1. Determining the impact of mandatory seasonal influenza vaccination policies on long-term care and assisted living staff in Flathead County, Montana during the 2014-2015 influenza season Theresa Majeski, MPH Public Health Advisor/PHAP Associate Public Health Associate Program Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 PHAP/PHPS Summer Seminar June 2, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Background  People aged 65 and older are at greatest risk from influenza related deaths and complications  Estimated that 90% of seasonal influenza-related deaths occur in people 65 and older  Estimated that 50-60% of seasonal influenza-related hospitalizations occur in people 65 and older  Multiple studies have shown reduced influenza-related complications and risk of death with vaccination of health care personnel (HCP) in long-term care settings CDC. www.cdc.gov/flu/about/disease/65over.htm CDC. www.cdc.gov/flu/heatlhcareworkers.htm

3. Background  Healthy People 2020 goal of 90% seasonal influenza vaccination coverage for HCP  Early 2014-2015 seasonal influenza national data show 54% of long-term care HCP vaccinated  Compared to 79% of HCP in hospitals  2011-2012 Montana Immunization Program data show 62% of long-term care and assisted living facility (LTCF-ALF) staff vaccinated  Studies show that mandatory vaccination policies increase HCP vaccination rates Healthy People 2020. Objective IID-12.13. www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives CDC. www.cdc.gov/flu/healthcareworkers.htm Apenteng, B.A. & S.T. Opoku. Employee influenza vaccination in residential care facilities. American Journal of Infection Control 2014; 42:294-299. Sawyer, M.H. et.al. A public health initiative to increase annual influenza immunization among hospital health care personnel: The San Diego Hospital Influenza Immunization Partnership. American Journal of Infection Control 2012; 40:595-600.

4. Methods  Eighteen participating facilities identified via Montana’s licensed LTCF-ALF registries  Key Informant Survey  9 question survey  Distributed to Administrator or designee after introductory telephone call  Collected information about seasonal influenza staff vaccination policies and procedures  Results collected via telephone or fax

5. Methods  HCP Survey  5 question survey  Used a contact at each facility to distribute and collect surveys from all facility staff  Collected information about self-reported seasonal influenza vaccination status and influenza vaccination attitudes and beliefs

6. Results – Key Informant Survey  Key Informant Survey had response rate of 83% (n=15)  5 of 6 LTCF  10 of 13 ALF  Six (40%) LTCF-ALF had mandatory or recommended vaccination policies  4 mandatory  2 recommended

7. Results – HCP Survey  HCP surveys were received from 276 (28%) of 990 HCP  13 facilities participated  91% (251 of 276) of HCP respondents performed direct patient contact  68% (189 of 276) received seasonal influenza vaccination

8. Results – HCP Survey  Of the 189 vaccinated HCP, 65% (N=152) cited the presence of a workplace policy as a reason for vaccination

9. Results  Facilities with mandatory vaccination policies had 3-fold or greater HCP vaccination rates compared to facilities with recommendation policies

10. Conclusions  Workplace policies are a reason LTCF-ALF HCP receive seasonal influenza vaccination  Mandatory policies yield higher vaccination rates than recommendation policies  Mandatory vaccination policies can be one method used to work towards the Health People 2020 goal of a 90% vaccination rate in HCP

11. Limitations  HCP survey may have had selection bias  HCP survey participation depended upon methods used by each facility’s contact  Vaccination status is self-reported  Many Key Informants stated their corporate entity makes policy decisions

12. Next Steps  Develop a toolkit to help facilities move towards mandatory vaccination policies  For facilities not able to adopt a mandatory vaccination policy at this time:  Develop targeted educational campaigns based on why the facility’s HCP did not get vaccinated  Offer other interventions such as providing seasonal influenza vaccinations on-site

13. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Questions? Theresa Majeski, MPH Public Health Advisor/PHAP Associate CDC/OSTLTS/OD 1035 1 st Ave West Kalispell, MT 59901 406-260-4906 ypn6@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support