Determining the impact of mandatory seasonal influenza vaccination policies on long-term care and

assisted living staff in Flathead County, Montana during the 2014-2015 influenza season

Theresa Majeski, MPHPublic Health Advisor/PHAP Associate

Public Health Associate ProgramOffice for State, Tribal, Local and Territorial Support

Centers for Disease Control and Prevention

2015 PHAP/PHPS Summer SeminarJune 2, 2015

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support

Background

People aged 65 and older are at greatest risk from influenza related deaths and complications Estimated that 90% of seasonal influenza-related deaths occur in

people 65 and older Estimated that 50-60% of seasonal influenza-related hospitalizations

occur in people 65 and older

Multiple studies have shown reduced influenza-related complications and risk of death with vaccination of health care personnel (HCP) in long-term care settings

CDC. www.cdc.gov/flu/about/disease/65over.htmCDC. www.cdc.gov/flu/heatlhcareworkers.htm

Background

Healthy People 2020 goal of 90% seasonal influenza vaccination coverage for HCP

Early 2014-2015 seasonal influenza national data show 54% of long-term care HCP vaccinated Compared to 79% of HCP in hospitals

2011-2012 Montana Immunization Program data show 62% of long-term care and assisted living facility (LTCF-ALF) staff vaccinated

Studies show that mandatory vaccination policies increase HCP vaccination rates

Healthy People 2020. Objective IID-12.13. www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectivesCDC. www.cdc.gov/flu/healthcareworkers.htmApenteng, B.A. & S.T. Opoku. Employee influenza vaccination in residential care facilities. American Journal of Infection Control 2014; 42:294-299.Sawyer, M.H. et.al. A public health initiative to increase annual influenza immunization among hospital health care personnel: The San Diego

Hospital Influenza Immunization Partnership. American Journal of Infection Control 2012; 40:595-600.

Methods

Eighteen participating facilities identified via Montana’s licensed LTCF-ALF registries

Key Informant Survey 9 question survey Distributed to Administrator or designee after introductory telephone

call Collected information about seasonal influenza staff vaccination

policies and procedures Results collected via telephone or fax

Methods

HCP Survey 5 question survey Used a contact at each facility to distribute and collect surveys from all

facility staff Collected information about self-reported seasonal influenza

vaccination status and influenza vaccination attitudes and beliefs

Results – Key Informant Survey

Key Informant Survey had response rate of 83% (n=15) 5 of 6 LTCF 10 of 13 ALF

Six (40%) LTCF-ALF had mandatory or recommended vaccination policies 4 mandatory 2 recommended

Results – HCP Survey

HCP surveys were received from 276 (28%) of 990 HCP 13 facilities participated

91% (251 of 276) of HCP respondents performed direct patient contact

68% (189 of 276) received seasonal influenza vaccination

Results – HCP Survey

Of the 189 vaccinated HCP, 65% (N=152) cited the presence of a workplace policy as a reason for vaccination

Results

Facilities with mandatory vaccination policies had 3-fold or greater HCP vaccination rates compared to facilities with recommendation policies

Conclusions

Workplace policies are a reason LTCF-ALF HCP receive seasonal influenza vaccination

Mandatory policies yield higher vaccination rates than recommendation policies

Mandatory vaccination policies can be one method used to work towards the Health People 2020 goal of a 90% vaccination rate in HCP

Limitations

HCP survey may have had selection bias HCP survey participation depended upon methods used by

each facility’s contact Vaccination status is self-reported

Many Key Informants stated their corporate entity makes policy decisions

Next Steps

Develop a toolkit to help facilities move towards mandatory vaccination policies

For facilities not able to adopt a mandatory vaccination policy at this time: Develop targeted educational campaigns based on why the facility’s

HCP did not get vaccinated Offer other interventions such as providing seasonal influenza

vaccinations on-site

For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support

4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: OSTLTSfeedback@cdc.gov Web: http://www.cdc.gov/stltpublichealth

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Questions?Theresa Majeski, MPH

Public Health Advisor/PHAP AssociateCDC/OSTLTS/OD1035 1st Ave West

Kalispell, MT 59901406-260-4906

ypn6@cdc.gov

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support