Protect yourself, your patients and your family – get your flu vaccine

The upcoming season’s flu vaccine will protect against the influenza viruses that research indicates will be most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus and one or two influenza B viruses, depending on the flu vaccine.

Public health officials recommend that everyone who is eligible receive their flu vaccine and get it every year.

Which viruses does the seasonal flu vaccine protect against?

The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called trivalent vaccines) are made to protect against three flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and an influenza B virus. There also are flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine as well as an additional B virus.

Can flu vaccines cause the flu?

No. Flu vaccines that are administered with a needle are currently made in two ways: The vaccine is made either with a) viruses that have been ‘inactivated’ (killed) and are therefore not infectious or b) with no flu viruses at all (which is the case for recombinant influenza vaccine). The nasal spray flu vaccine does contain live viruses. However, the viruses are attenuated (weakened) and therefore cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection only at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.

What about side effects?

Flu vaccines are safe. Serious problems from the flu vaccine are very rare. The most common side effect that a person is likely to experience is either soreness where the injection was given, or runny nose in the case of nasal spray. These side effects are generally mild and usually go away after a day or two. Visit Influenza Vaccine Safety (www.cdc.gov/flu/protect/vaccine/vaccinesafety.htm) for more information.

Influenza viruses are constantly changing. They can change in two different ways. One way they change is called “antigenic drift.” These are small changes in the genes of influenza viruses that happen continually over time as the virus replicates. These small genetic changes usually produce viruses that are closely related to one another, which can be illustrated by their location close together on a phylogenetic tree. Viruses that are closely related to each other usually share the same antigenic properties, and an immune system exposed to a similar virus will usually recognize it and respond. (This is sometimes called cross-protection.)

The other type of change is called “antigenic shift.” Antigenic shift is an abrupt, major change in the influenza A viruses, resulting in new hemagglutinin and/or new hemagglutinin and neuraminidase proteins in influenza viruses that infect humans. Shift results in a new influenza A subtype or a virus with a hemagglutinin or a hemagglutinin and neuraminidase combination that has emerged from an animal population that is so different from the same subtype in humans that most people do not have immunity to the new (e.g., novel) virus.

Such a “shift” occurred in the spring of 2009, when an H1N1 virus with a new combination of genes emerged to infect people and quickly spread, causing a pandemic. When shift happens, most people have little or no protection against the new virus. While influenza viruses are changing by antigenic drift all the time, antigenic shift happens only occasionally. Type A viruses undergo both kinds of changes; influenza type B viruses change only by the more gradual process of antigenic drift.

The Centers for Disease Control and Prevention’s National Healthcare Safety Network tracks health care-associated infections. The network also is used to track health care process measures such as health care personnel influenza vaccine status and infection control adherence rates.

Hospitals must count vaccination rates for anyone who works for any part of one day in the health care facility between October 1 and March 31. That includes everyone from volunteers and clerical workers to doctors and executives. Organizations then report their rates to the National Healthcare Safety Network for public reporting on Hospital Compare, where the percentage of healthcare workers given influenza vaccinations is one of the measures displayed.

WSNA is committed to advocating for the health of nurses, patients and the communities they serve. Because of this commitment, WSNA strongly recommends that all nurses and other health care providers be vaccinated against all influenza viruses. WSNA strongly supports and urges voluntary efforts that aim for 100 percent vaccination rates, including annual education and implementation of comprehensive influenza vaccination programs for all health care providers.

WSNA supports enforcement of existing federal and state regulations to ensure that all employers meet the Centers for Disease Control (CDC) and Occupational Health and Safety Administration (OSHA) requirements for influenza prevention.

WSNA believes a hospital-by-hospital approach to mandatory vaccinations is poor public policy. It lacks consistency and adequate protection for patients and health care workers. WSNA believes that any vaccination policy is only one component of a comprehensive influenza prevention policy and should only be enacted as a result of federal or public health regulation. WSNA believes that any such regulation must include the following core components:

• The policy must cover all health care settings and health care workers. This includes all settings such as hospitals, long-term care facilities, adult boarding homes, outpatient clinics, etc. Health care workers must include those licensed and unlicensed who work in close proximity to patients, (e.g. nurses, emergency responders, physicians, housekeeping personnel, health care secretarial staff, etc).
• Employers must ensure that appropriate protection and safety measures are in place to provide a safe workplace environment for nurses and health care workers.
• Employers must ensure that influenza vaccines are available and offered to every health care worker annually at convenient times and locations. The employer must not discriminate against or discipline nurses for the appropriate use of sick time.
• If a declination form is required for vaccination, the nurse must be able to sign the form confidentially; that is, the nurse must not be required to divulge personal health information or declare the reason(s) for refusal of a vaccine. The employer must not discriminate against or discipline a nurse for opting out.
• The employer must comply with CDC and OSHA Guidelines must be used for prevention, protection, and safety of nurses and patients.