5_HPS_fluVacc

Influenza Vaccination and Exposure Management Modules

Influenza Vaccination and Exposure Management Modules
Introduction: The Advisory Committee on Immunization Practices (ACIP) recommends that
all HCP and persons in training for healthcare professions should be vaccinated annually against
influenza.[1,2] Persons who are infected with influenza virus, including those with subclinical
infection, can transmit influenza virus to persons at higher risk for complications from influenza.
Vaccination of HCP has been associated with reduced work absenteeism [3] and with fewer
deaths among nursing home patients [4,5] and elderly hospitalized patients.[5] Although annual
vaccination is recommended for HCP and is a high priority for reducing morbidity associated
with influenza in healthcare settings, national survey data have demonstrated vaccination
coverage levels of <50% among HCP over several vaccination seasons.[1]
Facilities that employ HCP should provide vaccine to personnel using approaches that have
demonstrated effectiveness in increasing vaccination coverage. Healthcare administrators should
consider the level of vaccination coverage among HCP to be one measure of a patient safety
quality program and consider obtaining signed declinations from personnel who decline
influenza vaccination for reasons other than medical contraindications.[6-9] Influenza
vaccination rates (including ward-, unit-, and specialty-specific coverage rates) among HCP
within facilities should be regularly measured and reported to occupational health services.[9]
Healthcare facilities should offer influenza vaccinations to all HCP, including night, weekend,
and temporary staff. Particular emphasis should be placed on providing vaccinations to personnel
who provide direct care for persons at high risk for influenza complications. Efforts should be
made to educate HCP regarding the benefits of vaccination and the potential health consequences
of influenza illness for their patients, themselves, and their family members. Studies have
demonstrated that organized campaigns can attain higher rates of vaccination among HCP with
moderate effort and by using strategies that increase vaccine acceptance.[6,10,11] All HCP
should be provided convenient access to influenza vaccine at the work site, free of charge, as part
of employee health programs.[6,11,12]
Although annual vaccination with the seasonal influenza vaccine is the best way to prevent
infection, antiviral drugs can be effective for prevention and treatment of influenza. When HCP
have not been vaccinated or are exposed to an influenza strain with no vaccine (i.e., nonseasonal), a plan for anti-viral chemoprophylaxis and treatment could be implemented.

(ii) Methodology
A facility may choose to report influenza vaccination with (or without) exposure management
(i.e., antiviral medication use for chemoprophylaxis or treatment) or only exposure management.
Influenza Vaccination Module with (or without) Exposure Management

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Influenza Vaccination and Exposure Management Modules

Use of the Influenza Vaccination Module with (or without) Exposure Management enables a
healthcare facility to record information on influenza vaccination and anti-viral medication use
for chemoprophylaxis or treatment after exposure to influenza. It can be used in any healthcare
setting. This module requires that data be entered into NHSN on a monthly basis. This module
includes reporting individual-level vaccination details plus antiviral medication use for
chemoprophylaxis or treatment. Administration of one or more seasonal and non-seasonal (e.g.,
novel, 2009 H1N1) vaccines can be reported, including multi-dose vaccination series. If the
module is being used to satisfy federal record-keeping requirements for the administration of
vaccine covered by the Vaccine Injury Compensation Program, additional vaccination details
must be included, such as vaccinator name, title and work address. Vaccination status of all HCP
in the facility should be reported, regardless of whether they received the vaccine, in order to
accurately assess vaccination rates.
The module will permit characterizations of reasons for HCP declining vaccine that might be
used to improve future vaccination rates. Although surveillance of exposure management is not
required under this module, reporting of antiviral use to NHSN will also permit systematic
collection of information on antiviral medication use related to the prevention and treatment of
influenza.
Influenza Exposure Management Module
Use of the Influenza Exposure Management Module permits a healthcare facility to record
information on antiviral medication use for chemoprophylaxis or treatment without reporting
influenza vaccination. It can be used in any healthcare setting. This module requires that data be
provided to CDC as per reporting requirements. This module includes reporting of individuallevel antiviral medication use for chemoprophylaxis or treatment after exposure to influenza. The
reason for antiviral medication use can be attributed to either seasonal or non-seasonal influenza.
Use of this module will allow facilities and CDC to measure antiviral medication use related to
the prevention and treatment of influenza.
Settings: Any healthcare settings
Requirements: Surveillance for influenza in the healthcare facility is to be conducted during the
vaccination season. Actively participating NHSN sites will be required to submit data for a
minimum of 6 months per calendar year. A waiver is granted for the first year of participation
since facilities may not have 6 months of data in one calendar year in the first vaccination
season.

Definitions:

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Influenza Vaccination and Exposure Management Modules

• HCW (Healthcare Worker): A person who works in the facility, whether paid or unpaid,
who has the potential for exposure to infectious materials, including body substances,
contaminated medical supplies and equipment, contaminated environmental surfaces, or
contaminated air. Healthcare worker is the singular form of healthcare personnel.
• HCP (Healthcare Personnel): The entire population of healthcare workers working in
healthcare settings.
• Non-seasonal influenza vaccine: A vaccine for additional/novel influenza virus strains
(e.g., 2009 H1N1) not included in the seasonal influenza vaccine which may or may not be
offered on an annual basis.
• Seasonal influenza vaccine: A vaccine for seasonal influenza virus strains that is offered on
an annual basis.
• Severe adverse reaction to antiviral medication use for influenza chemoprophylaxis or
treatment: Adverse reactions severe enough to affect daily activities and/or result in the
discontinuation of the antiviral medication.
• Vaccination season: A 12-month period starting from September 1, 2xxx to the start of the
next traditional influenza season (i.e., August 31 of the following year).
Reporting Instructions
Forms Description and Purpose: (See also: Tables of Instructions for Completion of Healthcare
Personnel Safety Component forms)
All NHSN sites following any Influenza Module:
For either Influenza Vaccination with Exposure Management Module or the Influenza Exposure
Management Module, a site should complete the following forms:
›

Healthcare Personnel Safety Component Facility Survey (CDC 57.200) – Used to collect
facility administrative data including total acute care beds, inpatient and outpatient days,
inpatient and outpatient surgeries performed, and total numbers of HCP (full- and parttime) and numbers of HCP in selected occupational groups (full-time equivalents and
numbers of HCP). Numbers of HCWs for at least one nurse occupation (e.g., registered
nurse, nurse midwife) and one physician occupation (i.e., intern/resident, fellow,
attending physician) are required. All other fields are optional for the Selected HCW
Occupational Groups; you may enter 0 for these optional fields.

›

Healthcare Personnel Safety Reporting Plan (CDC 57.203) – Used to collect data on
which modules and which months (if any) the facilities intend to participate in NHSN
HPS Component. This form should be completed for every month that the facility will

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Influenza Vaccination and Exposure Management Modules

participate in the HPS influenza surveillance modules (either influenza vaccination with
exposure management or exposure management only).
›

Healthcare Worker Demographic Data (CDC 57.204) – Used to collect data on HCW
demographics such as gender and occupation for each individual HCW. This form also is
used optionally to collect information about immune status for certain vaccinepreventable diseases (e.g., measles, mumps, rubella). This form should be completed for
all HCP offered influenza vaccine. The demographic data may already be contained in a
facility database that can be uploaded into NHSN as an ASCII comma delimited text file.
File specifications and importing instructions are available on the NHSN website
(http://www.cdc.gov/nhsn).

Influenza Exposure Management only Reporting:
Facilities participating in Healthcare Personnel Influenza Exposure Management Module for
antiviral medication use should complete the following form:
›

Healthcare Worker Prophylaxis/Treatment – Influenza (CDC 57.210) – Used to collect
data on which (if any) antiviral medications were administered to the HCW and any
severe adverse reactions associated with their use.

Influenza Vaccination with Exposure Management Reporting:
Facilities participating in Healthcare Personnel Influenza Vaccination with Exposure
Management Module should complete the forms listed above and the forms listed below. The
Pre- and Post-season facility-level surveys will be used to capture information on vaccination
planning (pre-season) and actual (post-season) strategies implemented by the facilities.
›

Pre-season Survey on Influenza Vaccination Programs for Healthcare Personnel (CDC
57.211) – Used to collect data on the strategies that the facility plans to provide for
influenza vaccine of HCP. In addition, denominator data regarding the target vaccination
population (e.g., number of FTEs, PTEs, contractors, volunteers, others) are collected.
This form should be completed at the beginning of the vaccination season.

›

Healthcare Worker Influenza Vaccination (CDC 57.209) – Used to collect specific
information on whether a seasonal and/or non-seasonal influenza vaccination was
received or declined by the HCW, and the date, time, location and type of vaccination
that was administered. A separate form is required for each dose of vaccine. For example,
a 2-dose vaccine series administered on 2 separate dates would require 2 separate forms.
The form also contains information on any adverse reactions experienced as a result of
the vaccine. If NHSN is used to satisfy federal record-keeping requirements for vaccine
administration, identifiers of the person administering the vaccine and the edition date of
the vaccine information statement provided to the HCW will be required. This form
should be completed for all HCP.

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Influenza Vaccination and Exposure Management Modules

›

Post-season Survey on Influenza Vaccination Programs for Healthcare Personnel (CDC
57.212) – Used to collect information on the strategies actually implemented in order to
vaccinate HCP against influenza. This survey will capture any changes that occurred to
the facilities’ vaccination strategies and/or target vaccination populations during the
vaccination season. This form should be completed at the conclusion of the vaccination
season.

Data Analyses:
The use of the Influenza Vaccination and Exposure Management Module will allow the NHSN
site to measure its rate of vaccination coverage. In addition, antiviral medication use for
chemoprophylaxis or treatment after exposure to influenza can be evaluated and monitored.
Frequencies of the various healthcare influenza surveillance data will be calculated and
summarized. Vaccination rates can be calculated using the total number of vaccinated HCP
entered into the system divided by the total number of HCP targeted in the vaccination strategy
(from the Pre-season Season Survey). In addition, vaccination uptake rates by work location,
occupation, gender or another demographic data element, can be calculated by stratifying
analysis by the demographic data element of interest. Among the potential data points that could
be analyzed are general estimates of influenza vaccination coverage, the frequency of antiviral
medication use as chemoprophylaxis or treatment, as well as information on adverse effects
associated with the receipt of vaccines or antiviral medications (as part of chemoprophylaxis or
treatment).
For the data related to the pre- and post-survey on influenza vaccination programs, frequencies
for program-related questions will be calculated, and changes in pre- and post- frequencies will
be compared. On a national level, effectiveness of certain vaccination strategies in increasing
vaccine uptake can be evaluated.
References:
[1] Centers for Disease Control and Prevention, Prevention and control of seasonal influenza
with vaccines: Recommendations of the Advisory Committee on Immunization Practices
(ACIP), 2009, MMWR, 58 (2009) 1-52.
[2] Centers for Disease Control and Prevention, Influenza vaccination of health-care personnel,
MMWR, 55 (2006) 1-16.
[3] R. T. Lester, A. McGeer, G. Tomlinson, and A. S. Detsky, Use of, effectiveness of,
attitudes regarding influenza vaccine among house staff, Infection Control and Hospital
Epidemiology, 24 (2003) 839-844.

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[4] J. Potter, D. J. Stott, M. A. Roberts, A. G. Elder, B. ODonnell, P. V. Knight, and W. F.
Carman, Influenza vaccination of health care workers in long-term-care hospitals reduces
the mortality of elderly patients, Journal of Infectious Diseases, 175 (1997) 1-6.
[5] R. E. Thomas, T. O. Jefferson, V. Demicheli, and D. Rivetti, Influenza vaccination for
health-care workers who work with elderly people in institutions: a systematic review,
Lancet Infectious Diseases, 6 (2006) 273-279.
[6] F. J. Walker, J. A. Singleton, P. Lu, K. G. Wooten, and R. A. Strikas, Influenza vaccination
of Healthcare workers in the United States, 1989-2002, Infection Control and Hospital
Epidemiology, 27 (2006) 257-265.
[7] P. M. Polgreen, Y. Chen, S. Beekmann, A. Srinivasan, M. A. Neill, T. Gay, J. E.
Cavanaugh, and Infect Dis Soc Amer Emer Infect, Elements of influenza vaccination
programs that predict higher vaccination rates: Results of an emerging infections network
survey, Clinical Infectious Diseases, 46 (2008) 14-19.
[8] Centers for Disease Control and Prevention, Interventions to increase influenza vaccination
of health-care workers- California and Minnesota, MMWR, 54(08) (2005) 196-199.
[9] National Quality Forum. National Voluntary Consensus Standards for Influenza and
Pneumococcal Immunizations.
http://www.qualityforum.org/Publications/2008/12/National_Voluntary_Consensus_Standa
rds_for_Influenza_and_Pneumococcal_Immunizations.aspx , 1-68. 2008. Washington DC,
National Quality Forum. 8-12-2009.
[10] G. A. Poland, P. Tosh, and R. M. Jacobson, Requiring influenza vaccination for health care
workers: seven truths we must accept, Vaccine, 23 (2005) 2251-2255.
[11] Joint Commission on Accreditation of Healthcare Organizations, New infection control
requirement for offering influenza vaccination to staff and licensed independent
practitioners, Joint Commission Perspectives, 26 (2006) 10-11.
[12] Infectious Diseases Society of America. Pandemic and seasonal influenza: principles for
U.S. action. http://www.idsociety.org/influenza.htm . 2007. Arlington, VA, Infectious
Diseases Society of America.

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