Preparing for the Next Pandemic – VA Enhances Flu Vaccination and Surveillance Programs

By Annette M. Boyle

WASHINGTON–Influenza attacks 5% to 20% of Americans and kills between 3,000 and 49,000 individuals in the average year. Annually, more than 225,000 people require hospitalization for the symptoms of seasonal influenza.

The Department of Health and Human Services projects that a moderate pandemic, such as that experienced in 1957 and 1968, would cause 865,000 hospitalizations and 209,000 deaths, while a severe, 1918-like pandemic could send nearly 10 million people to hospitals and kill more than 1.9 million.

VA’s patient population includes many of those most vulnerable to the disease. With seasonal influenza, individuals over the age of 65 account for 90% of deaths, and risk rises sharply with increasing age.  Patients who are immunocompromised or have chronic medical conditions such as pulmonary or cardiac disease or diabetes also face significantly elevated risk. Among patients with cardiovascular disease who contract influenza, 50% will develop pneumonia, and10% will die.

The Wilmington, DE, VA Medical Center has held drive-through influenza vaccine clinics to increase compliance. Photo from Wilmington VA website.

Annual vaccinations provide the most effective protection against influenza and limit its spread within institutions and communities. As a result, communicating the importance of immunizing veterans and healthcare workers is a central feature of the VA’s “Infection: Don’t Pass It On” (I:DPIO) program. Annual efforts to develop new and engaging messaging have been so successful that “one poster ended up on the TV show ‘Glee’ and others have been requested by people in New Zealand and Wales,” said Connie Raab, director, public health communications at the VA.

“A very impressive 82% of VA patients over age 65 were vaccinated in 2009-2010, compared to 67% of those over age 65 in the country as a whole. For VA patients ages 50-64, 71% were vaccinated, compared to the flu vaccine rate in the United States overall, which was 41%. In 2009-2012, we vaccinated 77% of our VA healthcare personnel, and we continue to strongly promote vaccination among our health care providers,” wrote Robert Petzel, MD, under secretary of health, Veterans Health Administration in the VA influenza Manual 2011-2012. For 2011-2012, the VA “set goals of 80% for employee vaccination rates, 95% for inpatient veterans, 83% for outpatients 65 years or older and 66% for those aged 60-64,” according to the manual.

Vaccination rates in 2010-2011 were notably lower, dropping 21% among healthcare workers, which Kristin Nichol, MD, MPH, MBA, associate chief of staff for research, Minneapolis VA Medical Center, attributed to “flu fatigue” following the intensive push for immunization during the 2009 pandemic.

“Obtaining the seasonal flu vaccine each year is one of the most important interventions VA healthcare workers can take to protect the health of their patients, their colleagues, themselves and their families,” Richard Martinello, MD, chief consultant, Clinical Public Health, told U.S. Medicine. Healthcare workers (HCWs) are at especially high risk for influenza infection, he noted.

According to research co-authored by Martinello and three other members of the VHA Office of Public Health that appeared in the September 2011 issue of Disaster Medicine and Public Health Preparedness, 50% of the H1N1 influenza infection among HCWs in the first wave of the 2009 pandemic was acquired in the workplace. Because of their position in the front line of an epidemic, the authors wrote, tracking illness among HCWs may “represent a means of conducting near-real-time syndromic surveillance that may prove useful in identifying and managing future influenza pandemics.”  In addition, they noted that this surveillance mode “may prove to be a sensitive indicator of the severity of influenza and potential outbreaks of other transmissible infections.”

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