What We've Learned From Flu Vaccination Data
Jun 14, 2013

Although the 2012-2013 influenza season may be behind us, there were several studies released this week that offered some interesting considerations for future flu seasons.

First, there was discussion pertaining to the fact that young adults and children in school are responsible for the vast majority of flu transmission.  It’s no surprise really.  These populations often spend hours of the day in extremely close quarters.  But even though there have been 152 pediatric deaths from the flu this past season, and sadly 90% of those children were not vaccinatedflu deaths are typically highest among the elderly.
Image courtesy of Jeroen van OostromIn the past, the emphasis has typically been to concentrate vaccination efforts among those who are most likely to suffer the most.  However, in a recent study published in the journal Vaccine, a computer modeling analysis suggested it could be more effective to reduce the impact of the flu by increasing vaccination amongst those most likely to spread it – a population that consists mainly of young adults and school children.  The model suggests that if we could break the cycle of transmission with increased vaccination among the young, we could effectively reduced the incidence of flu circulating in our communities, which will benefit everyone from the elderly to those too young to be vaccinated.
This idea leads to another consideration.  What efforts can be made to boost vaccination rates among children?  Since we know influenza vaccination rates among children are historically low, (with approximately 40% of children receiving a flu vaccine during the 2012-2013 season), would it be beneficial to offer vaccination clinics in the schools?In another study, conducted from research in 2009 of elementary schools in Rochester, NY, area, the journal Vaccine reported that flu vaccination rates were indeed higher among students at schools where vaccination clinics were held.  In fact, they were 13% higher than among students at the schools that did not have vaccination clinics.  Of the 32 elementary schools included in the data, two  flu vaccination clinics were held four weeks apart at 21 of the schools, while no vaccination clinics were held at the 11 other schools.  While these kinds of clinics may not be commonplace across the country at this point in time, the data suggests that they could be very cost-effective and beneficial.  Now it’s just a matter of determining the barriers that are preventing these kinds of school based influenza clinics so that we can help reduce the impact of seasonal influenza.
Another avenue that has been discussed is the effort to reduce flu transmission through vaccination of healthcare workers.  Although the CDC recommends that all healthcare personnel receive a seasonal flu vaccine, the national average for 2011-2012 was only 67%.   But just this week, reports of a four-year analysis of Chicago’s Loyola University  Medical Center, one of the first hospitals to adopt an influenza vaccination mandate, indicated that mandatory influenza vaccination, as a condition of employment, did not lead to excessive voluntary termination.
It is reported that the Loyola University Medical Center had a 67% flu vaccination rate among employees before adopting a mandatory vaccination policy.  However, compliance among their 8,008 workers is now exemplary with 98.7% vaccinated last year and 99% the year before.  In total, the hospital allowed 97 employees an exemption on religious or medical grounds last year, and only five employees were terminated for refusing vaccination.  Interestingly enough, three of those five were unpaid volunteers who later reconsidered, got vaccinated and returned to work.  As many hospitals, clinics and health facilities across the country have begun to make flu vaccination a stipulation of employment, we continue to hear some vocal dissent.  However, the data seems to indicate that mandatory flu vaccination as a condition of employment has not lead to excessive termination.  Instead, it appears to be effective in increasing influenza vaccination rates among an important population.
Jorge Parada, MD,  professor of medicine at Loyola, MD and author of a report on the Loyola effort to immunize workers, explained that while there was some “pushback” to their policy, the reasons workers were objecting to the vaccines were typically overcome through town hall  meetings and educational initiatives at the hospital.  The most effective argument, he says, was the reasoning that the virus can make healthcare workers sick and that they can transmit it to their vulnerable patients.

“But at the end of the day my number one answer is that it’s not about you, the healthcare worker. It’s not about the worker’s right to get the vaccine or not get the vaccine. It’s about the responsibility to make sure that I don’t make my patients sick.”

In looking ahead to next year’s influenza season, we will certainly see lots of changes, to include the introduction of  quadrivalent influenza vaccines that will cover four influenza strains as opposed to the three that previous vaccines have been limited to.  Back in April, I participated in a special VIC Network webinar that discussed concerns about the effectiveness of 2012-2013 influenza vaccine and reviewed the new vaccine options that will be available next season.  It was very informative and something that readers can download for more specifics about the new influenza vaccines we’ll be seeing in the year ahead.
Once again, I’m encouraged by the public health community and their effort to evaluate influenza vaccination policies and find ways to reduce the impact of seasonal flu upon on our society.   Hopefully, as we continue to promote a universal influenza vaccination policy, we will continue to see a reduction in the number of flu-related illnesses and deaths, as well as an emphasis on better health among everyone within our communities.

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