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

Influenza is a serious health threat for older adults.

Influenza can be a serious health threat, especially for people who are vulnerable to serious flu illness, like older adults and people living with certain long-term medical conditions. People older than 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 71 percent and 85 percent of seasonal flu related deaths have occurred in people 65 years and older.
• It’s estimated that between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people 65 years and older.

CDC recommends everyone 6 months of age and older get vaccinated against influenza every year.

This includes special emphasis on vaccinating people who live with or care for people who are at high risk of serious flu illness, including people who work in the field of long-term care (LTC).

Different flu vaccines are approved for use in different people. Factors that can determine what vaccines are suitable for a given person might include a person’s age, health and any allergies to flu vaccine or any of its components. Flu shots are approved for use in pregnant women and people with chronic health conditions.

CDC recommends a flu shot with either inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) during 2017-2018. The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) is not recommended this season.

More information is available at Who Should Get Vaccinated Against Influenza.

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Getting Vaccinated: Options for Older Adults

Several vaccine options are available for people 65 years and older, including standard dose inactivated influenza vaccine, a high dose influenza vaccine, and a standard dose vaccine with adjuvant. The “high dose” flu vaccine( (Fluzone® High-Dose) contains four times the antigen (the part of the vaccine that helps your body build up protection against flu viruses) of standard flu shots. The “adjuvanted” flu vaccine (FLUAD™) is a trivalent vaccine containing MF59 adjuvant for people 65 years and older.

Health Care Personnel: At risk of occupationally acquired influenza and transmitting influenza to patients

Health care personnel in long-term care 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. Health care personnel may become infected with influenza through contact with infected residents or someone in the community, and spread influenza to residents and other health care personnel. In addition, people infected with influenza may be able to spread influenza one day before they feel sick through five to seven days after becoming sick.

Studies have documented that health care personnel 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. Sometimes health care personnel 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. 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.

Health care personnel should get their flu vaccine early in the fall, by the end of October, if possible. Since it takes about two weeks for antibodies to develop after being vaccinated, it’s important that health care personnel are vaccinated early in the influenza season so that they are protected before influenza infections become prevalent in the community.

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.

CDC recommends influenza vaccination for all health care personnel 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 health care personnel is recommended by the Advisory Committee on Immunization Practices (ACIP). ACIP includes recommendations specifically for health care personnel  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 health care personnel are based on a body of research that documents measurable benefits of vaccination:

Vaccination may reduce:

• transmission of influenza
• the number of personnel continuing to work while they are ill (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 high flu vaccination coverage among health care personnel and increased protection against lab-confirmed flu among people in long-term care facilities and hospitals.