Influenza Vaccination Information for Health Care Workers
- CDC, the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza.
- Health care workers include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from health care workers and patients.
- Influenza (the flu) can be a serious disease that can lead to hospitalization and sometimes even death. Anyone can get very sick from the flu, including people who are otherwise healthy.
- You can get the flu from patients and coworkers who are sick with the flu.
- If you get the flu, you can spread it to others even if you don’t feel sick.
- By getting vaccinated, you help protect yourself, your family at home, and your patients.
- Overall, the number of health care workers who reported having had an influenza vaccination increased in the 2012-13 influenza season compared to the 2011-12 season.
- The coverage rate for health care workers was estimated at 72% for the 2012-13 season, an increase from 66.9% in the 2011-12 season and 63.5% in the 2010-11 season.
- Coverage was highest among health care workers working in occupational settings with vaccination requirements (96.5%) and physicians (92.3%).
- Comprehensive, work-site intervention strategies that include education, promotion, and easy access to vaccination at no cost for multiple days can increase health care worker vaccination coverage.
- Educating health care workers on the benefits and risks of influenza vaccination, providing vaccinations in the workplace at convenient locations and times, and providing influenza vaccination at no cost are effective strategies to increase coverage among health care workers in all settings.
The results of this report were based on an Internet panel survey of a total of 1,944 health care workers, conducted in April 2013.
More information is available at FluVaxView: Influenza Vaccination Coverage.
- Influenza (the flu) can be a serious disease that can lead to hospitalization and sometimes even death. Anyone can get sick from the flu.
- People with flu can spread it to others. Influenza viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are up to about 6 feet away or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.
- Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Children may pass the virus for longer Symptoms start 1 to 4 days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some persons can be infected with the flu virus but have no symptoms. During this time, those persons may still spread the virus to others.
- Some people, such as older adults, pregnant women, and very young children as well as people with certain long-term medical conditions are at high risk of serious complications from the flu. These medical conditions include chronic lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), diabetes, heart disease, neurologic conditions and pregnancy.
- Since health care workers may care for or live with people at high risk for influenza-related complications, it is especially important for them to get vaccinated annually.
- Annual vaccination is important because influenza is unpredictable, flu viruses are constantly changing and immunity from vaccination declines over time.
- CDC recommends an annual flu vaccine as the first and best way to protect against influenza. This recommendation is the same even during years when the vaccine composition (the viruses the vaccine protects against) remains unchanged from the previous season.
- The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called trivalent vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. In addition, this season, there are flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine as well as an additional B virus.
- Flu vaccines CANNOT cause the flu. Flu vaccines that are administered with a needle are currently made in two ways: the vaccine is made either with a) flu vaccine viruses that have been ‘inactivated’ and are therefore not infectious, or b) with no flu viruses at all (which is the case for recombinant influenza vaccine). The nasal spray flu vaccine does contain live viruses. However, the viruses are attenuated (weakened), and therefore cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.
- Flu vaccines are safe. Serious problems from the flu vaccine are very rare. The most common side effect that a person is likely to experience is either soreness where the injection was given, or runny nose in the case of nasal spray. These side effects are generally mild and usually go away after a day or two. Visit Influenza Vaccine Safety for more information.
Everyone who is at least 6 months of age should get a flu vaccine this season. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the United States to expand protection against the flu to more people.
While everyone should get a flu vaccine this season, it’s especially important for some people to get vaccinated.
Those people include the following:
- People who are at high risk of developing serious complications (like pneumonia) if they get sick with the flu.
- People who have certain medical conditions including asthma, diabetes, and chronic lung disease.
- Pregnant women.
- People younger than 5 years (and especially those younger than 2), and people 65 years and older.
- A complete list is available at People Who Are at High Risk of Developing Flu-Related Complications.
- People who live with or care for others who are at high risk of developing serious complications (see list above).
- Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease.
- Household contacts and caregivers of infants less than 6 months old.
- Health care personnel.
More information is available at Who Should Get Vaccinated Against Influenza.
Special Consideration Regarding Egg Allergy:
People who have ever had a severe allergic reaction to eggs may be advised not to get vaccinated. People who have had a mild reaction to egg—that is, one which only involved hives—may receive a flu shot with additional precautions. Make sure your health care provider knows about any allergic reactions. Most, but not all, types of flu vaccine contain small amount of egg.
Influenza vaccine is not approved for children younger than 6 months of age.
People who have had a severe allergic reaction to influenza vaccine should generally not be vaccinated.
There are some people who should not get a flu vaccine without first consulting a physician.
- People who have a moderate-to-severe illness with or without a fever (they should wait until they recover to get vaccinated), and
- People with a history of Guillain–Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Tell your doctor if you ever had Guillain-Barré Syndrome. Your doctor will help you decide whether the vaccine is recommended for you.
There are several flu vaccine options for the 2013-2014 flu season.
Traditional flu vaccines made to protect against three different flu viruses (called “trivalent” vaccines) are available. In addition, this season flu vaccines made to protect against four different flu viruses (called “quadrivalent” vaccines) also are available.
The trivalent flu vaccine protects against two influenza A viruses and an influenza B virus. The following trivalent flu vaccines are available:
- Standard dose trivalent shots that are manufactured using virus grown in eggs. These are approved for people ages 6 months and older. There are different brands of this type of vaccine, and each is approved for different ages. However, there is a brand that is approved for children as young as 6 months old and up.
- A standard dose trivalent shot containing virus grown in cell culture, which is approved for people 18 and older.
- A standard dose trivalent shot that is egg-free, approved for people 18 through 49 years of age.
- A high-dose trivalent shot, approved for people 65 and older.
- A standard dose intradermal trivalent shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot, approved for people 18 through 64 years of age.
The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The following quadrivalent flu vaccines are available:
- A standard dose quadrivalent shot
- A standard dose quadrivalent flu vaccine, given as a nasal spray, approved for healthy* people 2 through 49 years of age
(*”Healthy” indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.)
CDC does not recommend one flu vaccine over the other. The important thing is to get a flu vaccine every year.
Nearly all healthy, non-pregnant health care workers, may receive nasal spray vaccine if eligible, including those who come in contact with newborn infants (e.g., persons working in the neonatal intensive care unit, or NICU), pregnant women, persons with a solid organ transplant, persons receiving chemotherapy, and persons with HIV/AIDS.
However, health care providers should not get the nasal spray vaccine if they are providing medical care for patients who require special environments in the hospital because they are profoundly immunocompromised, for example if they work in bone marrow transplant units. This is intended as an extra precaution and is not based on reports of vaccine virus transmission in those settings. The flu shot is preferred for vaccinating health care workers who are in close contact with severely immunocompromised patients who are being cared for in a protective environment. These health care workers may still get nasal spray vaccine, but they must avoid contact with such patients for 7 days after getting vaccinated. See Persons Who Live With or Care for Persons at Higher Risk for Influenza-Related Complications for more information.
No special precautions (e.g., masks or gloves) are necessary for health care personnel who have been vaccinated with nasal spray vaccine and who do not work with patients undergoing bone marrow transplantation.
The role that you and other health care workers play in helping prevent influenza-related illness and death—especially in high-risk patients—is invaluable. By setting a good example and spreading flu facts (instead of the flu itself) among your colleagues and patients, you have the opportunity to save even more lives.
The seasonal flu vaccine protects against the influenza viruses research indicates will be most common during the upcoming season. Antibodies develop in the body about two weeks after vaccination. These antibodies provide protection against infection from viruses that are the same as or similar to those used to make the vaccine.
The 2013-2014 influenza vaccine provides protection against the following viruses:
- an A/California/7/2009 (H1N1)pdm09-like virus;
- an A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011;
- a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus.
Compared to the 2012-2013 seasonal influenza vaccine, the H1N1 component is the same, the H3N2 component is the same*, and the B component is different.
Quadrivalent vaccine this year contains the three viruses listed in the bullets above, and also a B/Brisbane/60/2008-like (B/Victoria lineage) virus. See Quadrivalent Vaccine: Questions and Answers for more information.
Yes. CDC recommends annual vaccination for everyone 6 months and older. Influenza viruses are constantly changing, and the composition of this season’s vaccine is different from the composition of last season’s vaccine.
You should get your flu vaccine soon after it becomes available, and ideally by October. However, as long as flu viruses are circulating, vaccination should continue to be offered throughout the flu season, even in January or later. While seasonal influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people get vaccinated so they are protected before influenza begins spreading in their community.
Protect yourself, your family, and your patients by getting a flu vaccine this season.
CDC conducts science-based investigations, research, and public health surveillance both nationally and internationally. CDC adopts recommendations that are made by the Advisory Committee for Immunization Practices. These recommendations may be considered by state and other Federal agencies when making or enforcing laws. However, CDC does not issue any requirements or mandates for state agencies, health systems, or health care workers regarding infection control practices, including influenza vaccination. There are no legally mandated vaccinations for adults, except for persons entering military service. CDC does recommend certain immunizations for adults, depending on age, occupation, and other circumstances, but these immunizations are not required by law.
However, some employers require certain immunizations for those employees who work with people who are sick or vulnerable to disease, or employees who handle or are exposed to dangerous substances, such as certain bacteria or viruses. Hospitals, for example, may require some staff to get the flu vaccine or hepatitis B vaccine.
To find out more about the laws in your state, contact your state health department through Public Health Resources: State Health Departments.
State Immunization Laws for Healthcare Workers and Patients and Vaccines and Immunizations: Basics and Common Questions National Center for Immunization and Respiratory Diseases have more information. For more information, updates, and access to free materials to assist with educating staff and patients about the impact of influenza and the benefits of vaccination, visit CDC Seasonal Influenza (Flu) or call the National Immunization Hotline at (800) 232-2522 (English), (800) 232-0233 (español), or (800) 243-7889 (TTY).
1 Ahmed F, Lindley M, Allred N, Weinbaum C, Grohskopf L. Effect of Influenza Vaccination of Health Care Personnel on Morbidity and Mortality Among Patients: Systematic Review and Grading of Evidence. Clin Infect Dis 2013; epublished ahead of print.
2 Griffin MR. Influenza Vaccination of Health Care Workers: Making the Grade for Action. Clin Infect Diseases 2013; epublished ahead of print.
Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD005187. DOI: 10.1002/14651858.CD005187.pub4.
CDC. Influenza Vaccination Coverage Among Health-Care Personnel – 2011-12 Influenza Season, United States. MMWR 2012:61:753-757.
CDC COCA Conference Call. Update on Influenza Vaccination for Health Care Personnel: Recent Coverage, Recommendations, Reporting, and Resources. November 15, 2011.CDC. Influenza Vaccination Coverage Among Health-Care Personnel—United States, 2010-11 Influenza Season. MMWR 2011;60:1073-1077.
CDC. Telebriefing on Influenza Vaccination Among Health Care Personnel and Pregnant Women. Thursday, August 18, 2011.
Vanhems P, Voirin N, Roche S, Escuret V, Regis C et al. Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004-2005, 2005-2006, and 2006-2007: a prospective study. Arch Intern Med 2011; 171(2);151-17.
Apisarnthanarak A, Uyeki T, Puthavathana P, Kitphati R, Mundy L. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: A 4-year intervention study in Thailand. Infect Control Hosp Epidemiol 2010; 31(10);996-1003.
Turnberg W, Daniell W, Duchin J. Influenza vaccination and sick leave practices and perceptions reported by health care workers in ambulatory care settings. Am J Infect Control 2010; 38(6):486-8.
CDC. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(No. RR-2).
Salgado CD, Giannetta ET, Hayden FG, Farr BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004;25:923--8.
Saito R, Suzuki H, Oshitani H, Sakai T, Seki N, Tanabe N. The effectiveness of influenza vaccine against influenza A (H3N2) virus infections in nursing homes in Niigata, Japan, during the 1998--1999 and 1999--2000 seasons. Infect Control Hosp Epidemiol 2002;23:82--6.
Cunney RJ, Bialachowski A, Thornley D, Smaill FM, Pennie RA. An outbreak of influenza A in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2000;21:449--54.
WF, Elder AG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355(9198): 93--7.
Saxen H, Virtanen M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779--83.
Wilde JA, McMillan JA, Serwint J, Butta J, O'Riordan MA, Steinhoff MC. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281:908--13.
Potter J, Stott DJ, Roberts MA, et al. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175:1--6.