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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

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
Content outline
  • Influenza situation in Hong Kong
  • Situation update on H5 Influenza
  • Influenza vaccination suggestions by CHP
  • HA influenza Vaccination program 2007/08
important messages
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

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

as of 10 Sept 2007 ( 12 countries)

summary of current situation of h5 influenza
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


risk assessment clinical features
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)

who recommendation for influenza vaccine for the year 2007 2008
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
  • 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
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
targeted groups of ha program
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 age b)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

why healthcare workers need to be vaccinated
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
targeted hcw
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
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
timing on flu vaccine
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
  • 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
side effects mild
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

side effects severe
Side effects (severe)
  • Severe side effects associated with influenza vaccine are very rare
  • They include severe allergic reactions, severe local reactions, & neurological complications
side effects severe26
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)
side effects severe27
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
guillain barre syndrome gbs and flu vaccine
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

adverse reaction report form
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

information package on ha home
Information Package on ha.home
  • Information kit prepared for patients & staff
  • Staff
  • Time schedule
  • Information pamphlet
  • Vaccination adverse reaction reporting form
  • Weekly return form from GOPD/SOPD

HA Influenza Vaccination Program 2007/08

  • 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
logistics staff
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.
Patient Consent Form
  • Staff Consent Form
knowledge gap of hcws and the truth of flu vaccine
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)
misconceptions the consequences
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”
influenza vaccine efficacy
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%
knowledge gap of hcws and the truth of flu vaccine43
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
knowledge gap of hcws and the truth of flu vaccine44
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?
learn the facts n get a shot today
“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.
intervention known to increase immunization rates
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
  • CICO
  • SEB, CHP
  • PHLC
  • Dr Dominic Tsang, QEH
thank you


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