The United States’ CDC (Centers for Disease Control and Prevention) reported late last week (Feb 8) that levels of influenza-like-illness (ILI) had reached the peak of the 2009 H1N1 pandemic with unusually high numbers of hospitalisations in the 50-65 age group.
CDC reported that it didn’t believe the flu season had peaked in the US yet but the United Kingdom’s Public Health Service at the same time reported that flu numbers had stabilised and at this stage didn’t seem as severe as some other recent seasons. Both countries reported that the main flu strains circulating were flu A(H3N2) plus H1N1 strains and flu B strains.
Last year 66 per cent of district health board employees received the influenza vaccine – up on 61 per cent in 2014. Doctors remain the profession with the highest uptake of the flu vaccine with 72 per cent receiving the jab last year but nurses are now not far behind having increased their uptake from 59 per cent in 2014 to 68 per cent last year.
The DHB with the highest nurse vaccination rate remained Tairawhiti at 84 per cent followed by Auckland, Northland and Waikato all at 81 per cent. The DHBs with the lowest nurse vaccination rates were Wairarapa (47%), Lakes (49%) and MidCentral (55%).
Midwives remain the profession with the lowest uptake which fell from a high of 59 per cent in 2015 to 54 per cent last flu season.
The Immunisation Advisory Committee (IMAC) and Ministry of Health are again pointing out that healthcare workers can transmit influenza without knowing they are infected as the flu doesn’t always cause symptoms or make people unwell.
Data from the Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) study, based in Auckland, suggest that four out of five children and adults (80%) with flu were asymptomatic. And an earlier study – following the 2009 ‘swine flu’ pandemic in New Zealand – found almost one quarter of the adults who reported that they had not had influenza in 2009 were tested and found to have been infected by the H1N1 virus that caused the pandemic.
The New Zealand-based Southern Hemisphere Influenza and Vaccine Effectiveness, Research and Surveillance (SHIVERS) study has indicated that flu vaccine effectiveness in New Zealand is around 50 per cent or more.
Four strain vaccine available this year
Pharmac has confirmed that this year it will be funding for the first time a flu vaccine targeted at four strains of the flu virus rather than the usual three strains.
Two forms of quadrivalent vaccine will be funded from March 1 with Influvac Tetra funded for eligible people aged three years and over and another vaccine, Fluarix Tetra, funded for eligible children aged 6 to 35 months.
Pharmac deputy medical director Dr Bryan Betty says the four-strain vaccine will offer additional protection against influenza in 2018, and into the future.
Pharmac negotiated long-term supply with Mylan in 2016, including provision for a four-strain vaccine once it was approved for use by Medsafe. This has now occurred.
The funded vaccines will both contain the strains of influenza virus specified by the World Health Organisation for the 2018 Southern Hemisphere influenza season which are:
CDC Acting Director Dr. Anne Schuchat said last week that it was known that flu vaccines can often have lower effectiveness against H3N2 viruses but added that “however some protection is better than none” against the virus strains which were often linked to more severe illness – especially among children and people aged 65 and older.
Stock of the New Zealand seasonal influenza vaccine is typically available from early March until 31 December each year.
The exact start date for the 2018 seasonal influenza vaccination programme will be notified by the Ministry of Health in due course. The Fluarix Tetra vaccine for children under 3 years is likely to be available from mid-April 2018.
7876IMAC 2017 FLU_infographic_audio from Theo Brandt on Vimeo.
]]>Waikato DHB’s acting chief executive Derek Wright has asked for a review of the previous CEO Nigel Murray’s policy of requiring non-vaccinated health workers to wear masks while delivering patient care.
Murray brought the unpopular VOM (vaccinate or mask) policy with him from his old employer, British Columbia’s Fraser Health Authority where the policy had successfully withstood a union legal challenge.
Waikato introduced the hardline policy in 2015 – including suspending two unvaccinated nurses – and saw its nurse vaccination rate jump from 52% in 2014 to 81% in 2015, 80 per cent in 2016 and 81 per cent again last year.
The New Zealand Nurses Organisation has been on the record that while the organisation was quite clear it encouraged nurses and other members to get the seasonal flu vaccine, it also had “significant concerns” about the co-ercive nature of a VOM policy.
Waikato’s staff immunisation rate has never surpassed Tairawhiti DHB whose positive campaign – centred around a focused week-long campaign into every DHB department followed by catch-up clinics near the staff cafeteria – has kept the DHB at the top of the vaccination tables for four years with 84 per cent of both nurses and overall staff getting the flu jab last season. Tairawhiti also had the highest percent of ‘other’ DHB staff getting immunised at 90 per cent and the highest percentage of midwives with 88 per cent.
A Waikato spokesperson said the DHB had decided it was timely to revisit the VOM policy to see whether it was working. “Our Infection Control Committee will be looking at the evidence and research around masking and make a recommendation to the Executive. It could mean the policy is amended, or it could remain,” said the spokesperson. She said Wright was keen to work with staff and find the best solution for the DHB’s staff which also kept patients safe. “Obviously getting immunised and staying home if you are sick is the best protection for everyone.”
The DHB’s acting chief executive initially trained as a general nurse and then mental health nurse in the United Kingdom and worked in a variety of mental health management positions in the UK, New Zealand and Australia before joining Waikato in early 2016 as the DHB’s mental health director.
]]>The three public health professionals from the University of Otago say New Zealand’s current emergency plans focus on influenza and have little guidance for emerging infectious diseases, such as the recent Ebola and Zika outbreaks. Also the National health Emergency Plan: Infectious Diseases, developed in response to the SARS epidemic in 2003, was now out of date, leaving the Influenza Pandemic Preparedness Plan 2010 as the core document.
“The Ministry of Health’s ‘Pandemic Planning and Response’ webpage links only to documents regarding influenza,” point out the authors in an article published today in the Australian and New Zealand Journal of Public Health.
“However, preparedness for pandemic influenza does not guarantee preparedness for another emerging infectious disease, as demonstrated by the emergence of blood-borne (Ebola) and vector-borne (Zika) threats in recent years.”
The trio point out that emerging infectious diseases have caused pandemics with the highest death rates in history, including the plague, the influenza of 1918/19, and HIV.
Outbreaks of emerging infectious diseases have also been on the increase since 1940, with many caused by zoonotic diseases (diseases that can be transmitted from animals to people), while at the same time antimicrobial resistance is increasing worldwide in what has been described as a “slow-motion tsunami”.
Recommendations in the article for New Zealand health authorities include:
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This winter was the second in three years in which the DHB required unvaccinated frontline staff to wear masks when caring for patients during the declared flu season (low influenza rates last year meant a flu season was never declared).
This winter the DHB also asked for visitors who hadn’t had the season’s flu vaccine to wear masks when with patients from July 3 until September 19, when the Medical Officer of Health Dr Felicity Dumble declared the flu season officially over.
The NZNO at the start of the flu season expressed ‘significant concerns’ about the DHB’s ‘vaccinate or mask’ policy, particularly because of the suspension of two unvaccinated nurses who declined to wear masks in the first winter the policy was in force.
Director of nursing Sue Hayward told Nursing Review that no issues involving staff unable to wear masks when working clinically had been brought to her attention this winter.
In late June, 71 per cent of nurses had had the seasonal flu vaccine but Hayward said by the end of the flu season 81.6 per cent of nurses had taken up the option of vaccination, which was slightly higher than the 80 per cent who had received the vaccine by the end of winter last year.
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