1. 1 Influenza Vaccination of Health-care Personnel: An Initiative to Improve a Serious Public Health Problem Anand Parekh, MD, MPH Office of Public Health and Science Department of Health and Human Services September 10, 2008

2. 2 Major Points Influenza causes frequent and serious illnesses in the United States Influenza vaccine is underutilized, including by health care personnel There are proven, recommended strategies available to improve vaccination rates HHS has begun an initiative to reach the Healthy People 2010 objective for health care personnel of 60% vaccination Influenza causes frequent and serious illnesses in the United States Influenza vaccine is underutilized, including by health care personnel There are proven, recommended strategies available to improve vaccination rates HHS has begun an initiative to reach the Healthy People 2010 objective for health care personnel of 60% vaccination

3. 3 Influenza Vaccination of Health-care Personnel Only 42 percent of U.S. health-care personnel were vaccinated in 2006 MMWR 2006;55 (RR-2). February 24, 2006.

4. 4 Common Themes* Reasons for accepting influenza vaccination –Protect self –Protect patients –Convenience –Peer influence –Prior experience Reasons for accepting influenza vaccination –Protect self –Protect patients –Convenience –Peer influence –Prior experience Reasons for rejecting influenza vaccination –Concerns about vaccine safety or efficacy –Not at risk (healthy immune system) –Lack of understanding of transmission of influenza –Fear of needles –Not convenient *Hofman F, Ferracin C, Marsh G, Dumas R. Infection 2005;34:142-147

5. 5 Cover of MMWR Recommendations

6. 6 HICPAC/ACIP Recommendations Offer influenza vaccine annually Educate HCP regarding the benefits of influenza vaccination and the potential health consequences of influenza illness Provide influenza vaccination to HCP at the work site and at no cost Monitor HCP influenza vaccination coverage and declination; provide feedback to staff and administration Obtain a signed declination from HCP who decline influenza vaccination Use the level of HCP influenza vaccination coverage as one measure of a patient safety quality program Offer influenza vaccine annually Educate HCP regarding the benefits of influenza vaccination and the potential health consequences of influenza illness Provide influenza vaccination to HCP at the work site and at no cost Monitor HCP influenza vaccination coverage and declination; provide feedback to staff and administration Obtain a signed declination from HCP who decline influenza vaccination Use the level of HCP influenza vaccination coverage as one measure of a patient safety quality program

7. 7 American College of Physicians (ACP) 3 –October 2007 - Recommendation that annual influenza vaccine should be required for every health care worker with direct patient care activities. Infectious Diseases Society of America (IDSA) 2 –January 2007- Recommendation that U.S. adopt policy to include mandatory annual influenza vaccination among healthcare workers Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 1 –New standard, effective 1/1/07: Influenza immunization offered to staff and licensed independent practitioners. National Foundation for Infectious Diseases (NFID) 4 –Call to Action recommendations and Best Practices for immunizing health care personnel against influenza American College of Physicians (ACP) 3 –October 2007 - Recommendation that annual influenza vaccine should be required for every health care worker with direct patient care activities. Infectious Diseases Society of America (IDSA) 2 –January 2007- Recommendation that U.S. adopt policy to include mandatory annual influenza vaccination among healthcare workers Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 1 –New standard, effective 1/1/07: Influenza immunization offered to staff and licensed independent practitioners. National Foundation for Infectious Diseases (NFID) 4 –Call to Action recommendations and Best Practices for immunizing health care personnel against influenza 1 http://www.jcrinc.com/26813/newsletters/12882/, accessed 11/11/07; 2 Pandemic and Seasonal Influenza Principles for U.S. Action, January 2007; 3 http://www.acponline.org/college/pressroom/hcw.htm, accessed 11/13/07; http://www.jcrinc.com/26813/newsletters/12882/ http://www.acponline.org/college/pressroom/hcw.htm 4 http://www.nfid.org, accessed 05/15/08. Support from Professional Groups

8. 8 Strategies for Improving HCP Vaccination Rates Successful HCP vaccination programs are multifaceted and combine: –Education campaigns –Role models –Improved access –Measurement and feedback Successful HCP vaccination programs are multifaceted and combine: –Education campaigns –Role models –Improved access –Measurement and feedback

9. 9 HHS Initiative for Influenza Vaccination of Health Care Personnel: Components Two components –Improving HHS health care employee influenza vaccination, with focus on  Federal Occupational Health  Indian Health Service  U.S. Public Health Service Commissioned Officers  NIH Clinical Center  CDC –Promoting influenza vaccination to non- federal health care organizations and HCP Two components –Improving HHS health care employee influenza vaccination, with focus on  Federal Occupational Health  Indian Health Service  U.S. Public Health Service Commissioned Officers  NIH Clinical Center  CDC –Promoting influenza vaccination to non- federal health care organizations and HCP

10. 10 HHS Initiative for Influenza Vaccination of Health Care Personnel: HHS Employees Three focus areas –Developing office and agency specific strategies to improve HCP vaccination levels –Measuring employee vaccination rates –Disseminating a toolkit containing  Standard presentation  Relevant articles  Posters  Fact sheets, questions and answers  Vaccine information statements  Links to other resources  Toolkit will be available on HHS OPHS website Three focus areas –Developing office and agency specific strategies to improve HCP vaccination levels –Measuring employee vaccination rates –Disseminating a toolkit containing  Standard presentation  Relevant articles  Posters  Fact sheets, questions and answers  Vaccine information statements  Links to other resources  Toolkit will be available on HHS OPHS website

11. 11 HHS Initiative for Influenza Vaccination of Health Care Personnel: Outreach Potential Partners include: American Academy of Family Physicians American Academy of Pediatrics American College of Obstetricians and Gynecologists American College of Occupational and Environmental Medicine American College of Physicians American Hospital Association American Medical Association American Nurses Association American Society of Health-System Pharmacists Association for Professionals in Infection Control and Epidemiology, Inc. National Black Nurses Association National Hispanic Nurses Association National Foundation for Infectious Diseases National Influenza Vaccine Summit National Medical Association National Hispanic Medical Association National Medical Association AFL-CIO AFSCME SEIU HHS will also promote Influenza Vaccination of Health Care Personnel (HCP) nationwide Healthy People 2010 target: 60% of all HHS HCP will be vaccinated annually By 2010 HHS plans to partner with many other organizations to promote HCP influenza vaccination

12. 12 External Partners Target specific HCP groups in initial phase Identify critical partners based on impact and access – narrower scope Meetings scheduled with the various groups –Long term care –HCP unions –Health professions’ schools’ representatives –Multiple organizations Sept 10, 2008 Target specific HCP groups in initial phase Identify critical partners based on impact and access – narrower scope Meetings scheduled with the various groups –Long term care –HCP unions –Health professions’ schools’ representatives –Multiple organizations Sept 10, 2008

13. 13 HHS Strategies for Assistance to Partners ASH will offer to co-sign letters to membership of interested HCP organizations HHS staff are available to either present at upcoming national or regional association meetings or to identify other potential briefers Write articles for organization newsletters and/or journals Promote use of HHS toolkit ASH will offer to co-sign letters to membership of interested HCP organizations HHS staff are available to either present at upcoming national or regional association meetings or to identify other potential briefers Write articles for organization newsletters and/or journals Promote use of HHS toolkit

14. 14 HHS Toolkit http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html