Epidemiology How significant is influenza - really?
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Influenza Epidemiology
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The Influenza Virus
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Getting Infected
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Viral Replication
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Multiplication & Migration of the Virus
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Preventive Medicine
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How do I stay healthy? The best way to prevent flu is to GET
VACCINATED!!! - unless: Youve had a documented serious reaction to
a previous dose Youve had a documented serious reaction to a
previous dose Youve had Guillain-Barre associated with the vaccine
Youve had Guillain-Barre associated with the vaccine Few Side
Effects Most common redness, soreness or swelling at injection site
(Bravo! for your immune system!) Most common redness, soreness or
swelling at injection site (Bravo! for your immune system!) Less
common fever and body aches Less common fever and body aches Egg
allergy is not a contraindication esp Egg allergy is not a
contraindication esp with a new recombinant vaccine made with a new
recombinant vaccine made without any eggs used in the process
without any eggs used in the process
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Recipe for Making a Flu Vaccine AKA: Why you cant get the flu
from the vaccine
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Making a Vaccine Step 1 Inoculate eggs with the virus
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Making a Vaccine Step 2 Incubate until egg is full of live
virus
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Making a Vaccine Step 3 Separate virus from egg, discard
egg
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Making a Vaccine Step 4 Thoroughly KILL virus (chemically,
multiple times)
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Making a Vaccine Step 5 Chop KILLED virus into small
pieces
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Making a Vaccine Step 7 Put remaining viral shell pieces with
Hs & Ns into vaccine
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Benefits of being vaccinated The ACIP recommends Universal
Vaccination (everyone >6 months old) For NH residents the
vaccine reduces the risk of: Hospitalization by 50% Hospitalization
by 50% Pneumonia by 60% Pneumonia by 60% Death and complications
related to flu by 75-80% Death and complications related to flu by
75-80% In kids / young adults, it is 70-90% effective in preventing
flu (also keeps them from spreading it to sibs, parents and our
patients) (also keeps them from spreading it to sibs, parents and
our patients)
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Flu Vaccines for 2013-14 Viral Strains A/California/7/2009
(H1N1) A/California/7/2009 (H1N1) A/Victoria/361/2011 (H3N2)
A/Victoria/361/2011 (H3N2) B/Massachusetts/2/2012
B/Massachusetts/2/2012 +/- B/Brisbane/60/2008 +/-
B/Brisbane/60/2008 Vaccines Available LAIV (FluMist; 2 49 yo)
Quadrivalent LAIV (FluMist; 2 49 yo) Quadrivalent Tri - &
Quadri - valent inactivated vaccine (IM) Tri - & Quadri -
valent inactivated vaccine (IM) High Dose Fluzone (over 65) High
Dose Fluzone (over 65) Intradermal Fluzone (ages 18-64) Intradermal
Fluzone (ages 18-64) RIV3 = Recombinant, egg-free vaccine for
persons 18 49 yo RIV3 = Recombinant, egg-free vaccine for persons
18 49 yo
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High Dose Fluzone For ages >65 only Contains 4X the antigen
for each of the 3 viral strains Only 20-25% of frail elderly (NH
pts) develop protective antibodies with the normal seasonal vaccine
Non-serious adverse events were more frequent Pain at injection
site Headache Muscle aches Low-grade fever Redness / swelling at
injection site Malaise Serious adverse event rates were
equivalent
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How do I stay healthy? Avoid close contact with people who are
sick Avoid close contact with people who are sick Stay home when
you are sick Stay home when you are sick Cover mouth & nose
when coughing / sneezing Cover mouth & nose when coughing /
sneezing Cover mouth & nose when someone else coughs or
sneezes! Cover mouth & nose when someone else coughs or
sneezes! Wash your hands and practice other good, common sense
health habits Wash your hands and practice other good, common sense
health habits VENTILATE! Open doors & windows on nice days!
VENTILATE! Open doors & windows on nice days!
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Clinical Medicine Influenza Recognition and Treatment
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Influenza A Respiratory Virus NOT the stomach flu Spread by
coughing and sneezing
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Symptoms AKA How do you know if a patient has the flu? 2 Major
Symptoms: 2 Major Symptoms: Sudden onset of HIGH Fever and/or a
Nonproductive Cough LTCFs: watch for multiple cases in a short
period of time LTCFs: watch for multiple cases in a short period of
time Other common symptoms: Muscle aches often profound Muscle
aches often profound Sore throat or nasal congestion Sore throat or
nasal congestion Headache Headache Confusion or Delirium Confusion
or Delirium
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Rapid Testing Problems with collecting / sending swabs Misses
H1N1
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Antiviral Treatment If you think someone has the flu: If you
think someone has the flu: Involve the provider as soon as there
are symptoms! Meds only work if started
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CDPHE Mandatory Vaccination in LTC General Provisions
Healthcare entities and workers have a shared responsibility to
prevent spread of infection and avoid causing harm to their
patients or residents by taking reasonable precautions to prevent
the transmission of vaccine-preventable diseases. Vaccine programs
are, therefore, an essential part of infection prevention and
control for slowing or stopping the transmission of seasonal
influenza viruses from adversely affecting those individuals who
are most susceptible.
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Definitions Employee: any person who performs a service for
wages or remuneration, including students, trainees, persons who
have individual contracts with the healthcare entity, physicians
with staff privileges and allied health professionals with
privileges. Employee: any person who performs a service for wages
or remuneration, including students, trainees, persons who have
individual contracts with the healthcare entity, physicians with
staff privileges and allied health professionals with privileges.
Does not include volunteers or persons who provide services through
a contractual arrangement between the licensee and a separate
organization, association or other healthcare entity. Does not
include volunteers or persons who provide services through a
contractual arrangement between the licensee and a separate
organization, association or other healthcare entity.
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Definitions Healthcare Worker: any person, working in a
facility who has the potential for exposure to patients, residents
or consumers of the entity and/or to infectious materials,
including body substances, contaminated medical supplies and
equipment, contaminated environmental surfaces or air. Healthcare
Worker: any person, working in a facility who has the potential for
exposure to patients, residents or consumers of the entity and/or
to infectious materials, including body substances, contaminated
medical supplies and equipment, contaminated environmental surfaces
or air. Includes, but is not limited to physicians, nurses, CNAs,
therapists, techs, EMTs, dental personnel, pharmacists, lab
personnel, students, trainees, contractual personnel, and persons
not directly involved in patient care (eg, clerical, dietary,
housekeeping, laundry, security, maintenance, billing and
chaplains) Includes, but is not limited to physicians, nurses,
CNAs, therapists, techs, EMTs, dental personnel, pharmacists, lab
personnel, students, trainees, contractual personnel, and persons
not directly involved in patient care (eg, clerical, dietary,
housekeeping, laundry, security, maintenance, billing and
chaplains)
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Definitions Influenza Season: November 1 through March 31
Influenza Season: November 1 through March 31 Proof of
Immunization: A written statement from a licensed healthcare
provider who has administered a flu vaccine to a healthcare worker
Proof of Immunization: A written statement from a licensed
healthcare provider who has administered a flu vaccine to a
healthcare worker
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Vaccination Targets to be Exempt from Masks % of Employees
Vaccinated by Dec 31 Vaccinated by Dec 31 201260% 201375%
201490%
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Other Requirements to be Exempt from Masks 1 Have defined
procedures to prevent spread of flu from unvaccinated workers 2
Maintain documentation for 3 years 3 Report vaccination to CDPHE by
March 31 4 Provide vaccine for each healthcare worker 5 Have a
written policy regarding vaccination of your healthcare workers
that addresses: Proof of immunization, or A signed medical
exemption 6 Maintain proof of annual immunization for employees 7
Inform other healthcare workers who provide services on the
premises that you have these policies, require them to be immunized
or wear a mask, and you can provide the mask.
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Masks Each healthcare worker without proof of immunization must
wear a surgical or procedure mask during flu season when in direct
contact with patients and in common areas.
