The Importance of Influenza Vaccination for Health Care Personnel in Long-term Care

Influenza is a serious health threat for older adults.

Influenza is a serious health threat, especially for vulnerable populations like older adults and people living with chronic medical conditions. It’s important for people living with and caring for high risk persons, including those who work in long-term care, to get vaccinated against influenza each year.

• People ≥65 years of age are at high risk for hospitalization and complications from the flu and account for the majority of flu hospitalizations and deaths in the United States each year.
• It’s estimated that between 80 percent and 90 percent of seasonal flu-related deaths have occurred in people 65 years and older.
• In the 2012–2013 influenza season, the most affected group was persons ≥65 years, accounting for about half of the total 12,336 reported influenza-associated hospitalizations.
• CDC recommends annual influenza vaccination for everyone 6 months and older.
• One vaccine option available for people 65 years and older is a “high dose” flu vaccine (Fluzone® High-Dose) which contains four-times the antigen (the part of the vaccine that helps your body build up protection against flu viruses) than standard flu shots. 
• CDC also includes specific recommendations for influenza vaccination of health care personnel and recommendations for persons who live with or care for persons at high risk for influenza-related complications.
• Visit Recommended Adult Immunization Schedule, by Vaccine and Age Group for more information on which vaccines are recommended for adults.

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HCP are at risk of occupationally acquired influenza and transmitting influenza to patients and other HCP.

HCP in (LTC) facilities may have direct or indirect contact with older adults, persons with disabilities, and persons with chronic medical conditions receiving care. Studies show that during a confirmed influenza outbreak in a long-term care facility, up to one in three residents and one in four staff develop an influenza-like illness. Preventing influenza among health care personnel can help reduce the spread of influenza in resident populations.HCP who are not vaccinated against influenza may

• become infected with influenza through contact with infected residents.
• become infected with influenza through contact with other infected HCP.
• spread influenza to residents and other HCP. People infected with influenza can spread influenza one day before they feel sick through five to seven days after becoming sick.

HCP should get their influenza vaccinations early in the fall (soon after the vaccine is available). Since it takes about two weeks for antibodies to develop after being vaccinated, you want to make sure your HCP are vaccinated early in the influenza season so that they are protected before influenza infections become prevalent in the community. Sometimes HCP have mild flu symptoms but do not realize they have influenza and might report to work. During flu season, health care personnel should not report to work if experiencing flu symptoms.

Studies have documented that HCP might report to work on days when they have a fever or a respiratory disease because they feel they are needed at work or they do not receive paid sick leave.

Other recommended influenza prevention measures can be found within CDC’s Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities and CDC’s Prevention Strategies for Seasonal Influenza in Health Care Settings.

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CDC recommends influenza vaccination for all health care personnel (HCP) to reduce the spread of influenza, especially to vulnerable populations.

Vaccination is the most effective intervention to prevent influenza—although vaccine effectiveness varies depending on the match between the vaccine and the circulating strain in any given year. Vaccination of all HCP is recommended by the Advisory Committee on Immunization Practices (ACIP). ACIP includes recommendations specifically for HCP and those who live with or care for persons at high risk for influenza-related complications. In addition, 14 medical and health professional organizations, including the American Academy of Family Physicians; American College of Physicians, and AMDA- the Society for Post-Acute and Long-Term Care Medicine have published position statements that support influenza vaccination for health care personnel.

The ACIP recommendations for HCP are based on a body of research that documents measurable benefits of vaccination:

• Vaccination of HCP may reduce:
  • transmission of influenza
  • the number of HCP continuing to work while they are ill due to a potential loss in wages or a lack of paid sick leave (also known as presenteeism)
  • staff illness and absenteeism
  • influenza-related illness and hospitalization, especially among people at increased risk for severe influenza illness
• Studies have found an association between influenza outbreaks in long-term care facilities and hospitals and low flu vaccination coverage rates among health care personnel.
• Higher vaccination levels among hospital staff have been associated with a lower rate of hospital-acquired influenza.