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Influenza Vaccination Information for Health Care Workers

Note: The Advisory Committee on Immunization Practices (ACIP) 2015-16 Recommendations for prevention and control of seasonal influenza were published in complete form in the Morbidity and Mortality Weekly Report on August 6, 2015. The report is available at MMWR.

Visit What You Should Know for the 2015-2016 Influenza Season for flu and flu vaccine information specific to the current flu season.

Did You Know?

  • 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.

Why Get Vaccinated?

  • 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.

How Many Health Care Workers Got Vaccinated Last Season?

  • Overall, final 2013-14 flu vaccination coverage among health care workers was 75.2% , similar to coverage of 72.0% in the 2012-13 season.
  • Coverage was highest among HCP working in settings with flu vaccination requirements (97.8%).
  • By occupation, flu vaccination was highest among physicians (92.2%) and nurses (90.5%), followed by nurse practitioners/physician assistants (89.6%), other clinical personnel (87.4), and pharmacists (85.7%).
  • Flu vaccination coverage was higher among HCP whose employers required (88.8%) or recommended (70.1%) that they be vaccinated compared to those HCP who did not have an employer policy regarding flu vaccination (44.3%).
  • Coverage by occupation was lowest for assistants/aides (57.7%) and non-clinical personnel (68.6%).
    • Non-clinical personnel include administrative supportstaff or managers, and non-clinicalsupport staff (food service workers, housekeeping staff, maintenance staff, janitors, laundry workers, etc.).
  • 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.
  • Coverage by occupational setting was highest for HCP working in hospitals (89.6%), a 6.5 percentage point increase from the 2012-13 season (81.9%).
    • Coverage by setting was lowest for those working in LTC settings (63.0%)
      • Vaccination of HCP in LTC settings is extremely important because:
        • People 65 years and older are at greater risk of serious complications from the flu.
        • Flu vaccine effectiveness is generally lowest in the elderly, making vaccination of close contacts even more critical.
        • Multiple studies have demonstrated health benefits to patients, including reduced flu-related complications and reduced risk of death, with vaccination of HCP in LTC settings.
    • See A Toolkit for Long-term Care Employers: Increasing Influenza Vaccination among Healthcare Personnel in Long-term Care Settings.

The results of this report were based on an Internet panel survey of health care workers, conducted April 1-16, 2014.

Influenza (Flu) Facts

  • 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.

Flu Vaccine Facts

  • 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. There also 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) viruses that have been ‘inactivated’ (killed) 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.
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Who is recommended for vaccination?

Everyone 6 months of age and older should get a flu vaccine every 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.

Vaccination to prevent influenza is particularly important for people who are at high risk of serious complications from influenza. See People at High Risk of Developing Flu-Related Complications for a full list of age and health factors that confer increased risk.

More information is available at Who Should Get Vaccinated Against Influenza.

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Who shouldn't be vaccinated?

Different flu vaccines are approved for use in different groups of people. Factors that can determine a person's suitability for vaccination, or vaccination with a particular vaccine, include a person's age, health (current and past) and any relevant allergies, including an egg allergy.

Flu Shot:

Nasal Spray Vaccine:

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What kinds of seasonal flu vaccines are available?

There are several flu vaccine options for the 2015-2016 flu season.

Traditional flu vaccines made to protect against three different flu viruses (called “trivalent” vaccines) are available. In addition, flu vaccines made to protect against four different flu viruses (called “quadrivalent” vaccines) also are available.

Trivalent flu vaccine protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. The following trivalent flu vaccines are available:

The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The following quadrivalent flu vaccines are available:

  • A quadrivalent flu shot that is manufactured using virus grown in eggs. There are several different flu shots of this type available, and they are approved for people of different ages. Some are approved for use in people as young as 6 months of age.
  • An intradermal quadrivalent shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
  • A quadrivalent nasal spray vaccine, approved for people 2 through 49 years of age.

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.

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How do flu vaccines work?

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.

What viruses does the 2014-2015 vaccine provide protection against?

The 2014-2015 influenza vaccine provides protection against the following viruses:

  • an A/California/7/2009 (H1N1)pdm09-like virus;
  • an A/Texas/50/2012 (H3N2)-like virus ;
  • a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus.

The vaccine viruses recommended by WHO for the 2014-15 northern hemisphere influenza season are the same as those for the northern hemisphere 2013-14 influenza season and 2014 southern hemisphere season.

Quadrivalent vaccine for this season contains the three viruses listed above, and also a B/Brisbane/60/2008-like (B/Victoria lineage) virus. See Quadrivalent Vaccine: Questions and Answers for more information.

If I got vaccinated during the 2013-2014 season, do I need to get vaccinated this season?

Yes. CDC recommends a yearly flu vaccine for everyone 6 months and older, even when the viruses the vaccine protects against have not changed from the previous season. The reason for this is that a person's immune protection from vaccination declines over time, so an annual vaccination is needed to get the “optimal” or best protection against the flu.

When should I get vaccinated?

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.

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What is CDC’s position on mandating flu vaccination for health care workers?

The findings of a recent CDC review of related published literature indicate that influenza vaccination of health care personnel can enhance patient safety. 1,2

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).

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More Information

Influenza Vaccination Coverage Among Health-Care Personnel — United States, 2012–13 Influenza Season. MMWR Morb Mortal Wkly Rep 2013;62(38);781-786

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.

CDC. Prevention and control of influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8).

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.

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