Why is annual influenza vaccination recommended for healthcare workers?
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. Infected HCW can pass the virus on to their patients before they even know they are sick.
HCW 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 and adopting additional preventative measures, such as proper hand hygiene and proper sneezing and coughing etiquette.
Are healthcare workers at greater risk of infection?
Yes. Anyone can catch influenza if exposed to the virus but healthcare workers are more likely to be exposed to influenza because of their work. (3)
Does the influenza vaccine work?
When the vaccine and circulating viruses are similar, influenza vaccination prevents laboratory-confirmed influenza illness among approximately 70%-90% of healthy adults aged less than 65 years in randomised controlled trials. (4)
While the efficacy of influenza vaccines can drop to as low as 30% protection when poorly matched with circulating strains, they remain the best way of preventing influenza and are an important control measure in conjunction with regular hand cleaning and respiratory hygiene. In addition, there is evidence that vaccination also reduces the severity of illness among people who are vaccinated but still get sick. (6)
Each year the vaccine is reformulated to match what the World Health Organization (WHO) and an advisory group of experts believe will be the circulating strains that winter.
WHO has estimated that influenza vaccination of HCW prevents serologically confirmed influenza infection among HCWs with an efficacy of 88% (5), but this will change from year to year.
Without a vaccination am I likely to infect others?
Yes. Infected healthcare workers regularly transmit influenza to patients and are likely to be an important source of infection for patients in healthcare and residential care settings.
Higher influenza vaccination levels among healthcare workers reduces the risk of influenza and influenza-complications among vulnerable patients. There have also been cases of influenza-related deaths in neonatal intensive care units and paediatric oncology wards following healthcare worker transmission.
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. (7)
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 (PD2018_009) 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.
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.
- 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.
- Kuster SP, Shah PS, Coleman BL, Lam P-P, Tong A, et al. Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis PLoS ONE . Published 18 October 2011. DOI:10.1371/journal.pone.0026239.
- Fiore AE et al. Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010MMWR Morbidity and mortality weekly report, 2010, 59(RR 08):1–62.)
- World Health Organization (WHO). Vaccines against influenza WHO position paper November 2012. See Table 5a - Efficacy of influenza vaccine in health care workers.
- Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clinical Infectious Diseases, 65,8,15 October 2017, 1289–1297. https://doi.org/10.1093/cid/cix468.
- Hayward AC, Harling R, Wetten S, et al. 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.