Why is annual influenza vaccination recommended for healthcare workers?

Vaccination is our best protection against influenza infection.

Healthcare workers are at risk of getting (and possibly spreading) vaccine-preventable diseases, such as influenza, as they come into regular contact with patients or infective material from patients.

Annual influenza vaccination is an important part of infection control practices and provides effective protection for staff and their patients. Influenza vaccination reduces a healthcare worker’s risk of getting influenza and then spreading it to patients, especially patients who are young children, older people and patients with medical conditions who may be at higher risk of developing severe disease from influenza. An infected healthcare worker can pass on influenza before they even know they are sick.

Influenza outbreaks not only cause harm to affected patients and staff members, but also disrupt patient services through staff absenteeism and service cancellations. Protecting healthcare workers through vaccination helps maintain essential health services during influenza epidemics.

Does the influenza vaccine work?

When vaccines are well-matched to circulating strains of influenza, vaccination provides safe and effective prevention of infection with influenza. A Cochrane review of randomised control trials over many influenza seasons estimated that influenza vaccines had an efficacy against laboratory-confirmed influenza of 59% (RR 0.41, 95% CI 0.36-0.47) for healthy individuals aged 16 to 65 years ¹.

During influenza 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.

Am I likely to infect others?

Healthy adults who have influenza are infectious from one day before symptoms develop and for five to seven days after becoming sick, so it is possible to spread the virus to patients before symptoms even develop.

While the source of hospital-acquired (nosocomial) influenza transmission may not always be clear, hospital outbreaks can occur through healthcare workers spreading influenza to patients. One review of hospital-acquired influenza outbreaks found probable transmission by a healthcare workers was reported in around one third of hospital outbreaks ².

Who should get vaccinated?

As healthcare workers, carers and household contacts may spread influenza to people at higher risk of severe disease from influenza, vaccination of the following groups is strongly recommended: ³

• all healthcare workers, particularly those caring for people who are immunocompromised
• staff and volunteers working in residential care facilities
• providers of home care to people at high risk of severe disease from influenza  
• household contacts of people at high risk of severe disease from influenza  
• staff working in early childhood education and care
• staff and volunteers providing care to homeless people.

Higher influenza vaccination levels among staff of residential aged care facilities also reduces influenza-related disease and deaths in residents. ⁴

Information for workers in NSW Health facilities

Annual influenza vaccination is provided free for all NSW Health staff. While highly recommended for all healthcare workers, under the policy directive Occupational assessment, screening and vaccination against specified infectious diseases (PD2023_22) it is mandatory for those in Category A positions .

Category A positions involve either:

• direct physical contact with:
• patients or clients
• deceased persons or body parts
• blood, body substances, infectious material or surfaces, or equipment that might contain these (e.g., soiled linen, surgical equipment, syringes), or
• contact that would allow the acquisition or transmission of diseases that are spread by respiratory means, including:
• workers with frequent or prolonged face-to-face contact with patients or clients (e.g., interviewing or counselling individual clients or small groups; performing reception duties in an emergency or outpatients department)
• where the normal work location is in a clinical area such as:
• a ward
• an emergency department
• an outpatient clinic (including ward clerks and patient transport officers)
• workers who are required to attend clinical areas frequently throughout their working week, such as workers employed in food services who deliver meals and maintenance workers.

All students who undertake clinical placements within NSW Health facilities are considered Category A workers.

For further information see Occupational Assessment, Screening and Vaccination frequently asked questions (FAQs).

When should I get vaccinated?

Influenza vaccination is generally recommended to be done as soon as possible after the seasonal vaccine becomes available (usually in April each year). It takes about two weeks after vaccination for the vaccine to become most effective. While influenza continues to circulate, it is never too late to vaccinate.

Workers in Category A positions in NSW Health facilities must be vaccinated prior to 1 June each year.

Is the influenza vaccine safe?

Serious adverse reactions to influenza vaccines are very rare. The influenza vaccines used in Australia do not contain live virus, 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 1 or 2 days.

When making a choice to get vaccinated, it is important to compare the significant risks from infection of influenza with the risks from the influenza vaccine. Discuss this with your doctor or vaccination 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 an influenza vaccine?

Check with your employer first - many healthcare workplaces provide influenza vaccination for their staff. Alternatively, influenza vaccine is available from your GP and from some pharmacies.

Annual influenza vaccination is provided free for all NSW Health staff in NSW Health facilities.

Are there other ways I can prevent getting the flu?

As well as getting vaccinated, other ways to limit the spread of influenza 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
• stay at home when you are ill.

Can the influenza and COVID-19 vaccines be given together?

Yes, the influenza and COVID-19 vaccines can be given together, at the same time.

Further information

• The Australian Immunisation Handbook - Influenza Recommendations
• National Immunisation Program
• National Centre for Immunisation Research and Surveillance - Influenza vaccines for Australians
  
• Influenza vaccination for residential care staff brochure
• COVID-19 vaccination in NSW

References

• 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.
• Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook Australian Government Department of Health, Canberra. 
  
• 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.