Requirement for Influenza Requirement for Influenza Vaccination of Health Care Vaccination of Health Care

Personnel: New York State’s Personnel: New York State’s ExperienceExperience

Debra Blog, MD, MPHDebra Blog, MD, MPHBureau of ImmunizationBureau of Immunization

New York State Department of New York State Department of HealthHealth

January 20, 2010January 20, 201011

Pre-existing Immunization Pre-existing Immunization Requirements for Certain Health Requirements for Certain Health

Care Facilities (Not LTCFs)Care Facilities (Not LTCFs)In regulationIn regulation

Must have immunity to measles and rubellaMust have immunity to measles and rubella

Must have annual PPD test for TBMust have annual PPD test for TB

Some individual facilities require more, eg. Some individual facilities require more, eg. mumps and varicella, but not in regulationmumps and varicella, but not in regulation

Requirement for measles, rubella, and Requirement for measles, rubella, and PPD: NO religious exemption. PPD: NO religious exemption.

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Long Term Care FacilitiesLong Term Care Facilities

April 2000, Article 21A, the Long term Care April 2000, Article 21A, the Long term Care Resident and Employee Immunization Act Resident and Employee Immunization Act required that influenza immunization be offered required that influenza immunization be offered to all residents and employees (and to all residents and employees (and pneumococcal vaccine as appropriate)pneumococcal vaccine as appropriate)

Includes nursing homes, adult day health care Includes nursing homes, adult day health care programs, adult homes, and enriched housing programs, adult homes, and enriched housing programsprograms

Employee can refuseEmployee can refuse

Vaccination status must be documented yearlyVaccination status must be documented yearly

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LTCFs ContinuedLTCFs Continued

The enactment of this law has failed to The enactment of this law has failed to promote consistent immunization rates of promote consistent immunization rates of personnel over 44%personnel over 44%

Influenza/Immunization Influenza/Immunization RequirementsRequirements

For LTCFs in statuteFor LTCFs in statute

For certain health care facilities in For certain health care facilities in regulationregulation

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Efforts Made Under a Voluntary Efforts Made Under a Voluntary SystemSystem

Two letters from the NYSDOH Commissioner Two letters from the NYSDOH Commissioner emphasizing influenza immunization of health care emphasizing influenza immunization of health care personnel as the standard of carepersonnel as the standard of care

Emphasized in many advisoriesEmphasized in many advisories

Tool kitsTool kits

Continuous promotion of influenza vaccination and Continuous promotion of influenza vaccination and the use of incentivesthe use of incentives

Educational materialsEducational materials

Outreach to healthcare partnersOutreach to healthcare partners

Media campaignsMedia campaigns

Laying the Foundation for Laying the Foundation for Regulatory ChangeRegulatory Change

Preparation for this change was Preparation for this change was implemented over past few years. implemented over past few years. Included:Included:– Meetings with partnersMeetings with partners– Outreach to nurses’ unions/organizationsOutreach to nurses’ unions/organizations– Educational effortsEducational efforts– Presentations to the State Hospital Review Presentations to the State Hospital Review

and Planning Committee (SHRPC) meetings, and Planning Committee (SHRPC) meetings, which are open to the publicwhich are open to the public

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TimelineTimelineSHRPC voted to accept as an SHRPC voted to accept as an emergencyemergency regulation on August 13, 2009, effective regulation on August 13, 2009, effective immediately.immediately.

Included both seasonal and H1N1 influenza Included both seasonal and H1N1 influenza vaccinesvaccines

Emergency reg was renewed onceEmergency reg was renewed once

Regulation suspended on October 23, 2009 Regulation suspended on October 23, 2009 due to lack of sufficient supply of both types due to lack of sufficient supply of both types of vaccine (along with other NYS flu laws)of vaccine (along with other NYS flu laws)

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Subpart 66-3 – Health Care Facility Subpart 66-3 – Health Care Facility Personnel Influenza Immunization Personnel Influenza Immunization

RequirementsRequirementsDefinitionsDefinitions

Health care facility-personnel influenza Health care facility-personnel influenza immunization requirements immunization requirements

Health care facility requirements, existing Health care facility requirements, existing personnelpersonnel

Health care facility requirements, new personnelHealth care facility requirements, new personnel

DocumentationDocumentation

ExceptionsExceptions

Reporting requirementsReporting requirements

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DefinitionsDefinitions

Medically contraindicatedMedically contraindicated– Vaccination would be detrimental to the person’s healthVaccination would be detrimental to the person’s health– In a manner recognized nationallyIn a manner recognized nationally– Guidance will be posted on the NYSDOH websiteGuidance will be posted on the NYSDOH website

Personnel-broad definitionPersonnel-broad definition– All persons employed or affiliatedAll persons employed or affiliated– Paid or unpaid-includes members of the medical staff, Paid or unpaid-includes members of the medical staff,

contract staff, students, and volunteers contract staff, students, and volunteers – who either have direct contact with patients or whose who either have direct contact with patients or whose

activities are such that if they were infected with activities are such that if they were infected with influenza, they could potentially expose patients, or influenza, they could potentially expose patients, or others who have direct contact with patientsothers who have direct contact with patients

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Definitions ContinuedDefinitions Continued

Health Care Facilities (HCFs)Health Care Facilities (HCFs)– General hospitalsGeneral hospitals– Diagnostic and Treatment CentersDiagnostic and Treatment Centers– Certified Home Health AgenciesCertified Home Health Agencies– Licensed Home Care Service AgenciesLicensed Home Care Service Agencies– Long Term Home Health Care ProgramsLong Term Home Health Care Programs– AIDS Home Care ProgramsAIDS Home Care Programs– HospicesHospices

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Personnel influenza immunization Personnel influenza immunization requirementsrequirements

HCFs must notify personnel about the HCFs must notify personnel about the requirementrequirementHCFs must require that all be immunized against HCFs must require that all be immunized against influenzainfluenzaImmunization will be conducted according to Immunization will be conducted according to national recommendations in effect and posted national recommendations in effect and posted on the NYSDOH websiteon the NYSDOH websiteImmunization will take place unless the Immunization will take place unless the Commissioner of Health has determined that Commissioner of Health has determined that supply is not adequatesupply is not adequate

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Cost of VaccinationCost of Vaccination

HCFs must offer influenza at no cost to the HCFs must offer influenza at no cost to the personnelpersonnel

Personnel can obtain the vaccination Personnel can obtain the vaccination elsewhere but then the person or their elsewhere but then the person or their insurance will have to pay for itinsurance will have to pay for it

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Existing PersonnelExisting Personnel

If personnel choose to get vaccinated If personnel choose to get vaccinated elsewhere documentation must be elsewhere documentation must be providedprovided

Vaccination or provision of documentation Vaccination or provision of documentation no later than November 30 of each yearno later than November 30 of each year

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New PersonnelNew Personnel

If enters employment after November 30If enters employment after November 30thth but before April 1but before April 1Needs influenza immunization status Needs influenza immunization status evaluatedevaluatedIf not immunized for the current season, If not immunized for the current season, need to do soneed to do soCan receive elsewhere if provides Can receive elsewhere if provides documentationdocumentation

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DocumentationDocumentation

HCF must document annual influenza HCF must document annual influenza vaccination in the personnel filesvaccination in the personnel filesMust record Must record – date, site of administration, type of vaccine, dose, date, site of administration, type of vaccine, dose,

manufacturer, lot number, that a vaccine information manufacturer, lot number, that a vaccine information statement was given to the vaccinee and which one, statement was given to the vaccinee and which one, name of the person giving the vaccination, any name of the person giving the vaccination, any reactions knownreactions known

If vaccinated elsewhere HCF must document If vaccinated elsewhere HCF must document date, type of vaccine, dose, and name of person date, type of vaccine, dose, and name of person administering the vaccineadministering the vaccine

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ExceptionsExceptions

Medical contraindications onlyMedical contraindications only

Immunization will be conducted according Immunization will be conducted according to national recommendations in effect and to national recommendations in effect and posted on the NYSDOH websiteposted on the NYSDOH website

Consistent with previous regsConsistent with previous regs

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Reporting requirementsReporting requirements

Each HCF shall collect and report aggregate Each HCF shall collect and report aggregate data on influenza immunization of personneldata on influenza immunization of personnel

Shall report on the status of personnel between Shall report on the status of personnel between April 1 and March 31 of each yearApril 1 and March 31 of each year

Report to the NYSDOH by May 1 of each yearReport to the NYSDOH by May 1 of each year

Data to include but not be limited to: number of Data to include but not be limited to: number of personnel immunized by occupation, total personnel immunized by occupation, total number of personnel by occupation, reasons number of personnel by occupation, reasons any personnel did not receive vaccineany personnel did not receive vaccine

ResponseResponse

Strong opposition from nursesStrong opposition from nurses

New York State Nurses Association (NSYNA) New York State Nurses Association (NSYNA) was opposedwas opposed

Thousands of lettersThousands of letters

Thousands of phone callsThousands of phone calls

Several small protestsSeveral small protests

Organized letter writing campaignsOrganized letter writing campaigns

Anti-vaccine movement became involvedAnti-vaccine movement became involved

Two law suitsTwo law suits

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NYSDOH ExperienceNYSDOH Experience

Rapidly changing Q and As draftedRapidly changing Q and As drafted

Responding to the huge volume of calls Responding to the huge volume of calls and letters took up staff timeand letters took up staff time

Staff was verbally attacked on the phoneStaff was verbally attacked on the phone

All this right when H1N1 hitAll this right when H1N1 hit

A call center was set up to accept the A call center was set up to accept the thousands of phone callsthousands of phone calls

And then it all stoppedAnd then it all stopped

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Some Sticking PointsSome Sticking Points

Definition of personnel was difficult to Definition of personnel was difficult to interpret and operationalizeinterpret and operationalize

Lack of religious exemption was contentiousLack of religious exemption was contentious

Adhering to a standard of medical exemptions Adhering to a standard of medical exemptions was also contentiouswas also contentious

What should be done with those who refusedWhat should be done with those who refused

What should be done with those who have What should be done with those who have medical exemptionsmedical exemptions

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FutureFuture

Regs are being revised and clarified based Regs are being revised and clarified based on what we learnedon what we learned

Plans are to go forward with permanent Plans are to go forward with permanent adoptionadoption

Plans to address long term care facilities Plans to address long term care facilities through statutethrough statute

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