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Influenza Vaccination Seminar “ Learn the Facts N ’ Get a Shot TODAY! ” Oct 2007 PowerPoint PPT Presentation

Influenza Vaccination Seminar “ Learn the Facts N ’ Get a Shot TODAY! ” Oct 2007 Prepared by Infection Control Branch, CHP Infectious Disease Control Training Centre, HAHO Content outline Influenza situation in Hong Kong Situation update on H5 Influenza

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Influenza vaccination seminar learn the facts n get a shot today oct 2007 l.jpg

Influenza Vaccination Seminar“Learn the Facts N’ Get a Shot TODAY!”Oct 2007

Prepared by

Infection Control Branch, CHP

Infectious Disease Control Training Centre, HAHO


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Content outline

  • Influenza situation in Hong Kong

  • Situation update on H5 Influenza

  • Influenza vaccination suggestions by CHP

  • HA influenza Vaccination program 2007/08


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Situation updates onInfluenza in HK


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Sentinel Surveillance of influenza from GP (2005-2007)


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Sentinel Surveillance of influenza from GOPC (2005-2007)


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Important messages

  • H3N2 remains to be the predominant strain over the past 3 years

  • No H5, H7, or H9 human case in Hong Kong last year


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Situation update on H5 Influenza


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Breakdown of confirmed human cases of avian influenza A (H5N1)

as of 10 Sept 2007 ( 12 countries)


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Summaryof current situation of H5 influenza

  • Endemic in South East Asia

  • Increasing in geographical area

  • Increasing in affected host range

  • Limited human-to-human transmission has occurred (family cluster in Thailand September 2004 and in Indonesia May 06)

  • Atypical clinical presentation

For details pls refer to Risk Assesssment of Influenza A H5N1 Pandemic version 10Sep07

http://ha.home/idctc/document/risk_assessment_of_ai__predispositions_influenza_pandeminc_10_sep_07.pdf


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Risk AssessmentClinical Features

  • Risk of fecal-oral transmission?

  • Case fatality rate (CFR) around 60%

  • Incubation period: 2-10 days; 3-7 days

  • Atypical presentations: diarrhea & encephalitis

  • Asymptomatic or Mildly symptomatic infections

Summary of Case-fatality rate (CFR) of the human cases of avian influenza A (H5N1) by onset of year and age group

(WHO weekly epidemiological record No 26,2006,81, 249-260)


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Current situation


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HA Influenza Vaccination Program2007/08


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WHO recommendation for influenza vaccine for the year 2007/2008

  • Northern hemisphere

  • An A/Soloman Islands/3/2006(H1N1)-like virus

  • An A/Wisconsin/67/2005(H3N2)-like virus

  • A B/Malaysia/2506/2004-like virus


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Rationale

  • Most people are ill with flu for a few days

  • Some may get more severe signs and symptoms or be even fatal, especially for elderly & immunocompromized

  • Flu vaccine is documented to reduce infection and complication rates

  • Vaccination will not protect humans from H5N1 infection, but it minimizes the risk of co-infection and genetic reassortment of human and avian influenza viruses in humans


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Scientific Committee on Vaccine Preventable DiseasesStatements on Influenza Vaccination for the 2007/08 Season

  • Elderly Persons Living in Residential Care Homes

  • Long-stay Residents of Institutions for the Disabled

  • Elderly Persons Aged 65 Years or Above

  • Persons with Chronic Illnesses

  • Health Care Workers

  • Poultry Workers

  • Children aged 6 to 23 months

  • Pregnant women


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Targeted Groups of HA program

  • In-patient (IP) of infirmary, psycho-geriatric, mentally ill and mentally handicapped units/wards, and hospitalized patients with chronic diseases under HA

  • Paediatric IP & Out-patient (OP) with chronic diseases, or on long term aspirin therapy

  • Non-institutionalized elderly aged 65 or above with chronic illness and followed up in public clinics

  • Poultry workers and those who may be involved in poultry culling operations

  • Comprehensive Social Security Assistance (CSSA) recipients under the following categories*:

    a) Persons with chronic diseases regardless of ageb)Elderly aged 65 or above*

    c) Children aged 6-23 months from families receiving CSSA*

    d) All pregnant women with antenatal FU in public clinics


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Why Healthcare workers need to be vaccinated?

  • To REDUCE the risk of transmitting influenza to patients who are at high risk of complications from influenza

  • To REDUCE absenteeism among health care workers related to respiratory infections

  • Influenza vaccination is recommended for ALL health care workers


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Targeted HCW

  • HA staff (including part time, contract and temporary staff)

  • Civil servants under HA management or whose normal place of work is in HA hospitals or clinic compounds (e.g., E&M staff)

  • Contract out colleagues who have direct patient care or work in a patient-care environment

  • Registered hospital volunteers


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HCW for RCHE and RCHD

  • There is strong local and overseas evidence that influenza vaccination is effective in reducing the risk of complications from influenza among elderly persons living in residential care homes.

  • Local data shows that long-stay residents of institutions for the mentally and physically disabled have high rates of hospitalization during influenza outbreaks


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Timing on flu vaccine

  • Vaccine composition is updated every year

  • Protection develops about 2 weeks after vaccination

  • The best time for vaccination is October to December


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Precautions

  • Consult the doctor or nurse in charge of staff vaccination program in your hospital before getting a flu shot if you have

  • Serious egg allergic reactions or reactions to previous influenza vaccine; allergy to neomycin

  • History of severe paralytic disease called Guillain-Barre Syndrome (GBS)

  • Moderate to severe acute illness


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Side effects (Mild)

- No need to report

  • Soreness, redness, or swelling where the shot was given

  • Fever

  • Aches

    If these problems occur, they usually begin soon after the shot and last 1-2 days


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Side effects (severe)

  • Severe side effects associated with influenza vaccine are very rare

  • They include severe allergic reactions, severe local reactions, & neurological complications


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Side effects (severe)

Within 24 hours of immunization

  • Anaphylactoid reaction

  • Anaphylaxis

  • Severe allergic reaction (e.g. angioedema and allergic asthma)

Within 5 days of immunization

  • Severe local reaction

  • Sepsis

  • Injection site abscess (bacterial / sterile)


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Side effects (severe)

Within 15 days of immunization

  • Seizure & Encephalopathy

Within 3 months of immunization

  • Neurological disorders, such as Guillain-Barre Syndrome, encephalomyelitis, neuritis

  • Vasculitis

  • Neuralgia & Paraesthesia

  • Thrombocytopenia


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Guillain-Barre Syndrome (GBS) and flu vaccine

  • In 1976, swine influenza vaccine was associated with GBS. Since then, flu vaccines have not been clearly linked to GBS.

  • However, if there is a risk of GBS from current flu vaccines, it would be no more than 1 or 2 cases per million people vaccinated.

  • It peaks 2 weeks after vaccination and usually within 3 months of the vaccination.

  • This is much lower than the risk of severe influenza, which can be prevented by vaccination

Lasky T et al. NEJM 1998; 339: 1797- 1802


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Adverse Reaction Report Form

ONLY severe adverse reactions are required to be reported

Note: Also report any death, hospitalization or other severe & unusual events thought to be related to immunization


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Information Package on ha.home

  • Information kit prepared for patients & staff

  • SOPD / GOPD

  • Staff

  • Time schedule

  • Information pamphlet

  • Vaccination adverse reaction reporting form

  • Weekly return form from GOPD/SOPD

HA Influenza Vaccination Program 2007/08


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Logistics

  • Referral not required

  • Staff consent form

  • For all patients (in-patients & out-patients), a consent from patient suffices

  • Adult immunization card for both public and private sector with effect from Oct 2007


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Logistics - Staff

  • HCEs are required to make arrangement / derive plan to vaccinate their staff

  • Alternatively, hospital colleagues may make arrangement for vaccination via the normal booking system at any of the 8 designated staff clinics

  • HAHO staff may make arrangement for vaccination through the 8 designated staff clinics

  • DH will make separate arrangement for poultry-related workers.


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  • Patient Consent Form

  • Staff Consent Form


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HA Influenza Vaccination Programme 2007/08Time Schedule of Vaccination


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To boost up vaccination rate!


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Knowledge Gap of HCWs and the Truth of Flu vaccine

  • Misconception of flu vaccine:

    • Belief that they’re not at risk

    • Ignorance regarding the risk they represent to their patients

    • Inappropriate knowledge about vaccine efficacy

    • Fear of needles

    • Ignorance about the vaccine (eg it causes the flu)


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Misconceptions : the consequences

  • Fears emotionally driven and not based on data

  • As a result, HCWs don’t get the vaccine, nor do their patients

  • “ We have met the enemy and he is us”


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US CDC. 2003 Recommendations of ACIP


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Influenza Vaccine Efficacy

  • Defining efficacy is important

  • The vaccine’s benefit is in preventing hospitalization and death, not symptoms

  • The vaccine

  • - reduce death: 50-85%

  • - reduces illness : 30-70%

  • - reduces lower respiratory tract involvement:70-90%


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Nichol KL. Vaccine 1999; 17: S47-S52


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Margolis KL, et al. JAMA 1990;264:1139- 1141


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Knowledge Gap of HCWs and the Truth of Flu vaccine

  • Facts:

    • Epidemiology of seasonal flu is clear

    • Flu vaccine efficacy is clear

    • S/E of flu vaccine is clear

    • BENEFITS >>> HARMS for flu vaccine is clear


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Knowledge Gap of HCWs and the Truth of Flu vaccine

  • Belief: Do you believe in the figures?

  • Burden: Do you think HK has a similar flu morbidities and mortalities?

  • Budget: Does it cost anything to get a shot?

  • Barrier: Any barrier from admin/logistics/people/workflow?

  • Biology: Is your body build different from the people being investigated?


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“Learn the Facts N’ Get a Shot TODAY!”

  • “Learn the Facts N’ Get a Shot TODAY!”

  • Benefits: Save lives, prevent health care disruptions, prevent hospitalizations

  • Benefits HCWs

  • Patient safety issue- benefits the patient (esp. immunocompromised hosts increasing)

  • Benefit hospitals and clinics

  • Set a good example for our patients

  • Be smart and ASK questions to your doctor-in-charge.


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Intervention known to increase immunization rates

  • The rates can be increased using methods demonstrated to work

  • eg. strong recommendation from a trusted health care provider

  • Immunization requirement


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Acknowledgements

  • CCID-ER

  • CICO

  • SEB, CHP

  • PHLC

  • Dr Dominic Tsang, QEH


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THANK YOU

“Learn the Facts N’ Get a Shot TODAY!”


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