccine has reduced the flu incidence rate from 18.7% in unvaccinated HCWs to 6.5% in vaccinated HCWs Kuster SP et al. Incidence of Influenza in Health adults and Health Care Workers: A systematic review and Meta Analysis 2011 PLoS ONE 6(10):e doi: /journal.pone

30 One study showed a 40% reduction of influenza related deaths in hospitals with higher rates of HCP influenza vaccination. 20 long-term care geriatric hospitals in Scotland randomised and followed for 6 months during the season (1217 HCWs, 1437 patients) HCWs in 10 hospitals offered vaccination HCWs in 10 hospitals not offered vaccination 50% of HCWs vaccinated 5% of HCWs vaccinated 749 patients monitored 688 patients monitored Crude patient mortality: 14% Crude patient mortality: 22% Carman WF, et al. Lancet. 2000;355:

31 Healthy adults (<65 years) savings include*: 13%-44% fewer health-care provider visits 18%-45% fewer lost work days 18%-28% fewer days working with reduced effectiveness 25% decrease in antibiotic use for influenza like illness (ILI) *Molinari NA, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007;25:

32 Chronic illness e.g. CF and other chronic respiratory diseases, CHD, immunosuppression, asplenia or splenic dysfunction 65yrs Children and teenagers on long-term aspirin therapy Residents of nursing homes and long stay facilities HCW Pregnant women 32

33 Myths healthy people can get seriously ill from flu >20% HCWs get flu every year may only have mild symptoms and continue to work highly transmissible 1 day before & 5-7 days after symptoms Provides indirect protection against influenza to the high-risk patients 33

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35 Health Protection Surveillance Centre (HPSC) National Immunisation Office (NIO) 35