Vaccination of healthcare workers during an influenza vaccine shortage

Abstract

ISSUE: To prevent transmission of influenza to high-risk persons, annual vaccination of healthcare workers (HCWs) is recommended. In 2004 only 4 of the system's 12 hospitals, 4 long-term care facilities, and multiple outpatient entities received inactivated influenza vaccine. Facing an 87% shortage, a process to maximize vaccine distribution to 26,000 employees was needed. PROJECT: An influenza vaccine rapid response team (IVRRT) was established. Infectious disease, occupational health, infection control, pharmacy, human resources, public relations, and patient safety were represented. The IVRRT goals were to assess vaccine supply, obtain more vaccine, develop a distribution plan based on Centers for Disease Control and Prevention (CDC) guidelines that included prioritization of HCWs, and develop strategies to prevent influenza transmission. RESULTS: The injectable vaccine supply was pooled and redistributed to entities based on the number of priority HCWs. Priority HCWs were defined as those providing direct hands-on care with prolonged face-to-face patient contact. Priority departments were defined as areas where HCWs would have frequent exposure to influenza patients or where patients were at highest risk of influenza complications. Small amounts of additional injectable vaccine and 10,000 doses of live attenuated influenza vaccine (LAIV) were obtained. Injectable vaccine was offered to HCWs in a phased approach starting with priority HCWs caring for high-risk patients who could not be exposed to recipients of LAIV. Injectable vaccine and LAIV were next offered to priority HCWs in priority departments. Once vaccine had been offered to priority HCWs in priority departments, vaccination was extended to all HCWs. LAIV became the main form of vaccine offered to medically eligible HCWs. The use of LAIV mandated process changes from the organization's vaccination best practice. Injectable vaccine was reserved for priority HCWs who were ineligible for LAIV. Influenza vaccine was offered to HCWs at all entities. Information about the vaccine shortage, distribution plan, LAIV, and influenza prevention was communicated via the intranet, internal newspaper, posted flyers, and letters. Protocols for HCW influenza screening, treatment, and prophylaxis were developed to reduce influenza transmission. LESSONS LEARNED: Rapid response to the vaccine shortage, interdepartmental partnerships, careful planning, and close monitoring of activities facilitated a successful influenza vaccination program despite a vaccine shortage.