What's New With The Flu Claire Farella RN BScN MN Manager Community Health Protection
Historical Data 100 anniversary of the Spanish Flu - H1N1 500 million infected world wide with 50-100 million deaths- represented 5 % of the worlds population Taking lives of otherwise healthy young adults which was a change from very young and very old being impacted Was felt to be one of the deadliest natural disasters in human history.
2017/2018 Flu Season Fast Track 100 years later. 2017/18 has been reported as a very unusual season for a variety of reasons Influenza A lasted several more weeks than usual Influenza B started earlier, increase in the number and hung around longer As many of you experienced in your institutions both influenza A & B outbreaks occurred at the same time.
PHO (2018) Figure 3: Total number of influenza tests performed and percent of positive respiratory tests by surveillance week: Ontario, April 9, 2017 to April 7, 2018
PHO (2018) Figure 6: Institutional respiratory infection outbreaks by week of illness onset in the first case: Ontario, April 9, 2017 to April 7, 2018
2017/2018 Flu Season PHO reported that Eastern Region: Had more cases of influenza A than B H3N2 dominated the season Higher, early & sustained Influenza B activity. Eastern Region was similar with rest of Canada with an overlap of Influenza A & B cases with increase in B
2017/2018 Flu Season Australia (Southern Hemisphere) influenza season is very similar to Canada and is used a predictor Australia experienced: An overlap of A & B cases at the same time H3N2 predominately High, early and sustained B activity
What is expected in 2018/2019 Influenza activity to date in the Southern Hemisphere - Australia Predominately H1N1 season Lower rates of infection to previous year Vaccine matched the circulating strain Influenza hospitalizations were down from previous year Lower levels of influenza B than last year
Ontario Respiratory Pathogen Bulletin Weekly summary of provincial respiratory pathogen activity https://www.publichealthontario.ca/en/servic esandtools/surveillanceservices/pages/ontari o-respiratory-virus-bulletin.aspx
Leeds Grenville Lanark Outbreak Status Website https://healthunit.org/forprofessionals/hospitals-ltc-retirementhomes/outbreak-managementresources/outbreak-status-report/ Opportunity to subscribe to website for automatic updates in LGL.
Flu Vaccine 2018/2019 Vaccine - Quadrivalent & Trivalent Quadrivalent - FluLaval Fluzone- FluMist A/Michigan/45/2015(H1N1) A/Singapore/INFIMH-16-0019/2016(H3N2) B/Colorado/06/2017-like virus (B Victoria/2/87lineage) B/Phuket/3073/2013 like virus (B/Yamagata/16/88 lineage).
Flu Vaccine 2018/2019 Trivalent Vaccine- Fluzone-High-Dose A/Michigan/45/2015/(H1N1)pdm09-like virus A/Singapore/INFIMH-16-0019/2016(H3N2) like virus B/Colorado/06/2017/like virus (B/Victoria/2/87 linkage) High-dose - (4x) increase in antigen to mount a better immune response Influenza A more significant to greater than 65 age group i.e., Infection rates 82% A vs 17 % B
Flu Vaccine 2018/2019 FluMist 2-17 yrs. Live attenuated Cold adapted/temperature sensitive Grows in nasopharynx Increase success in children than adults as child have less immunity to inhibit Replication in nasopharynx Comes down to parent choice as long as no contraindications
Flu Vaccine 2018/2019 New 2018/2019 All individuals aged 6 months or older will be offered a quadrivalent inactivated vaccine Individuals 2-17 will be offered the quadrivalent live attenuated influenza vaccine- FluMist Individuals 65 years of age and older will be offered the high-dose trivalent inactivated vaccine.
Antiviral Medication Still recommended for prevention and treatment If influenza circulating in community don t wait for lab confirmation Important to have an antiviral plan in place i.e. medical directive and arrangement with pharmacy For treatment start within 48 hr. of symptoms Can decrease symptoms within 24 hrs. as well as decrease secondary complications
Flu Vaccine Rates MOHLTC requires institutions to report influenza vaccination rate by Dec 15, 2018 Reporting forms have been emailed to each institution As reported rates from previous year (2017) recorded Hospitals at 54% LTCH at 73% Still room for improvement
PHO (2018) Figure A. Median influenza immunization coverage rates among LTCH and hospital staff, by influenza season: Ontario, 2003-2004 to 2017-2018 seasons
Increasing Immunization Rates This is a question that has been asked year after year Healthcare providers are provided scientific evidence on the impact of herd immunity to protect the most vulnerable Despite having this information there is a hesitancy to participate in influenza immunization
Increasing Immunization Rates Some experts have recommended mandatory influenza immunization for all health care personnel as they feel it is ethical, just and necessary to improve patient safety Others feel this is a direct impact on individual choice Some strategies have focused on behaviors Other strategies have focused on creating a supportive environment making immunization an easy choice
Points to Remember When Trying to Create a Change in Immunization Rates Just because science states it is the best strategy doesn t mean that everyone will buy in Often one can agree in principal but have difficulty participating Remember that culture has tremendous influence on how strategies related to change will be accepted and mobilized Change requires intentional actions that can be sustained over the long term There are no guaranteed strategies for change- it all rests in how it is packaged and presented
Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel Lack of access to influenza vaccine Provide free vaccine at the workplace Offer vaccine at multiple times and locations convenient to all workers on all shifts during the flu season Use a mobile vaccination cart to take influenza vaccinations to staff Partner with a larger health care organization (e.g., hospital) to provide vaccinations Work with pharmacy consultants to offer influenza vaccinations for facility staff Work with visiting nurses associations or other community immunizers to provide vaccination on-site Offer influenza vaccine at mandatory trainings, departmental conferences, and other meetings
Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel Beliefs Provide a strong educational program for staff Focus on protecting the worker and their family as well as the residents in the educational materials Share Influenza Vaccine Information Statements Share the Joint Commission s Influenza fact sheet Use a Declination Form to learn why staff are declining vaccination to focus your own messages Ask vaccinated health care personnel to encourage their coworkers to get vaccinated
Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel Lack of enthusiasm about influenza vaccination Publicize a vaccine day in combination with education to offer influenza vaccinations Emphasize that flu vaccination protects the employees, their loved ones and those they work with Encourage employees to set an example; remind them that their action and recommendation carries a lot of weight in others decisions to get vaccinated Encourage employees via e-mail, posters, an employee newsletter, and any other communication tools used in your workplace to get the vaccine Track and report vaccination rates to staff and supervisors Remind unvaccinated employees with e-mail, letters, encouragement from supervisors, and telephone calls Provide contests or incentives to get vaccinated (small gift cards, raffles, pizza party, etc.) Vaccinate the medical director and all managers in front of the staff
Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel High staff turnover Offer influenza vaccination education multiple times during the flu season Offer opportunities to be vaccinated at multiple times and locations convenient to all workers on all shifts during the flu season Educate and vaccinate staff as part of new employee orientations Establish a process to determine and track proof of influenza vaccination each year for each employee Establish a written influenza vaccination policy for employees Work with pharmacy consultants to offer influenza vaccination for facility staff, as a standard procedure
Questions
References Public Health Ontario (2018). Webinar- What's new with the flu. Oct 11, 2018 Public Health Ontario (2018) Ontario Respiratory Virus Bulletin 2017/2018 Week 14 https://www.publichealthontario.ca/en/servicesandto ols/surveillanceservices/pages/ontario-respiratory- Virus-Bulletin.aspx Centres for Disease Control and Prevention. Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel. Accessed October 2018. https://www.cdc.gov/flu/toolkit/long-termcare/strategies.htm
References Ministry of Health and Long-Term Care. (2018) 2018/2019 Universal Influenza Immunization Program http://health.gov.on.ca/en/pro/programs/publichealth /flu/uiip/docs/flu_uiip_6mo-17yrs_2018-19.pdf Ontario Ministry of Health and Long-Term Care,(2018) Ontario Influenza Immunization Database (OIID), analyzed by Public Health Ontario. https://www.publichealthontario.ca/en/servicesandto ols/surveillanceservices/pages/ontario-respiratory- Virus-Bulletin.aspx
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