WELLNESS WATCH: Fight Against the Flu!

Updated September 10, 2019 —
(*Originally posted August 30, 2018)

Submitted by Dr. Patricia L. Blanchette, MD, MPH
Chief Medical Officer, UHP Hawaii and Associate Dean, John A. Burns School of Medicine

Pictured above: Third-year JABSOM students inject vaccines as part of their annual Transition to Clerkship training. Deborah Dimaya photo. 

IT IS TIME FOR YOUR FLU SHOT!

The flu season in Hawaii has already started.  There have been well-documented cases of Influenza Type A already circulating in the community.  Influenza (flu) is highly contagious and every year some people die from the flu. As healthcare workers, it is our responsibility to protect ourselves to reduce the risk of passing on the flu to our patients and families.  

There are three types of influenza, A, B, and C, arranged in order of the likelihood of spread and causing epidemics.  Type A is the most likely to spread widely and tends to occur early in the typical flu season. Type B is more prevalent later in the season.   Type C usually only causes minor illness in most people. There are several strains of influenza in each type. While the flu season is generally recognized as occurring in the fall and winter, it is now apparent that the flu occurs year round.  

There are several flu vaccines.  Most adults should consider getting an injection (a “flu shot”) of the quadrivalent vaccine, such as Fluzone™, which protects against two strains of Type A and two strains of Type B.  The injection type vaccines are produced using killed virus and cannot cause the flu.  

For people over age 65, the high dose trivalent vaccine, Fluzone-High Dose™, should be used.  The Fluzone-High Dose™ contains four times the amount of antigen than the regular Fluzone and is more likely to result in a good immune response in older people.  

The intranasal (sprayed into the nose) vaccine called FluMist™, is made with weakened (not killed) virus antigen and was not recommended for the 2016-2017 nor the 2017-2018 season because of weaker protection against the H1N1 strain.  Some experts still question its effectiveness, but it is now available for people who are so afraid of needles that they will not get a shot. However, because people who get the intranasal vaccine can shed the weakened flu virus into the environment for up to a week, there are special precautions for its use in health care workers and others who could shed the weakened live virus to people with very weak immune systems.  

Although severe allergic reactions to vaccines are extremely rare, vaccines should be administered by health care workers who are trained to recognize and respond to severe allergic reactions.  Vaccines that are not produced using egg products are available. See the CDC.gov website for recommendations for individuals with egg allergies.  

Most hospitals and nursing homes now require that employees receive their flu shot as a condition of employment.  Hospital and nursing home employees who cannot or refuse to get the flu shot must wear a mask whenever they are in patient care areas, including nursing stations.   A regular surgical mask is acceptable. In testing, N95 masks did not offer better protection against flu.  

UHP has decided to implement the “mask up” policy as well.  So from October 1, 2019 to May 1, 2020 UHP employees who have not been vaccinated against the flu must wear a mask whenever they are in UHP clinics or other patient care areas.  

For More Information:

CDC:
https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html

Information/Poster for Patients:
https://www.cdc.gov/vaccines/hcp/adults/downloads/fs-influenza-hcp.pdf

High Dose Vaccine for people age 65+:
https://www.nejm.org/doi/full/10.1056/NEJMoa1315727?query=featured_home

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2817%2930235-7/fulltext

FluMist™ Intranasal quadrivalent vaccine:
https://www.flumistquadrivalent.com/hcp/eligibility-criteria/healthcare-worker.html