NIVW 2012

 

Credit CDC

 

# 6759

 

Regular readers of this blog know by now that I get the flu vaccine every year, and that I encourage others to do the same. Not because the vaccine is perfect (it isn’t), but because it is the best preventive measure we have available to us at this time.

 

This week (Dec 2-8)  is National Influenza Vaccination Week (NIVW), the CDC’s annual attempt to reach flu vaccine holdouts before the heart of the flu season arrives.

 

So this week, you’ll be hearing a lot about the flu vaccine on the news and online.

 

The theme this year is It’s Not Too Late To Vaccinate.

 

The CDC will hold a Twitter chat on Wednesday, December 5th, from 1-2pm EST hosted by Dr. Mike Jung. You can participate or follow the conversation via the twitter hash tags @CDCFlu and #NIVW2012.

 

And you’ll find videos and promotional materials on the National Influenza Vaccination Week website, including:

• NIVW Matte Article: It’s not too late to vaccinate – Get your flu vaccine today!  [106 KB, 2 pages]
• 2012-2013 NIVW Update  [223 KB, 2 pages]
• 2012 NIVW Key Points  [308 KB, 3 pages]
• CDC Influenza Awareness Campaign: Media Toolkit  [521 KB, 22 pages]
• NIVW 2012 Flyer and Poster including customizable versions

 

 

I’d be remiss if I didn’t point out that In this year’s NIWV talking points, noticeably absent are any estimates of vaccine effectiveness.

 

Flu campaigns in the past have touted that for healthy adults under the age of 65, in years when the vaccine is a good match to circulating strains, effectiveness ranges from 70%-90%. This year, that message is replaced with a more generic:

The flu vaccine is the best way modern medicine currently has to protect against this potentially serious disease.

a.  While how well flu vaccines work can vary, the findings of many studies from multiple countries across age groups support the benefits of vaccination, especially during years when the vaccine is well-matched to circulating viruses.

The reason for this change is that studies in recent years have shown the effectiveness of the flu vaccine to vary considerably from year-to-year, and among different age cohorts.

 

A little over a year ago, CIDRAP’s  Comprehensive Flu Vaccine Effectiveness Meta-Analysis) found the trivalent inactivated vaccine (TIV) had a combined efficacy of 59% among healthy adults (aged 18–65 years).

 

Among children aged 2-7, the LAIV proved more protective, showing efficacy in 9 out of 12 flu seasons (75%) with a pooled efficacy of 83%.

 

Not awful, but not terrific either. This is a problem we’ve covered many times before, including:

 

CID Study: Effectiveness Of 2010-11 Flu Vaccine

Study: Flu Vaccines And The Elderly

Flu Shots For The Elderly May Have Limited Benefits

 

 

All of which makes issuing blanket statements about the vaccine’s effectiveness problematic. While I might prefer the CDC could find a way to be more precise, I have to admit are simply too many caveats and exceptions to fit into an easily deliverable press meme.

 

Despite their limitations, flu shots have an excellent safety profile (see Harvard Study Reaffirms Safety Of Flu Vaccine), and remain one of the most important steps we can take to avoid catching influenza each year.

 

Of course, flu shot or not, practicing good flu hygiene is important, too.  Washing your hands frequently, covering coughs & sneezes, and staying home when sick.

 

Flu shots are like seat belts in your automobile. They may not guarantee you’ll walk away from a collision unscathed, but they certainly improve your chances.  

 

Which is why I buckle up every time I get into a car, and why I get the flu shot every year. Not because I’m 100% certain of a good outcome, but because sometimes you’ve just got to play the odds.

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Canada & Switzerland Clear Novartis Flu Vaccine For Use

 

# 6683

 

Last week (see Novartis Fluad And Agriflu Vaccines Suspended In Canada), Canada joined Italy, Switzerland, and France in temporarily suspending the use of two Flu vaccines produced by a Novartis plant in Italy pending a review after `protein clumping’ was observed in some vials.

 

Today  Reuters is reporting that Health Canada, and the Swiss government have lifted their suspensions, after being reassured of the vaccine’s safety.  

 

 

Italy, reportedly, is `cautiously positive’ that they will be able to lift their ban in the next few days as well.

 

As I mentioned on Saturday, the clumping of proteins is not uncommon in flu vaccines, and has never been associated with a health risk in the past.  But given ongoing fungal meningitis outbreak due to contaminated steroids in the United States, public health officials are understandably being cautious.

 

Here is the Health Canada announcement, released earlier today.

 

Voluntary Suspension of Flu Vaccines (Agriflu and Fluad) Lifted

Information Update
2012-164
October 31, 2012
For immediate release

OTTAWA - Health Canada has completed its review of safety information for Agriflu and Fluad and is releasing the two seasonal flu vaccines for immediate use. As a precautionary step, the products were temporarily pulled from distribution last week by the manufacturer and held from use in flu vaccination clinics at the request of Health Canada while it investigated any possible concerns.

 

Health Canada looked at the results of its own testing, conducted a health risk assessment, and reviewed information from its European partners and data submitted by Novartis in making its decision. None of the information reviewed indicated a safety issue.

 

The Public Health Agency of Canada is now advising health care professionals in possession of these vaccines that they can start using them once again. As such, those administering the vaccines are reminded to follow existing labelling directions as well as allowing the vaccine to come to room temperature before use. The products should also be shaken and checked for any white floating material before they are injected. Such material is not uncommon in vaccines and does not pose a risk to health.

 

The Public Health Agency of Canada closely monitors for vaccination-related adverse events to detect potential safety issues in a timely manner. To date it has received no reports of serious or unexpected adverse events related to these vaccines.

 

The Public Health Agency of Canada and Health Canada will continue to work with the company to monitor the safety and effectiveness of the vaccines used here in Canada. Should a safety concern be identified, immediate and appropriate action will be taken.

 

Agrippal is marketed in Canada as Agriflu and is authorized for use in people older than 6 months. Fluad is authorized for use in Canadians 65 years of age or older.

 

Flu season is upon us, and a seasonal influenza vaccine is a safe and effective way to protect children, families and communities from influenza viruses. Canadians can learn more about fighting flu by getting a copy of Fight Flu: Your Seasonal Flu Guide by contacting 1 800 O-Canada or visiting  Fight Flu.

 

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CMAJ On Mandatory Flu Shot For HCWs

Photo Credit – CDC PHIL

# 6676

 

In an editorial today, the CMAJ (Canadian Medical Association Journal) endorsed requiring HCWs (Health Care Workers) to get a seasonal flu shot, thus joining a growing list of medical associations around the world calling for similar policies.

 

First, the press release followed by a link to the editorial, then I’ll return with more.

 

Canadian Medical Association Journal

Mandatory flu vaccine for health care workers to protect patients

All health care workers in health care institutions should be vaccinated with the annual influenza vaccine to protect patients, argues an editorial in CMAJ (Canadian Medical Association Journal).

 

Each season, 20% of health care workers get influenza, and 28% of young healthy adults who get it have asymptomatic or subclinical infections," writes Dr. Ken Flegel, Senior Associate Editor, CMAJ. "Some of them may shed virus up to a day before symptoms appear. It is time that all people who work in a health care institution be vaccinated."

 

In Canada, there are approximately 20 000 hospital admissions related to influenza and an estimated 4000 to 8000 deaths attributed to the illness. However, 55%% of physicians do not get vaccinated against the flu and are putting patients at risk of illness and death.

 

Dr. Flegel argues that flu vaccination for health workers must be compulsory, although there could be exemptions for medical or religious reasons. A vaccination rate above 90% is required to prevent outbreaks in hospitals. Mandatory programs for health care workers in many US institutions have resulted in participation rates of about 95%.

 

"Our schools have shown us the way. During measles outbreaks, access to schools has been successfully denied to nonvaccinated children and staff. The time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change," Dr. Flegel concludes.

 

You can read the entire editorial at this link:

 

EDITORIAL

Health care workers must protect patients from influenza by taking the annual vaccine

October 29, 2012

We know that health care workers import and transmit seasonal influenza to patients. We know that many patients get seriously ill from it and that some die. We know that the annual influenza vaccine can interrupt most of this imposed disease burden. It is time that we act on our knowledge and require all health care workers to be vaccinated. 

Full article

 

 

Despite vocal resistance from some HCWs and their unions, calls for mandatory flu vaccination for health care workers have been coming from many professional organizations for several years.

 

A few earlier blogs on these include:

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

In 2011, the following editorial opinion appeared in The Lancet.

 

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

 

This perspective was penned by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, and addresses the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

 

Caplan argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

 

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

 

Both tenets, he argued, are violated when HCWs fail to accept a yearly flu vaccination.

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

And earlier this month we saw Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Although many infection control experts see this as a long overdue step in patient and employee protection, compulsory vaccination remains a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

I’ve covered some of the HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

While their concerns over the vaccine’s safety may be overblown, one of their arguments that does carry some weight is the relative effectiveness of the flu vaccine.

 

It simply isn’t as good as with other vaccines.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

Having a better flu vaccine would remove at least one of the objections that many HCWs have voiced.

 

Popular with HCWs or not, hospitals are increasingly looking at this as both a liability and an economic issue. Unless the courts intervene, the momentum increasingly appears to be moving towards mandating yearly flu shots for many Health Care Workers down the road.

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Week 41 Flu Activity & Flu Shot Finder

 

 

# 5918

 

 

While the 2011-2012 flu season has yet to get rolling in North America and Europe, the experiences south of the equator over the last few months suggest we may see a fair amount of influenza activity later this year.

 

For now, the CDC’s weekly  KEY FLU INDICATORS report, aside from noting the single trH3N2 case in Maine, paints an  otherwise unremarkable picture of flu activity this fall. It should be noted, however, that many years influenza doesn’t make an impact until December or January.  

 

Influenza activity in the United States remains low according to the second FluView of the 2011-2012 season. Nationally, all key flu indicators were low. Below is a summary of the most recent key indicators:

• Visits to doctors for influenza-like illness (ILI) remained below the national baseline this week. All 10 U.S. regions reported ILI activity below region-specific baseline levels as well.
• No states reported widespread, regional or local influenza activity. Sporadic influenza activity was reported by 18 states (a decrease from 20 states last week) and the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands. Thirty-two states (an increase from 29 states last week) reported no influenza activity.
• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Mortality Reporting System increased slightly from last week, but remained within the level expected for this time of year.
• No influenza-associated pediatric deaths were reported this week.
• Nationally, the percentage of specimens testing positive for influenza in the United States was 0.5%, a decrease from what was reported last week (1.2%).
• Though very few viruses have been submitted so far this season, these include 2009 H1N1 viruses, influenza A (H3N2) viruses and influenza B viruses. Overall, these viruses remain susceptible to the antiviral drugs oseltamivir and zanamivir.
• One report of human infection with swine origin influenza A (H3N2) is being reported this week.

 

 

The CDC recommends getting your flu shot now – to give your body enough time to develop antibodies before you are exposed to the virus. I got my shot the last week of September, but I know many people are still putting it off.

 

To make it easier for you to get the jab, Flu.gov has a handy, interactive web app that allows you to input your location, and get a list of pharmacies, clinics, and stores where you can get the flu vaccine near you.

 

 

 

By entering my zip code, I’m presented with a local map showing 26 places offering flu shots, along with their prices, phone numbers, and hours of operation.

 

 

I’ve  made my case for getting the seasonal flu shot every year many times, including in Flu Shot Ethics and NPM11: Giving Preparedness A Shot In The Arm, so I’ll not repeat them here.

 

While the vaccine doesn’t offer 100% protection, the CDC maintains it is the single best thing you can do to protect yourself – and others – from influenza. 

 

And this year, just about everyone over the age of 6 months is encouraged to get the shot (see MMWR: ACIP Updated Flu Vaccination Recommendations).

 

 

The CDC reminds you that:

 

»» Read More

The CDC’s Expert Flu Vaccine Commentary

 

 

# 5869

 

Since the recommendations for seasonal flu vaccines have changed in recent years, and there are some new options available as well, there’s some confusion out there as to what the CDC is currently recommending.

 

Many people mistakenly believe that since the vaccine formula is unchanged since last year, they don’t need a shot this year. Or that since they had `the flu’ last year, they are already immune.

 

But the flu shot’s immunity can wear off over time, and the `flu’ you had last year – assuming it was the flu – was only one strain.  The seasonal flu shot has antigens against three different strains (H1N1, H3N2, B).

 

So yes, if you want to be protected you still need a flu shot.

 

The general public can get a lot of their questions answered at FLU.GOV, but the CDC also provides information geared for doctors, nurses, and other health care providers.

 

Their Expert Commentary Series is a collaboration between CDC and Medscape and is `designed to deliver CDC's authoritative guidance directly to Medscape's physicians, nurses, pharmacists, and other healthcare professionals.’

(Note: Free registration required to access)

While aimed primarily at Health Care Professionals, these concise briefings can also prove valuable to those of us who follow public health issues.

 

Last Friday, the CDC released a 7 minute video expert briefing on this year’s flu vaccination recommendations, presented by Dr. Tim Uyeki, Deputy Chief for Science in the Epidemiology and Prevention Branch of the CDC’s Influenza Division.

 

You can view the video, and read the transcript at:

From CDC Expert Commentary

Influenza Vaccination 2011-2012: Recommendations

Tim Uyeki, MD, MPH, MPP

 

 

You can find additional information on this year’s flu vaccine at:

 

MMWR: ACIP Updated Flu Vaccination Recommendations

FDA Approves 2011-2012 Seasonal Influenza Vaccines

 

And in a personal note, yesterday I popped into my local CVS pharmacy and in less than 10 minutes, got my yearly flu shot.  

 

It was quick, easy, and relatively painless.

 

I know some people are still reluctant to get the shot every year, but you’ll find my reasoning on why I consider it worth getting in:

 

NPM11: Giving Preparedness A Shot In The Arm

Flu Shot Ethics

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APIC Calls For Mandatory Flu Vaccination For HCWs

 

 

# 5282

 

 

APIC (the Association for Professionals in Infection Control and Epidemiology, Inc.) has joined the chorus of other professional infection control and medical organizations (including SHEA, IDSA, & AAP) who are calling for mandatory yearly flu vaccinations for healthcare workers (HCWs).

 

If this story sounds a bit like Deja Flu, you probably recall that in October of 2008 APIC released a similar statement (see APIC Seeking Mandatory Flu Shot For HCWs), but in that case provided for an informed `opt out clause’ if HCWs signed a declination form saying they understood the risks to patients.

 

The new statement eliminates that escape clause, recommending that that hospitals, nursing homes, and other facilities employing HCWs:

 

“require influenza immunization as a condition of employment unless there are compelling medical contraindications."

 

You can read the entire 4-page position paper, outlining their recommendations and rationale behind them, on the APIC home page.

 

APIC Position Paper:  Influenza Vaccination Should Be a Condition of Employment for Healthcare Personnel, Unless Medically Contraindicated

 

The paper also calls for those who are exempted for medical reasons to:

 

“. . .  be educated on the importance of careful adherence to all of the non-vaccine related HICPAC prevention strategies, including hand hygiene and cough etiquette.

Further, they may be  required to wear a surgical mask when contact with patients or susceptible employees is likely. “ 

 

Over the past year several other professional medical organizations have made similar calls for mandatory vaccinations.

 

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010  in  CDC: Proposed Influenza Infection Control Guidance.

 

Similarly, a UK Department of Health report issued in June 2010 called Learning The Lessons From the H1N1 Vaccination Campaign For Healthcare Workers  – while not mandating vaccination – stresses the `professional duty’ of all HCWs to get the vaccine.

 

New York State attempted to require vaccination as a requirement to work as a HCW in 2009, but legal challenges and vaccine shortages forced them to abandon – at least temporarily – that mandate  (see New York Rescinds Mandatory Flu Shots For HCWs).

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, the obstacles that lay before these sorts of policies are substantial.

 

This is a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

 

There will almost certainly be legal challenges, and possibly labor disputes as well. I’ve covered HCW’s objections to forced flu shots in the past, including:

 

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

 

 

Only a few large hospitals have thus far managed to implement mandatory flu vaccinations, including Seattle’s Virginia Mason Medical Center and BJC Heathcare of St. Louis, Missouri  which I blogged about here

.

Details on how Virginia Mason Medical Center implemented mandatory HCW vaccinations can be read in the following  PDF.

 

 

Over the past 5 years Virginia Mason MC has maintained a 98% vaccination rate, and has vigorously promoted the uptake of flu shots not only in the workplace, but the greater community as well.

 

An abstract from a study that appeared in the August 2010 Infection Control and Hospital Epidemiology journal concludes that a policy of mandatory HCW vaccination is feasible, sustainable, and effective.

 

DOI: 10.1086/656210

Mandatory Influenza Vaccination of Healthcare Workers: A 5‐Year Study

Robert M. Rakita, MD; Beverly A. Hagar, BSN, COHNS; Patricia Crome, MN; Joyce K. Lammert, MD, PhD

(EXCERPT)

Results.

In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.

 

Impressive results. 

 

And, when combined with increased calls from infection control organizations to adopt similar practices, likely to inspire other facilities to follow suit.

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H1N1 And The Road To A Universal Flu Vaccine

 

 

 

# 5218

 

A remarkable and unexpected finding stemming from the examination of antibodies derived from a small group of people who contracted the 2009 `swine flu’ virus may eventually lead to the creation of a `universal’ flu vaccine.

 

At least that is the hope of researchers whose findings will be published in the January 10th edition of Journal of Experimental Medicine.

 

It turns out that some of those who were tested developed a number of antibodies that conferred broad immunity against a variety of influenza viruses, not just the novel H1N1 flu strain.

 

We get the details from from a couple of press releases.  First from the University of Chicago Medical Center.

 

H1N1 pandemic points to vaccine strategy for multiple flu strains

Although the 2009 H1N1 influenza pandemic infected an estimated 60 million people and hospitalized more than 250,000 in the United States, it also brought one significant benefit—clues about how to make a vaccine that could protect against multiple strains of influenza.

 

In the Jan. 10, 2011, issue of the Journal of Experimental Medicine, researchers from the University of Chicago and Emory University report that people who were infected with pandemic H1N1 and recovered had an extraordinary immune response, producing antibodies that are protective against a variety of flu strains.

 

The 2009 H1N1 virus matched typical influenza strains only in the components that are absolutely critical for the virus to function. It induced an immune response to those components that overlapped with prior influenza exposures. Incorporating these defenses--focused on the virus's most essential molecules--into a vaccine could put an end to the yearly scramble to predict coming flu strains and quickly mass produce a different vaccine each fall.

 

"The result is something like the Holy Grail for flu-vaccine research," said study author Patrick Wilson, PhD, assistant professor of medicine at the University of Chicago. "It demonstrates how to make a single vaccine that could potentially provide immunity to all influenza. The surprise was that such a very different influenza strain, as opposed to the most common strains, could lead us to something so widely applicable."

(Continue . . .)

 

 

Next, from Emory University.

 

Pandemic flu strain could point way to universal vaccine

The search for a universal flu vaccine has received a boost from a surprising source: the 2009 H1N1 pandemic flu strain.

 

Several patients infected with the 2009 H1N1 strain developed antibodies that are protective against a variety of flu strains, scientists from Emory University School of Medicine and the University of Chicago have found. The results were published online Monday in the Journal of Experimental Medicine.

 

"Our data shows that infection with the 2009 pandemic influenza strain could induce broadly protective antibodies that are only rarely seen after seasonal flu infections or flu shots," says first author Jens Wrammert, PhD, assistant professor of microbiology and immunology at Emory University School of Medicine and the Emory Vaccine Center.

 

"These findings show that these types of antibodies can be induced in humans, if the immune system has the right stimulation, and suggest that a pan-influenza vaccine might be feasible."

(Continue . . .)

 

 

Additional coverage of this story today includes:

 

H1N1 pandemic flu points to vaccine strategy for multiple flu strains Science Daily

Universal flu shot that vaccinates for life a step closer Telegraph.co.uk

 

While enticing, this is just a step forward in the quest for a universal flu vaccine.   More of a clue or a strategy on how to proceed, than an actual solution.

 

A safe, effective, and commercially available formula is still years away.

 

But this is how progress is measured.  One small scientific discovery at a time.

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Referral: Flu Vaccination Programs and the Bottom Line

 

 

 

# 4956

 

 

Appearing today as a guest blogger on the Harvard Business Review, Dr. Paul D. Biddinger – an emergency physician and Associate Director of the Center for Public Health Preparedness at the Harvard School of Public Health – argues the economic advantages of company sponsored flu vaccination programs.

 

 

Flu Vaccination Programs and the Bottom Line

9:17 AM Monday October 4, 2010

 

 

Of course, if your company isn’t enlightened enough to offer a vaccination program, you should still go get a flu shot.   To help you find a location where they are available near you, the CDC has a flu vaccine locator app.

 

 

Their are also widgets available to put on your website to encourage others to get a flu shot this year, available here.

 

So far, their offerings don’t seem to be compatible with my blog, but I have hopes of adding one to my sidebar soon.

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