Nurse 'flu jab uptake fluctuates across country

7 May 2015

The 'flu vaccination uptake amongst hospital nurses keep steadily increasing but still varies radically across the country.

Increased focus on health care worker vaccination has seen a steady increase in nurse uptake of the flu vaccine from 42 per cent in 2011 to 55 per cent in 2013 and 59 per cent last winter.

But this increased average is largely lead by three district health boards whose vaccination rates are streaks ahead of the remaining 17 boards. Auckland DHB nurses uptake topped the country last year having jumped from 65 per cent to 77 per cent last winter and Tairawhiti nurses topped 70 per cent for the second year running.   At the other end of the scale MidCentral, Taranaki, Wairarapa and West Coast DHB nurse uptakes all hovered around the 40 per cent mark.

Nurses uptake (59%) continues to lag behind doctors (68%) and "other workers" like health care assistants and administration staff (62%). Nurses are slightly higher than allied health staff (57%) and midwives (also 57%) though midwives as a profession have made the biggest increase in uptake in recent years having had less than 40 per cent uptake in 2012.

Lance Jennings, a virologist and spokesperson for the National Influenza Specialist Group, is a long-time advocate for increasing the vaccination levels of health care workers to protect patients at risk; with research showing hospital-acquired influenza has a fatality rate of up to 27 per cent.

"There is good evidence that health care worker vaccination reduces both the risk to patients and of course protects health care workers themselves."

"And indeed health care systems have an ethical and moral responsibility to protect vulnerable patients from all transmissible diseases including influenza."

Jennings said he was an advocate of the pro-vaccination mask policy adopted by the Canadian province of British Colombia as a way forward to reducing the risk of health care workers infecting vulnerable patients with influenza.  (See related Waikato and Northland story)

He said the British Colombia policy was a response to reviewing the more 'draconian' mandatory vaccination policies introduced by some American hospital providers that had lead to 96% uptake. British Colombia had instead opted for requiring unvaccinated frontline staff to wear masks when working with patients which had lead to 86 per cent uptake by the second 'flu season of the policy.

Around New Zealand some district health boards Canterbury (where Jennings is based) and Tairawhiti have already reached 75 per cent uptakes across all staff without such policies and Auckland joined them last year with 74% uptake after using fellow nurses to vaccinate colleagues in their workplace.  But most other boards are much lower and the average rate across all DHBs remains 61 per cent.

Jennings said there had been little focus on immunisation of health care workers until the past four or five years and now that there was a "leader board" the DHBs that weren't doing so well were looking to strategies that have worked for other health providers.

"That is why I'm delighted to see Waikato taking the next step," said Jennings.

He said some people might object to mandatory mask wearing but people don't argue about the need for hand washing or using masks when caring for isolated infected patients, as that was "core business" for health care workers.

"So what we're arguing about is the core business of protecting the people that we care for by immunising our health care workers against influenza."

He said to those who argue they never get the flu the statistics show that annually 20-30 per cent of children get influenza and 5-10 per cent of adults, so on average most adults will only get influenza once every 10 years.

"But if you are unlucky and there are four new strains circulating in one year you may get four bouts all in one year." 

Also those who say they never get the flu may still be infected and be asymptomatic as was shown by research carried out following 2009's swine flu epidemic which found about 30 per cent of health care workers who were infected by the virus had been unaware and asymptomatic.

Research has also indicated that there is a three-fold risk of health care workers contracting influenza over other adults.   

Jennings says a 'flu vaccine is never perfect but last year's New Zealand influenza surveillance data indicated that being vaccinated reduce the risk by 67 per cent of seeing your general practitioner for influenza-like illness compared to non-vaccinated people.  It also reduced the risk of hospitalisation with severe acute respiratory infections by 54 per cent.








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