Claire Farella RN BScN MN Manager Community Health Protection

What's New With The Flu

Historical Data 100 anniversary of the Spanish Flu - H1N1 • 500 million infected world wide with 50-100

million deaths- represented 5 % of the worlds population

• Taking lives of otherwise healthy young adults which was a change from very young and very old being impacted

• Was felt to be one of the deadliest natural disasters in human history.

2017/2018 Flu Season Fast Track 100 years later…. 2017/18 has been reported as a very unusual season for a variety of reasons… • Influenza A lasted several more weeks than usual • Influenza B started earlier, increase in the number

and hung around longer • As many of you experienced in your institutions

both influenza A & B outbreaks occurred at the same time.

PHO (2018) Figure 3: Total number of influenza tests performed and percent of positive respiratory tests by surveillance week: Ontario, April 9, 2017 to April 7, 2018

PHO (2018) Figure 6: Institutional respiratory infection outbreaks by week of illness onset in the first case: Ontario,

April 9, 2017 to April 7, 2018

2017/2018 Flu Season PHO reported that Eastern Region: • Had more cases of influenza A than B • H3N2 dominated the season • Higher, early & sustained Influenza B activity. • Eastern Region was similar with rest of Canada

with an overlap of Influenza A & B cases with increase in B

2017/2018 Flu Season Australia (Southern Hemisphere) influenza season is very similar to Canada and is used a predictor Australia experienced: • An overlap of A & B cases at the same time • H3N2 predominately • High, early and sustained B activity

What is expected in 2018/2019 Influenza activity to date in the Southern Hemisphere - Australia • Predominately H1N1 season • Lower rates of infection to previous year • Vaccine matched the circulating strain • Influenza hospitalizations were down from

previous year • Lower levels of influenza B than last year

Ontario Respiratory Pathogen Bulletin

• Weekly summary of provincial respiratory pathogen activity

• https://www.publichealthontario.ca/en/ServicesAndTools/SurveillanceServices/Pages/Ontario-Respiratory-Virus-Bulletin.aspx

Leeds Grenville Lanark Outbreak Status Website

• https://healthunit.org/for-professionals/hospitals-ltc-retirement-homes/outbreak-management-resources/outbreak-status-report/

• Opportunity to subscribe to website for automatic updates in LGL.

Flu Vaccine 2018/2019 Vaccine - Quadrivalent & Trivalent Quadrivalent - FluLaval – Fluzone- FluMist • A/Michigan/45/2015(H1N1) • A/Singapore/INFIMH-16-0019/2016(H3N2) • B/Colorado/06/2017-like virus (B

Victoria/2/87lineage) • B/Phuket/3073/2013 like virus

(B/Yamagata/16/88 lineage).

Flu Vaccine 2018/2019 Trivalent Vaccine- Fluzone-High-Dose • A/Michigan/45/2015/(H1N1)pdm09-like virus • A/Singapore/INFIMH-16-0019/2016(H3N2) like

virus • B/Colorado/06/2017/like virus (B/Victoria/2/87

linkage) • High-dose - (4x) increase in antigen to mount a

better immune response • Influenza A more significant to greater than 65 age

group i.e., Infection rates…82% A vs 17 % B

Flu Vaccine 2018/2019 FluMist 2-17 yrs. • Live attenuated • Cold adapted/temperature sensitive • Grows in nasopharynx • Increase success in children than adults as child

have less immunity to inhibit • Replication in nasopharynx • Comes down to parent choice as long as no

contraindications

Flu Vaccine 2018/2019 New 2018/2019 • All individuals aged 6 months or older will be

offered a quadrivalent inactivated vaccine • Individuals 2-17 will be offered the

quadrivalent live attenuated influenza vaccine- FluMist

• Individuals 65 years of age and older will be offered the high-dose trivalent inactivated vaccine.

Antiviral Medication • Still recommended for prevention and treatment • If influenza circulating in community don’t wait

for lab confirmation • Important to have an antiviral plan in place i.e.

medical directive and arrangement with pharmacy

• For treatment start within 48 hr. of symptoms • Can decrease symptoms within 24 hrs. as well as

decrease secondary complications

Flu Vaccine Rates • MOHLTC requires institutions to report

influenza vaccination rate by Dec 15, 2018 • Reporting forms have been emailed to each

institution • As reported rates from previous year (2017)

recorded – Hospitals at 54% – LTCH at 73%

• Still room for improvement

PHO (2018) Figure A. Median influenza immunization coverage rates among LTCH and hospital staff, by influenza season:

Ontario, 2003-2004 to 2017-2018 seasons

Increasing Immunization Rates • This is a question that has been asked year

after year • Healthcare providers are provided scientific

evidence on the impact of “herd immunity” to protect the most vulnerable

• Despite having this information there is a hesitancy to participate in influenza immunization

Increasing Immunization Rates • Some experts have recommended mandatory

influenza immunization for all health care personnel as they feel it is ethical, just and necessary to improve patient safety

• Others feel this is a direct impact on individual choice

• Some strategies have focused on behaviors • Other strategies have focused on creating a

supportive environment making immunization an easy choice

Points to Remember When Trying to Create a Change in Immunization Rates

• Just because science states it is the best strategy doesn’t mean that everyone will buy in

• Often one can agree in principal but have difficulty participating

• Remember that culture has tremendous influence on how strategies related to change will be accepted and mobilized

• Change requires intentional actions that can be sustained over the long term

• There are no guaranteed strategies for change- it all rests in how it is packaged and presented

Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel

Lack of access to influenza vaccine • Provide free vaccine at the workplace • Offer vaccine at multiple times and locations convenient to all

workers on all shifts during the flu season • Use a mobile vaccination cart to take influenza vaccinations to staff • Partner with a larger health care organization (e.g., hospital) to

provide vaccinations • Work with pharmacy consultants to offer influenza vaccinations for

facility staff • Work with visiting nurses associations or other community

immunizers to provide vaccination on-site • Offer influenza vaccine at mandatory trainings, departmental

conferences, and other meetings

Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel

Beliefs • Provide a strong educational program for staff

– Focus on protecting the worker and their family as well as the residents in the educational materials

– Share Influenza Vaccine Information Statements – Share the Joint Commission’s Influenza fact sheet – Use a Declination Form to learn why staff are declining

vaccination to focus your own messages – Ask vaccinated health care personnel to encourage their

coworkers to get vaccinated

Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel

Lack of enthusiasm about influenza vaccination • Publicize a “vaccine day” in combination with education to offer influenza

vaccinations • Emphasize that flu vaccination protects the employees, their loved ones and

those they work with • Encourage employees to set an example; remind them that their action and

recommendation carries a lot of weight in others’ decisions to get vaccinated • Encourage employees via e-mail, posters, an employee newsletter, and any

other communication tools used in your workplace to get the vaccine • Track and report vaccination rates to staff and supervisors • Remind unvaccinated employees with e-mail, letters, encouragement from

supervisors, and telephone calls • Provide contests or incentives to get vaccinated (small gift cards, raffles, pizza

party, etc.) • Vaccinate the medical director and all managers in front of the staff

Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel

High staff turnover • Offer influenza vaccination education multiple times during

the flu season • Offer opportunities to be vaccinated at multiple times and

locations convenient to all workers on all shifts during the flu season

• Educate and vaccinate staff as part of new employee orientations

• Establish a process to determine and track proof of influenza vaccination each year for each employee

• Establish a written influenza vaccination policy for employees • Work with pharmacy consultants to offer influenza

vaccination for facility staff, as a standard procedure

Questions

References • Public Health Ontario (2018). Webinar- What's new

with the flu. Oct 11, 2018 • Public Health Ontario (2018) Ontario Respiratory Virus

Bulletin 2017/2018 Week 14 https://www.publichealthontario.ca/en/ServicesAndTools/SurveillanceServices/Pages/Ontario-Respiratory-Virus-Bulletin.aspx

• Centres for Disease Control and Prevention. Barriers and Strategies to Improving Influenza Vaccination among Health Care Personnel. Accessed October 2018. https://www.cdc.gov/flu/toolkit/long-term-care/strategies.htm

References

• Ministry of Health and Long-Term Care. (2018) 2018/2019 Universal Influenza Immunization Program http://health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/docs/flu_uiip_6mo-17yrs_2018-19.pdf

• Ontario Ministry of Health and Long-Term Care,(2018) Ontario Influenza Immunization Database (OIID), analyzed by Public Health Ontario. https://www.publichealthontario.ca/en/ServicesAndTools/SurveillanceServices/Pages/Ontario-Respiratory-Virus-Bulletin.aspx

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