Occupational Health Influenza Vaccination Anne McGowan Nurse Consultant Vaccine Preventable Disease Programme anne.mcgowan2@wales.nhs.uk Nothing new brief on evidence for occ health VPDP Flu meeting May 2011

Occupational Influenza Uptake 2010/11 Numbers over 14000 18.5%. Total over 50% more vaccinated all Wales all have improved. I know that occ health teams have worked very hard and set a number of initative with improved accessibility etc.

All Wales 18.5% All HB’s improved What happened in BCHB to reach >30%

English Uptakes VPDP Flu meeting May 2011 Different data collection methods England total 34.7% 2010/11 Over 1m doses given Range 5.2% to 94.9% Out of 388 trusts 45 above 50% @ 12% Cant make direct comparisons different methods of data collection and quality issues over denominators. VPDP Flu meeting May 2011

Why offer Flu vaccination to HCW’s ? Occupational risk of exposure, contraction and transmission. Significant reduction in ILI, medical consultations, hospital admissions and mortality (Hayward et al 2006) Service continuity Personal protection Reminder from evidence why Flu is important Asymptomatic carriers Reduce transmission in sick patients Hayward, AC, et al (2006) Effectiveness of an influenza programme for home care staff to prevent death, morbidity and health service use among residents: cluster RCT ‘ , BMJ Vol.333,p1241. VPDP Flu meeting may 2011

Evidence Systematic review and economic evaluation of 18 studies (Burls et al 2006) Concludes Highly effective Minimal adverse events Good use of HC resources Overwhelming evidence to support flu vaccine for HCW’s. Majority of European countries have a policy where Flu vaccine recommended for HCW’s Ref: Burls, A et al (2006) ‘Vaccinating healthcare workers against influenza to protect the vulnerable – Is it good use of healthcare resources? A Systematic review and economic evaluation’, Vaccine , 24,pp4212-4221. VPDP Flu Meeting may 2011

Evidenced based interventions RCT in Jerusalem, n344 primary care workers Intervention Lecture session, email literature and reminders Key figure from local staff who personally approached every member Results 52.8% in intervention group 86/163 26.5% in control 48/181 (p<0.001) REF; Abramson ZH, Avni O, Levi O et al . Randomized trail of a program to increase staff influenza in primary care clinic. Ann Fam Med . 2010 Jul-Aug;8(4):293 – 8. Bringing it down to alocal level findings suggest local staff who are respected and who champion who are approachable VPDP Flu meeting May 2011

HCW’s attitudes to Flu Vaccination Its complex !! Want scientific information (Yassi et al 2010) Culture of organisation important determinant (Moore et al 2005) Self protection v pt protection (Pareek et al 2009) Lack of understanding about risks (Hollymeyer et al 2009) Last yr provided an information sheet with evidence look to building on that GBs 1 in a million VPDP Flu meeting May 2011

5 Top reasons for refusal Fear about adverse reactions Lack of concern about flu Doubts about vaccine efficacy Organisational barriers ‘access’ Resources GBS 1 in 1million Source: DTB Vol 48, No 11 Nov 2010 BNF 14.4 VPDP Flu meeting May 2011

References VPDP Flu meeting May 2011 Hollymeyer, H,G, et al (2009) ‘Influenza vaccination of healthcare workers : a literature review of studies on attitudes and predictors’, Vaccine , Vol 27,pp3935 – 3944. Moore, DM, et al (2005)’ Occupational health and infection control practices related to severe acute respiratory syndrome: Health care worker pereceptions’,AAOHNJ,Vol53,No.6,pp257 -66. Parek,M et al (2009)’Willingness of healthcare workers to accept voluntary stock piled H5N1 vaccine in advance of pandemic activity’, Vaccine, Vol 27,pp3935-3944. Yassi A, et al (2010)’Vaccination of HealthCare Workers for Influenza :Promote Safety Culture, Not Coercion’, Can Journal Of Public Health , Vol 101, Suppl.1pp.S41 –S45. VPDP Flu meeting May 2011

Acknowledgements Dr Simon Cottrell VPDP PHW Dr Richard Peabody HPA Rachel Hale Uni Nottingham Initiatives, innovation and ideas to improve immunisation uptake Vaccine Preventable Disease Programme 2010