By Annette M. Boyle

After recorded seasonal influenza vaccination rates among VHA healthcare personnel plummeted 21% last year compared with 2009-2010, the agency has set an aggressive goal of vaccinating 85% of healthcare workers during the 2011-2012 flu season.

A VA employee receives his flu shot at the Tennessee Valley Healthcare System. Photo from VA website.

“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,” said Richard Martinello, MD, chief consultant, VA Clinical Public Health. “While we have a number of initiatives designed to improve and protect our healthcare workers, the annual flu vaccine is right at the top.”

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Healthcare workers are at especially high risk for influenza infection. According to a report coauthored 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 healthcare workers in the first wave of the 2009 pandemic was acquired in the workplace.

While surveys indicate that many healthcare workers consider general infection-control methods and good health to be largely protective against flu, the Centers for Disease Control and Prevention (CDC) estimates that 5% to 20% of all unimmunized individuals will develop influenza in any year. Healthcare workers’ high degree of exposure increases their likelihood of contracting the infection, making tracking sick days among healthcare personnel a leading indicator of influenza severity.

VA Population Vulnerable

For the vulnerable populations served by the VA, exposure to unimmunized and infected clinical staff poses great risk, particularly as infected workers can spread influenza for at least a full day before symptoms appear and for five to 10 days afterward. This risk is compounded by the reluctance of many physicians and nurses to take sick leave, even when they are suffering from influenza-like illnesses, and by the significant proportion — up to 50% — that experience asymptomatic influenza infection. In one study among healthcare workers, of the 23% with serologic evidence of infection, nearly 60% had no recollection of having had influenza, and almost 30% did not recall having any respiratory infection.

Many studies have shown a positive correlation between high rates of healthcare personnel influenza vaccination rates and lower proportions of nosocomial cases among hospitalized patients. Minimizing the spread of influenza to VA patients is critical to their health. Among the highest-risk patients, those with spinal-cord injury or disorders have a 37% higher likelihood of death from influenza than the general population. Half of patients with underlying cardiovascular disorders who contract influenza will develop pneumonia, and 10% will die. Among longterm-care personnel, a study in the British Medical Journal demonstrated that benefit associated with influenza vaccinations of 100 healthcare workers is equivalent to saving five lives, eliminating two hospital admissions and seven office visits, and keeping nine individuals from developing influenza-like illness.

Based on figures obtained from the Occupational Health Record-keeping System (OHRS), an electronic medical record system, only 54% of VHA healthcare workers received the flu vaccine last year, down from 77% who reported they had been vaccinated when surveyed in 2009-2010. In 2009, VA physicians reported the highest rates of vaccination at 88.7%, while nursing assistants and licensed practical nurses had rates of approximately 71%. Healthcare aides and HCWs under the age of 50 typically have the lowest rates of vaccination, according to the CDC.

“Changes in reporting procedures account for some of the drop in vaccination rates, but there is still quite a gap compared to previous years,” Martinello said.

“Flu fatigue” following the intense effort to vaccinate veterans and healthcare personnel during the 2009 H1N1 pandemic may have contributed to the lower vaccination rates reported in 2010, suggested Kristin Nichol, MD, MPH, MBA, associate chief of staff for research, in her introduction to the VA Influenza Manual 2011-2012.