2021 HCW Influenza vaccination surveillance in Victorian Hospitals - Dr Lyn-Li Lim and Alex Hoskins - VICNISS
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2021 HCW Influenza vaccination
surveillance in Victorian Hospitals
Dr Lyn-Li Lim
and
Alex Hoskins
Objective • Influenza virus & epidemiology • Clinical presentation & prevention • Review of 2020 influenza season • The 2021 influenza vaccine • VICNISS HCW Influenza vaccination surveillance module
Influenza: burden of illness
• Spectrum of illness severity
• Complications:
– pneumonia
– Reye syndrome (children)
– myocarditis
– death (90% occur in those >65 years)
• In Australia, annual illness burden of
– Up to 15,000 hospital admissions
– Up to 100,000 bed-days (FluCan)
• In epidemic setting, US healthcare workers estimated to have
5.8 exposures/year
Cheng AC, et al. Influenza epidemiology in adults admitted to sentinel Australian hospitals in 2014: the
Influenza Complications Alert Network (FluCAN). Commun Dis Intell Q Rep. 2016
Jones RM, Xia Y. J Occup Environ Hyg. 2016
The virus
• Surface antigens -
hemaglutinin (H) and
neuraminidase (N)
• Antigenic drift:
– minor change, same
subtype
– point mutations in gene
– seasonal epidemics
• Antigenic shift:
– major change, new
subtype
– exchange of gene
segments
– may result in pandemic
Epidemiology • Reservoir: human (Types A and B) & animals (Type A only) • Transmission via respiratory route (large droplet) and direct contact • Seasonality in temperate regions • Communicability: 1 day before to 5 days after onset of symptoms • Influenza A: moderate to severe illness, affects all ages • Influenza B: generally a milder disease, primarily affects children
Clinical presentation & prevention • Clinical: fever, headache, tiredness, respiratory tract symptoms (dry cough, sore throat, rhinorrhoea), myalgia (NB: diarrhoea/vomiting/abdominal pain, esp. in children) • Management: supportive, neuraminidase inhibitors (e.g. oseltamivir), M2 channel inhibitors (e.g. amantadine) • Prevention: hospital infection control (isolation, gowns & gloves), chemoprophylaxis, surveillance, seasonal vaccination
Immunity
• Duration of immunity < 1 year
– waning vaccine-induced antibody
– antigenic drift of circulating viruses
• Effectiveness in healthy individuals ≈60% when vaccine
strain similar to circulating strain
– Effectiveness of vaccine is optimal in first 3-4 months after
vacciantion
– In elderly, impact of vaccination is on reducing severity of
illness greater than illness prevention
• preventing hospitalisation (50-60%)
• death (80%)
Impact of COVID-19 • Data collection sources feeding into influenza surveillance systems (may not be able to directly compare data to previous years) • Impact of physical distancing measures • Changes in health seeking behaviours in community • Focussed testing on COVID-19
National 2020 Influenza Season Summary https://www1.health.gov.au/internet/main/publishing.nsf/Content/03943F9CD20D2CCCCA2586410078F296 /$File/National-Influenza-Season-Summary2020.pdf
Data sources: Influenza and ILI
Victoria
• DHHS Weekly Influenza reports (Apr to Nov)
– Includes VicSPIN (GP), NNDSS (lab notifications),
FluCAN (hospital)
Australia-wide
– Healthdirect (public health hotline)
– ASPREN (sentinel GP sites)
– Also FluCAN, NNDSSInfluenza: Severity of disease 2020 Measured by • FluCAN - ICU admissions • NNDSS – Deaths (under-estimate as does not follow-up cases) Australia-wide 2020 • 15 admissions to sentinel hospitals (1 ICU admission (2019- 3,915 admissions, 6.3% ICU) • 37 deaths (2019-812 deaths ) Data 6/4/2020 to 29/11/2020 https://www1.health.gov.au/internet/main/publishing.nsf/Content/03943F9CD20D2CCCC A2586410078F296/$File/National-Influenza-Season-Summary2020.pdf
Influenza activity in 2021?: Seasonality
Influenza activity in 2021?:At-risk In 2020; influenza notification rates were highest in children < 10 years. Notification rate in adults >65 years lower than 20-64 years.
Victorian RACF Influenza activity
in 2021?Victorian RACF Influenza activity
in 2021?
In Victoria, COVID-19 outbreak IN RACF
1 or more lab confirmed COVID-19 cases in aged care facility
(staff, resident, other)https://www.dhhs.vic.gov.au/assessment-and-testing-criteria-coronavirus-covid- 19[accessed 05Mar 2021
https://www.bettersafercare.vic.gov.au/sites/default/files/2020-10/COVID- 19%20screening%20tool%20for%20RACS%20V5%20September%202020.pdf
Virology • Predominant circulating strain Influenza A(H1N1)pdm09 • Influenza viruses are continually changing, making the targeting of an effective vaccine a constant challenge each year. • The small number of cases reported across systems during the 2020 influenza season in Australia precludes meaningful analysis to estimate vaccine effectiveness.
Influenza vaccines : 2021 • Inactivated influenza vaccine • For adults aged ≥65 years, the adjuvanted influenza vaccine, Fluad® Quad, is preferentially recommended over standard influenza vaccine. https://www.tga.gov.au/aivc-recommendation-composition-influenza-vaccine- australia-2021
ATAGI Clinical advice on administration
of influenza vaccine 2021
• Key points relevant to health services and RACF
– Co-administration of influenza vaccine on the same day as
a COVID-19 vaccine is not recommended
– Administration of an influenza vaccine and a COVID-19
vaccine should be a minimum of 14 days apart
– When scheduling influenza and COVID-19 vaccines,
consider the following principles:
• People in phase 1a for COVID-19 vaccination should receive the
COVID-19 vaccine as soon as it is available to them, and then
receive their influenza vaccine.
• People in later phases for COVID-19 vaccination should receive
their influenza vaccine as soon as it is available, and then receive
their COVID-19 vaccine when it becomes available to them.
https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-
influenza-vaccines-in-2021 (accessed 5 March 2021)ATAGI Clinical advice on administration
of influenza vaccine 2021
• Influenza vaccination for pregnant women
– Influenza vaccine is recommended in every pregnancy
and at any stage of pregnancy.
– Influenza vaccine can safely be given at the same time
as pertussis vaccine.
– Pregnant women who received an influenza vaccine in
2020 should receive a 2021 influenza vaccine if it
becomes available before the end of pregnancy.
– Women who receive influenza vaccine before
becoming pregnant should be revaccinated during
pregnancy to protect the unborn infantContraindications & precautions:
influenza vaccination
• Contraindications
– Severe allergic reaction (i.e. anaphylaxis) to a vaccine
component
– Moderate or severe acute illness
– History of Guillain-Barré syndrome within 6 weeks following a
previous dose of influenza vaccine
• Precautions
– History of egg allergy
– Persons with egg allergy (incl. anaphylaxis) can be safely
vaccinated with vaccines containing < 1 μg of residual egg
ovalbumin per dose
• Safe to administer
– Pregnancy (any stage), breastfeeding and immunosuppression
are not contraindications to influenza vaccination
Australasian Society of Clinical Immunology and Allergy (ASCIA) GuidelinesAddressing misconceptions
influenza vaccination
• Serious allergic reactions to flu vaccine very rare
• Vaccines used in Australia are not live – cannot get
the flu
• Risk of acquiring influenza greater than adverse
events related to vaccination
• Adverse events
Common Rare Very rare
minor local pain, urticaria (hives) anaphylaxis
redness, swelling
fever, fatigue &/or Guillain-Barré syndrome
muscle ache (1-2 days) (COVID-19 vaccine adverse effects (AE): Pfizer
• Phase II/III trial, adverse
events reported within 7
days following vaccination
– were very common
– generally mild to
moderate and well
tolerated
• Very common (>40%):
injection site pain, onset day
after injection and resolved
within 1-2 days, fatigue,
headache, muscle pain
• Chills common and more commonly reported after second dose
• Fever common and more commonly reported after second dose
• Other AE (Questions
2021 HCW Influenza Vaccination
ModuleHCW Influenza Vaccination data In 2021 - • All Victorian Public Hospitals/Health Services • All Victorian public funded Aged Care Homes • All Victorian Private Hospitals
Victorian Health Services
Performance monitoring framework
12th April to
13th August
2021 Target
90% ??
Victorian Department of Health and Human Services, 2019-2020Quadrivalent Vaccines
• Available mid April
• 2 vaccine providers:
– Sanofi Pasteur - FluQuadri
• Needleless pre-filled syringe
• Latex free
• Aged > 36 months
– Seqirus – Afluria Quad
• Needleless pre-filled syringe
• Latex free
• Aged > 5 years
– Seqirus – FluAd Quad
• Aged ≥ 65 years (including healthcare workers)
• Needleless pre-filled syringe
• Latex free• DHHS –The HCW influenza vaccine stock is available to order by using the Public hospital healthcare worker influenza vaccine order form at https://www2.health.vic.gov.au/public- health/immunisation/vaccine-order-and-stock/vaccine-order- forms. • When ordering you cannot specify which brand you want – 1300 882 008. – Mon-Fri 0900-1200 and 1400-1500 hrs.
Promotional materials • Sanofi Pasteur promotional materials – Vaxihelp@sanofipasteur.com
Seqirus (CSL) fax the completed material order form to 1800 284 699
Seqirus (CSL) fax the completed material order form to 1800 284 699
Education Resources • Webinar powerpoint • Webinar recording
Data collection
12 th
April
th
TO 13 August.Staff
• Staff (Denominator / Numerator data)
– Refers to people who are permanently,
temporarily or casually employed by hospitals or
health care facilities.
– It does not include staff who are contracted to
work such as university students or Dental Officers
and agency/locum staff.
– Volunteers are NOT countedStaff
• Category A/B staff
– Includes those who have contact with clients and/or blood
or body substances or infectious material.
– Optional further ‘Risk Categorisation’ of Medical, Nursing,
Laboratory and Other
• Category C staff
– Includes those who have no contact with clients and/or
blood or body substances or infectious material.
• The categories A/B and C are aligned with the risk
categorizations detailed in the 2014 Victorian DHHS
‘Vaccination for healthcareData - Facility details • This year all hospitals – acute, sub-acute, are required to submit data. • It is optional for either hospital OR Health Service level data to be submitted. • Within the Health Service, other health care facilities include: e.g. residential aged care and rehabilitation facilities.
Data
•Three options for ‘level’ of data to be submitted:
−Total (Category A/B + C staff combined) – * Mandatory fields
−Category A/B + Category C
−Category A/B risk-categories + Category C
Count only staff who have worked one or more shifts during
the influenza campaign.Data New in
2020
Include all staff who have been vaccinated, either at your hospital or
elsewhere.
- ALL counts must be acknowledged in writing.
It is now required to include No. of staff that declined or refused
vaccinationData – High risk ward staff • If applicable, count specific data about staff working in the ED and ICU • Include data entered in previous table
Emergency Departments
Intensive Care Units
(Adult)Intensive Care Units
Paediatric/NeonatalAged Care Data Form
Submitting data for individual hospitals
Acute hospital A
Submit data for entire
service on the “Acute
Acute hospital B health care service”
form as for previous
years ( 1 form for each
Rehab Unit
acute hospital)
AND
Palliative
care Submit data for each
aged care facility on the
new ACH –HCW
influenza vaccination
form. NOTE: if the
Aged care 1 facilities are co-located
and share staff you may
have the same
Aged care 3 numbers for each
facility however you
must fill in a separate
form for each to meet
Aged care 2 DHHS reporting
requirements (1 form
for each facility with a
RAC ID) See exampleSubmitting data as a health service
Submit data for entire
service on the “Acute
health care service”
Palliative Acute hospital A form as for previous
care years ( 1 form)
Acute hospital B
AND
Submit data for each
Aged care 1 aged care facility on the
new ACH –HCW
influenza vaccination
form. NOTE: if the
Aged care 3 facilities are co-located
and share staff you may
have the same
numbers for each
Aged care 2 facility however you
must fill in a separate
form for each to meet
Rehab unit DHHS reporting
requirements (1 form
for each facility with a
RAC ID) See exampleFacts for consideration
Denominator
includes ALL HCWs.
• Previous VICNISS survey: Numerator used to
calculate target of
90% is the TOTAL
– 50% ICPs stated they would not give a number of HCWs
construction contractor a vaccine vaccinated
– Staff that have completed a declaration form and
DECLINED the vaccine – 30% ICPs stated they would NOT
include them in the Denominator
– If a HCW works at a number of campuses throughout the
health service, he/she would be included in the
denominator/numerator at each site, IF data reported by
each acute hospital.Data submission • Due date: Friday, 28th August –Database CLOSED at midnight • Via web form –VICNISS web form registration required
Data reports
• Available -September 2020. IC consultants will
be notified by email
• It will be a self service report that can be
accessed via the VICNISS website
• Reports will be hospital or HS based,
dependent on the level of data submitted
– To enable comparison, state-wide aggregate
rates will be provided.Data reports
• A summary report will be forwarded to Department
of Health and Human Services
• For each hospital/health service:
• Total no. of staff vaccinated / Total number of staff
employed
• Total no. of staff that declined vaccination / Total
number of staff employed
• Note:
• Total = Category A/B + C, NOT just Category A/B
• The two percentages (vaccinated and declined)
will not be combined to give a vaccination status
percentage.Reports
Information www.vicniss.org.au • Phone: 9342 9333 • Email: vicniss@mh.org.au
Questions
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