Why is annual influenza vaccination recommended for healthcare workers?
The hospital patient population has high rates of serious underlying illnesses, making influenza more dangerous in this setting. Annual healthcare worker (HCW) vaccination against influenza is an important adjunct to infection control practices, with seasonal influenza immunisation providing effective influenza protection for HCW when well-matched to circulating strains.
Influenza vaccination helps healthcare workers (HCW) who come into regular contact with influenza patients to reduce their risk of contracting influenza and of then spreading it to other vulnerable patients. An infected HCW can pass the virus on to their patients before they even know they are sick.
HCW's are recognised as a priority group recommended for annual flu shots (1,2), and protecting them also helps maintain essential healthcare services during influenza epidemics.
The most effective way to prevent the flu is by getting vaccinated. Adopting additional preventive measures, such as proper hand hygiene and proper sneezing and coughing etiquette, reduces further your risk of getting and spreading the flu.
Are healthcare workers at greater risk of infection?
Because of their contact with patients or infective material from patients, many HCW's are at risk for exposure to (and possible transmission of) vaccine-preventable diseases, such as influenza. There is debate about whether the risk to a HCW of acquiring influenza at work is significantly greater than their risk of acquiring influenza in other settings.
Does the influenza vaccine work?
When vaccines are well-matched, seasonal influenza immunisation provides safe and effective influenza prevention for HCW. A Cochrane review of randomised control trials over many seasons estimated that influenza vaccines had a efficacy against laboratory-confirmed influenza of 59 per cent (RR 0.41, 95% CI 0.36-0.47) for healthy individuals aged 16 to 65 years (3).
During seasons where one or more of the circulating influenza virus strains shows significant drift away from the vaccine strains, influenza vaccine effectiveness in the community is usually reduced.
Without a vaccination am I likely to infect others?
While the source of hospital-acquired (nosocomial) influenza transmission may not always be clear, HCW's have been implicated in the transmission of influenza to inpatients, and this can lead to hospital outbreaks. One review of nosocomial influenza outbreak reports found probable transmission by HCW was documented in 10 (36%) of the 28 studies reported (4).
Influenza outbreaks not only cause harm to affected patients and staff members, but also disrupt patient services through staff absenteeism and service cancellations.
Even if you don't show symptoms of influenza you can transmit the virus to patients. Infected health adults are infectious from one day before symptoms develop and for five to seven days after becoming sick.
Who should get vaccinated?
The following groups of people can potentially transmit influenza to persons at increased risk of complications from influenza infection; vaccination of these groups is therefore recommended to protect those at risk: (1)
- all healthcare providers (particularly those of immunocompromised patients)
- staff (or volunteers) working in residential care facilities
- household contacts (including children ≥6 months of age) of those in high-risk groups, including providers of home care to persons at risk of high influenza morbidity
- staff working in early childhood education and care
- staff (or volunteers) providing care to homeless people.
Higher influenza vaccination levels among staff of residential aged-care homes also reduces influenza-related illness and deaths in residents. (5)
Information for NSW Health workers
Annual influenza vaccination is provided free for all NSW Health workers. While highly recommended for all health care workers, under the policy directive Occupational assessment, screening and vaccination against specified infectious diseases (PD2020_017) it is mandatory for those in Category A High Risk positions.
Category A High Risk positions are positions categorised as Category A risk where the worker also works in one or more of the following five high risk clinical areas:
- Antenatal, perinatal and post-natal areas including labour wards and recovery rooms and antenatal outreach programs
- Neonatal intensive care units; special care units; any home visiting heath service provided to neonates
- Paediatric intensive care units
- Transplant and oncology wards
- Intensive care units
- Multipurpose services (NSW Health)
- NSW Health Residential aged care facilities (except when special providions under 4.1 apply)
Workers employed in Category A - High Risk positions that are unable to receive influenza vaccine due to a medical contraindication must provide evidence from their doctor or treating specialist. During the influenza season these workers must wear a surgical/procedural mask while providing patient care in high risk clinical areas or be deployed to a non-high risk clinical area.
Workers employed in Category A - High Risk positions who refuse annual influenza vaccination (other than those with a recognised medical contraindication to influenza vaccine) must, during the influenza season, wear a surgical/procedural mask while providing patient care in high risk clinical areas or be deployed to a non-high risk clinical area.
Category A High Risk workers must be vaccinated prior to 1 June each year.
For further information see the Occupational Assessment, Screening and Vaccination frequently asked questions (FAQs).
When should you get vaccinated?
Flu vaccination is generally recommended to be done as soon as possible after the seasonal vaccine becomes available (usually in April) and it takes about two weeks after vaccination for it to become most effective. While influenza continues to circulate, it is never too late to vaccinate.
NSW Health workers in Category A High Risk positions must be vaccinated prior to 1 June each year.
Do I need to get vaccinated every year?
Yes. Serious adverse reactions to flu vaccines are very rare. The flu vaccines used in Australia are not live so you cannot get influenza from a vaccination. Post-vaccination symptoms (such as a mild fever, injection site soreness, and muscle aches) can occur in up to 10% of vaccine recipients. These symptoms may sometimes be confused with the influenza infection, but they are generally mild and last from a few hours to at most 1 to 2 days.
When making a choice to get vaccinated it is important to compare the significant risks from the infection (influenza) with the risks from the vaccine. Discuss with your immunisation provider.
People with egg allergy, including anaphylaxis, can be safely vaccinated with influenza vaccines – it is recommended that these people be vaccinated in medical facilities with staff experienced in recognising and treating anaphylaxis.
Where can I get a flu vaccine?
Check with your employer first - many healthcare facilities provide influenza vaccination for their staff. Alternatively, seasonal influenza vaccine is available from your GP and from some pharmacies.
Are there other ways I can prevent getting the flu?
Other preventive measures to limit the spread of flu are:
- wash your hands regularly with soap and water or alcohol hand rub
- cover your mouth and nose when you cough or sneeze - use a tissue or your elbow, not your hands
- bin your used tissues straight away
- stay at home when you are ill.
Relationship to COVID-19 vaccinations
It's recommended to wait 14 days between getting a flu vaccine and a COVID-19 vaccine. Given this, it will be important to plan both vaccinations.
- Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook Australian Government Department of Health, Canberra, 2018, immunisationhandbook.health.gov.au.
- World Health Organization (WHO). Strategic Advisory Group of experts on Immunization (SAGE) Report, April 2012. Weekly Epidemiological Record. No. 47, 2012, 87, 461–476.
- Demicheli V, et al. Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews 2018;2. doi: 10.1002/14651858.CD001269.pub6 .
- Voirin N, et al. Hospital-acquired influenza: a synthesis using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. J Hosp Infect. 2009; 71: 1–14.
- Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ;2006;333:1241.