There is a saying that if you’ve experienced one influenza season, you’ve experienced one influenza season. Influenza is a highly unpredictable virus, and the 2011-2012 season has proved to be one that was unexpected.
Overall the season began late and is described as relatively mild. The influenza season typically lasts from September to May, and disease incidence and peaks are difficult to predict. The Centers for Disease Control and Prevention (CDC) reported influenza-like illness only just reaching the national baseline in mid-March, and this represented the peak of incidence of the entire season. In contrast, other influenza seasons have seen the baseline reached in late December, and then the peak represented as a drastic increase from there, typically occurring in late winter. As of March 24, 16 states and territories reported “widespread” influenza activity, and this was the highest number of the year. Again, in contrast to other seasons, typically by late March almost all states and territories report that level of activity. Influenza mortality is within the rate expected for this time of year. Pediatric deaths attributed to influenza are significantly lower than in previous years – 12 deaths reported as of March 24 compared to 122 in the entire 2010-2011 influenza season.
While these signs are encouraging, health officials warn it is still possible for a large wave of influenza activity to occur. Influenza vaccination is still encouraged for those that haven’t received it, and disease surveillance activities will continue.
Attendees to the Advisory Committee on Immunization Practices meeting in February, which included ANA as a liaison member, discussed the influenza season. CDC officials said it was too soon to say what factors have contributed to the mild season. Some members of the committee speculated whether increased vaccination, due in part to the universal recommendation, was a major factor. This recommendation, which represented a landmark step in influenza vaccination policy, called for all persons over the age of six months to be vaccinated, regardless of risk condition. It could be contributing to an overall decrease in disease incidence and death, demonstrating the power of influenza vaccines on public health. However, CDC officials were hesitant to draw any conclusions just yet. [Watch the archived webcast of the meeting.]
Data is not yet available for overall seasonal influenza immunization rates. However, there were not any reported vaccine supply or distribution issues this season. Preliminary reports released by CDC in November gave a snapshot of vaccination rates of two key populations – pregnant women and health care workers. The report on health care worker vaccination rate showed that in the first few months of the influenza season, the rate among health care workers in general was 63.4 percent, already matching the highest rate achieved in all of 2010-2011 season. For nurses in particular, the rate was 75.7 percent, one of the highest rates ever. Late-season data from CDC on vaccination coverage will be available in late spring.
Continuing its immunization advocacy work for nurses and the public, ANA produced some informative and motivational tools as part of the Unite to Fight the Flu campaign. One was the
video address to all nurses from President Karen Daley, PhD, MPH, RN, FAAN. This video, in which President Daley reminds nurses of their professional and ethical responsibility to be vaccinated, has had almost 2,000 views on YouTube. Another feature is the comprehensive influenza tool-kit for nurses, with patient and nurse resources on the importance of preventing influenza through vaccination.
From the policy perspective, there was a continued discussion on employer requirements for influenza vaccination. ANA’s position supports influenza requirement policies that include certain criteria – among them that such policies are made at the highest level of decision making authority (e.g. state level); include medical and religious exemptions; are part of a funded comprehensive infection control program; are non-discriminatory; and when applicable, are negotiated through the collective bargaining process. ANA’s position promotes fairness and consistency in policies, and ensures adequate input from key stakeholders as the policies are developed. A development that lends credence to that policy is the model state legislation developed by the George Washington University, which articulates many of the same criteria in ANA’s position.
Even though the current influenza season is not quite over, plans are already underway for the 2012-2013 season. In late February, the World Health Organization announced its recommendation for the three strains that should be included in the season’s vaccine. The 2009 H1N1 strain was again recommended, as it has been in the vaccine since the 2009 pandemic. In the United States, the Food and Drug Administration is reviewing the recommendation and will make a decision for U.S. vaccine supply. Most likely they will follow the WHO recommendation, since it is based on global epidemiology of influenza.
Despite some encouraging news that the season has been mild, nurses should continue encouraging influenza vaccination for nurses and patients. Some surges in influenza activity can occur as late as April, so it’s not too late to be vaccinated. When we are all protected through vaccination, we truly can Unite to Fight the Flu!
Katie Brewer is a senior policy analyst at ANA.