- Email: [email protected]
Should we be vaccinating our patients against influenza?
YAJEM-158685; No of Pages 2 American Journal of Emergency Medicine xxx (xxxx) xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Should we be vaccinating our patients against influenza? Bruce J. Grattan Jr, DO, MS, RD, Conceptualization,, Investigation,, Writing - original draft,, Writing - review and editing Emergency Medicine PGY-1, Mercy/St. Vincent Medical Center, 2213 Cherry Street, Toledo, OH, 43608.
a r t i c l e
i n f o
Article history: Received 21 December 2019 Received in revised form 30 December 2019 Accepted 31 December 2019 Available online xxxx
a b s t r a c t There is a long history of vaccination administration from the Emergency Department. The morbidity, mortality and economic costs from influenza are staggering and an increasing body of literature supports initiatives for influenza vaccination from the Emergency Department. This article calls attention to this opportunity for Emergency Physicians to fill an unmet need with minimal impact to work-flow. © 2020 Elsevier Inc. All rights reserved.
Influenza is among the 8th leading causes of death in the United States [1]. There are over 700,000 influenza-related hospitalization annually and over 50,000 influenza-related deaths [2]. The annual economic burden of influenza is estimated to be $87 billion [3]. Despite these statistics, influenza vaccination compliance is poor, with only 37.1% of those eligible receiving the vaccination for the 2017–2018 influenza season. This is a 6% decrease from the 2016–2017 season [4], suggesting the need to address poor vaccination compliance. ED personnel are uniquely positioned to vaccinate a substantial number of patients who would not otherwise be vaccinated, including many high-risk populations. This represents a substantial missed opportunity as 2.8 million patients seen in the ED annually who are at high risk for complications from influenza leave without being vaccinated [5], despite such initiatives for ED-based vaccination programs being supported by national organizations. The 2015 American College of Emergency Physicians (ACEP) Policy statement supports the immunization of high-risk patients in the ED against influenza [6], and more broadly, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of hospitalized patients for over twenty years [7,8]. Only 36% of adults aged 65 and older receive the influenza vaccine annually, a population which is the fastest growing proportion of ED patients [9] and a population particularly at risk for influenza related complications [10]. Influenza vaccination of the elderly can have a profound impact, with studies showing upwards of a 75% reduction in death and up to a 39% reduction in hospitalization [11]. For the institutionalized elderly there is a 50% reduction in hospitalization [12]. The FLUVACS Trial, a prospective randomized study, demonstrated a 23% relative risk reduction for severe ischemia, nonfatal MI and cardiovascular death
E-mail address: [email protected].
among those immunized against influenza compared with unimmunized matched controls [13]. Influenza outbreaks have been associated with a substantial increase in ED utilization for those 65 and older for influenza related infections and its complications. In fact, it has been shown that for every 10 new cases of influenza in the community, there is a 1.5% increase in the proportion of elderly patients in the ED who presented with influenzarelated infections and upper respiratory infections [14]. Prevention of influenza can offset the surges in ED utilization seen during the 2009 H1N1 pandemic [15-20]. During times in which the CDC declared “widespread influenza activity” there is a significant increase in ED resource use [21]. ED resource use among patients with underlying respiratory illness is particularly prevalent during such outbreaks [22]. Additionally, influenza outbreaks are associated with increased ambulance diversion [23]. For every 100 cases of influenza per week, ambulance diversion increased by 2.5 h per week [23]. Taken together, these data suggest that influenza infections contribute to the complications associated with ED overcrowding. Differences in perspectives regarding vaccination are not uncommon among nurses and physicians [24-26]. While survey data collected from ED nurses suggests a negative view of influenza vaccine programs in the ED [27], it has been shown that such vaccination implementation programs can be effective, easily administered and do not have a detrimental effect on quality indicators [28]. Similarly, it has been suggested that those supporting such initiatives are more likely to be vaccinated themselves with research demonstrating higher vaccine rates among resident and attending ED physicians and lower rates among ED nursing staff [24,29], which may help explain these divergent findings. Similarly, providers who get vaccinated are more likely to recommend vaccination for their patients [30-32]. From a patient perspective, survey data suggests that most unvaccinated ED patients would be amenable to vaccination if it were offered [33,34].
https://doi.org/10.1016/j.ajem.2019.12.057 0735-6757/© 2020 Elsevier Inc. All rights reserved.
Please cite this article as: B.J. Grattan, Should we be vaccinating our patients against influenza?, American Journal of Emergency Medicine, https:// doi.org/10.1016/j.ajem.2019.12.057
2
B.J. Grattan Jr / American Journal of Emergency Medicine xxx (xxxx) xxx
While there have been concerns raised about the feasibility of ED based vaccination programs, such as perceived disruption of ED flow and lack of time [29], when these programs are actually implemented they are well received by both ED physicians, nursing staff and patients [28,35]. Similarly, some may point out that as Emergency Physicians (EPs) such a role in preventative health is best suited for the primary care setting, however nearly half of US medical care is now provided through the ED [36]. Notwithstanding some may say that as EPs we are responsible for providing the most vulnerable in our communities a safety net for healthcare services [37]. This is not a new concept. The delivery of a variety of screening measures in the ED have become commonplace and the value of which are supported by the literature including pneumococcal and tetanus vaccinations. Despite there only being 0.16 cases of tetanus per one million population [38], vaccination for tetanus from the ED has occurred since the beginning of the specialty with 27,738,000 doses being given between 1992 and 2000 [39]. The ED has a front-line role in combating vaccine preventable illness. In fact due to recent increases in the number of pertussis cases, the CDC recommended TDAP in lieu of Td for those requiring tetanus vaccination as part of wound management [40]. This approach has been found to be both beneficial and cost effective [41]. ED vaccination strategies have been shown to be successful, reimbursable and are advocated by several major clinical practice advisory groups. This represents a cost-effective opportunity to address the wellbeing of an underserved population, without disrupting work flow. Grants/financial support None. Declaration of competing interest The author has no conflicts of interest to disclose. References [1] Murphy S, Xu J, Kochanek K, Arias E. Mortality in the United States. National Center for Health Statistics; 2017. https://www.cdc.gov/nchs/products/databriefs/db328. htm Published 2018. Accessed November 28, 2019. [2] Prevention CfDCa. Vaccine-preventable adult diseases. https://www.cdc.gov/ vaccines/adults/vpd.html. Published 2016. Accessed November 28, 2019. [3] Molinari NA, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007;25(27): 5086–96. [4] Prevention CfDCa. Estimates of influenza vaccination coverage among adults— United States, 2017–18 flu season. FluVaxView web site. https://www.cdc.gov/flu/ fluvaxview/coverage-1718estimates.htm, Accessed date: 28 November 2019. [5] Slobodkin D, Kitlas J, Zielske P. Opportunities not missed–systematic influenza and pneumococcal immunization in a public inner-city emergency department. Vaccine 1998;16(19):1795–802. [6] ACEP. Immunization of adults and children in the emergency department. https:// www.acep.org/patient-care/policy-statements/immunization-of-adults-andchildren-in-the-emergency-department/. Published 2015. Accessed November 28, 2019. [7] Bridges CB, Fukuda K, Cox NJ, Singleton JA. Advisory committee on immunization P. prevention and control of influenza. Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 2001;50(RR-4):1–44. [8] Prevention and control of influenza: recommendations of the advisory committee on immunization practices (ACIP), MMWR Recomm Rep 1997;46(RR-9):1–25. [9] Fiore AE, Shay DK, Broder K, et al. Prevention and control of influenza: recommendations of the advisory committee on immunization practices (ACIP), 2008. MMWR Recomm Rep 2008;57(RR-7):1–60. [10] Smetana J, Chlibek R, Shaw J, Splino M, Prymula R. Influenza vaccination in the elderly. Hum Vaccin Immunother 2018;14(3):540–9. [11] Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med 2007;357(14):1373–81. [12] Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003;348(14):1322–32. [13] Gurfinkel EP, Leon de la Fuente R, Mendiz O, Mautner B. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) study. Eur Heart J 2004;25(1):25–31.
[14] Schull MJ, Mamdani MM, Fang J. Influenza and emergency department utilization by elders. Acad Emerg Med 2005;12(4):338–44. [15] Institute of Medicine Committee on the Future of Emergency Care in the USHS. The future of emergency care in the United States health system. Ann Emerg Med 2006; 48(2):115–20. [16] Sills MR, Hall M, Fieldston ES, et al. Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States. Emerg Infect Dis 2011;17(9): 1685–91. [17] Graham J, Shirm S, Storm E, Lyle K, Linam WM, Romero J. Challenges and solutions: pandemic 2009 H1N1 influenza a in a pediatric emergency department. Am J Disaster Med 2011;6(4):211–8. [18] Sugerman D, Nadeau KH, Lafond K, et al. A survey of emergency department 2009 pandemic influenza a (H1N1) surge preparedness–Atlanta, Georgia, July-October 2009. Clin Infect Dis 2011;52(Suppl. 1):S177–82. [19] Miroballi Y, Baird JS, Zackai S, et al. Novel influenza a(H1N1) in a pediatric health care facility in New York City during the first wave of the 2009 pandemic. Arch Pediatr Adolesc Med 2010;164(1):24–30. [20] Sills MR, Hall M, Simon HK, et al. Resource burden at children's hospitals experiencing surge volumes during the spring 2009 H1N1 influenza pandemic. Acad Emerg Med 2011;18(2):158–66. [21] Silka PA, Geiderman JM, Goldberg JB, Kim LP. Demand on ED resources during periods of widespread influenza activity. Am J Emerg Med 2003;21(7):534–9. [22] Menec VH, Black C, MacWilliam L, Aoki FY. The impact of influenza-associated respiratory illnesses on hospitalizations, physician visits, emergency room visits, and mortality. Can J Public Health 2003;94(1):59–63. [23] Schull MJ, Mamdani MM, Fang J. Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med 2004;44(1):61–7. [24] Martinello RA, Jones L, Topal JE. Correlation between healthcare workers' knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol 2003;24 (11):845–7. [25] Tapiainen T, Bar G, Schaad UB, Heininger U. Influenza vaccination among healthcare workers in a university children's hospital. Infect Control Hosp Epidemiol 2005;26 (11):855–8. [26] McEwen M, Farren E. Actions and beliefs related to hepatitis B and influenza immunization among registered nurses in Texas. Public Health Nurs 2005;22(3):230–9. [27] Venkat A, Hunter R, Hegde GG, Chan-Tompkins NH, Chuirazzi DM, Szczesiul JM. Perceptions of participating emergency nurses regarding an ED seasonal influenza vaccination program. J Emerg Nurs 2012;38(1):22–9. [28] Casalino E, Ghazali A, Bouzid D, et al. Emergency department influenza vaccination campaign allows increasing influenza vaccination coverage without disrupting time interval quality indicators. Intern Emerg Med 2018;13(5):673–8. [29] Fernandez WG, Oyama L, Mitchell P, et al. Attitudes and practices regarding influenza vaccination among emergency department personnel. J Emerg Med 2009;36 (2):201–6. [30] LaVela SL, Smith B, Weaver FM, Legro MW, Goldstein B, Nichol K. Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders. Infect Control Hosp Epidemiol 2004;25(11):933–40. [31] Toy WC, Janosky JE, Laird SB. Influenza immunization of medical residents: knowledge, attitudes, and behaviors. Am J Infect Control 2005;33(8):473–5. [32] Yassi A, Murdzak C, Cheang M, Tran N, Aoki FY. Influenza immunization: knowledge, attitude and behaviour of health care workers. Can J Infect Control 1994;9(4):103–8. [33] Polis MA, Smith JP, Sainer D, Brenneman MN, Kaslow RA. Prospects for an emergency department-based adult immunization program. Arch Intern Med 1987;147 (11):1999–2001. [34] Polis MA, Davey VJ, Collins ED, Smith JP, Rosenthal RE, Kaslow RA. The emergency department as part of a successful strategy for increasing adult immunization. Ann Emerg Med 1988;17(10):1016–8. [35] Taylor AVE, Elizalde M, Li-Brubacher J. Influenza and pneumococcal disease vaccinations: is there a role for prevention in the emergency department. BCMJ 2018;60(2): 116–20. [36] Marcozzi D, Carr B, Liferidge A, Baehr N, Browne B. Trends in the contribution of emergency departments to the provision of hospital-associated health care in the USA. Int J Health Serv 2018;48(2):267–88. [37] Rhodes KV, Gordon JA, Lowe RA. Preventive care in the emergency department, part I: clinical preventive services–are they relevant to emergency medicine? Society for Academic Emergency Medicine public health and education task force preventive services work group. Acad Emerg Med 2000;7(9):1036–41. [38] Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV. Tetanus surveillance– United States, 1998–2000. MMWR Surveill Summ 2003;52(3):1–8. [39] Pallin DJ, Muennig PA, Emond JA, Kim S, Camargo CA, Jr. Vaccination practices in U.S. emergency departments, 1992-2000. Vaccine. 2005;23(8):1048–1052. [40] Prevention CfDCa. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older—Advisory Committee on Immunization Practices (ACIP). Morbidity and mortality weekly report web site. https://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6125a4.htm. Published 2012. Accessed November 28, 2019. [41] Talbird SE, Graham J, Mauskopf J, Masseria C, Krishnarajah G. Impact of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine use in wound management on health care costs and pertussis cases. J Manag Care Spec Pharm 2015;21(1):88–99 [99a-c].
Please cite this article as: B.J. Grattan, Should we be vaccinating our patients against influenza?, American Journal of Emergency Medicine, https:// doi.org/10.1016/j.ajem.2019.12.057
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Should we be vaccinating our patients against influenza? Bruce J. Grattan Jr, DO, MS, RD, Conceptualization,, Investigation,, Writing - original draft,, Writing - review and editing Emergency Medicine PGY-1, Mercy/St. Vincent Medical Center, 2213 Cherry Street, Toledo, OH, 43608.
a r t i c l e
i n f o
Article history: Received 21 December 2019 Received in revised form 30 December 2019 Accepted 31 December 2019 Available online xxxx
a b s t r a c t There is a long history of vaccination administration from the Emergency Department. The morbidity, mortality and economic costs from influenza are staggering and an increasing body of literature supports initiatives for influenza vaccination from the Emergency Department. This article calls attention to this opportunity for Emergency Physicians to fill an unmet need with minimal impact to work-flow. © 2020 Elsevier Inc. All rights reserved.
Influenza is among the 8th leading causes of death in the United States [1]. There are over 700,000 influenza-related hospitalization annually and over 50,000 influenza-related deaths [2]. The annual economic burden of influenza is estimated to be $87 billion [3]. Despite these statistics, influenza vaccination compliance is poor, with only 37.1% of those eligible receiving the vaccination for the 2017–2018 influenza season. This is a 6% decrease from the 2016–2017 season [4], suggesting the need to address poor vaccination compliance. ED personnel are uniquely positioned to vaccinate a substantial number of patients who would not otherwise be vaccinated, including many high-risk populations. This represents a substantial missed opportunity as 2.8 million patients seen in the ED annually who are at high risk for complications from influenza leave without being vaccinated [5], despite such initiatives for ED-based vaccination programs being supported by national organizations. The 2015 American College of Emergency Physicians (ACEP) Policy statement supports the immunization of high-risk patients in the ED against influenza [6], and more broadly, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of hospitalized patients for over twenty years [7,8]. Only 36% of adults aged 65 and older receive the influenza vaccine annually, a population which is the fastest growing proportion of ED patients [9] and a population particularly at risk for influenza related complications [10]. Influenza vaccination of the elderly can have a profound impact, with studies showing upwards of a 75% reduction in death and up to a 39% reduction in hospitalization [11]. For the institutionalized elderly there is a 50% reduction in hospitalization [12]. The FLUVACS Trial, a prospective randomized study, demonstrated a 23% relative risk reduction for severe ischemia, nonfatal MI and cardiovascular death
E-mail address: [email protected].
among those immunized against influenza compared with unimmunized matched controls [13]. Influenza outbreaks have been associated with a substantial increase in ED utilization for those 65 and older for influenza related infections and its complications. In fact, it has been shown that for every 10 new cases of influenza in the community, there is a 1.5% increase in the proportion of elderly patients in the ED who presented with influenzarelated infections and upper respiratory infections [14]. Prevention of influenza can offset the surges in ED utilization seen during the 2009 H1N1 pandemic [15-20]. During times in which the CDC declared “widespread influenza activity” there is a significant increase in ED resource use [21]. ED resource use among patients with underlying respiratory illness is particularly prevalent during such outbreaks [22]. Additionally, influenza outbreaks are associated with increased ambulance diversion [23]. For every 100 cases of influenza per week, ambulance diversion increased by 2.5 h per week [23]. Taken together, these data suggest that influenza infections contribute to the complications associated with ED overcrowding. Differences in perspectives regarding vaccination are not uncommon among nurses and physicians [24-26]. While survey data collected from ED nurses suggests a negative view of influenza vaccine programs in the ED [27], it has been shown that such vaccination implementation programs can be effective, easily administered and do not have a detrimental effect on quality indicators [28]. Similarly, it has been suggested that those supporting such initiatives are more likely to be vaccinated themselves with research demonstrating higher vaccine rates among resident and attending ED physicians and lower rates among ED nursing staff [24,29], which may help explain these divergent findings. Similarly, providers who get vaccinated are more likely to recommend vaccination for their patients [30-32]. From a patient perspective, survey data suggests that most unvaccinated ED patients would be amenable to vaccination if it were offered [33,34].
https://doi.org/10.1016/j.ajem.2019.12.057 0735-6757/© 2020 Elsevier Inc. All rights reserved.
Please cite this article as: B.J. Grattan, Should we be vaccinating our patients against influenza?, American Journal of Emergency Medicine, https:// doi.org/10.1016/j.ajem.2019.12.057
2
B.J. Grattan Jr / American Journal of Emergency Medicine xxx (xxxx) xxx
While there have been concerns raised about the feasibility of ED based vaccination programs, such as perceived disruption of ED flow and lack of time [29], when these programs are actually implemented they are well received by both ED physicians, nursing staff and patients [28,35]. Similarly, some may point out that as Emergency Physicians (EPs) such a role in preventative health is best suited for the primary care setting, however nearly half of US medical care is now provided through the ED [36]. Notwithstanding some may say that as EPs we are responsible for providing the most vulnerable in our communities a safety net for healthcare services [37]. This is not a new concept. The delivery of a variety of screening measures in the ED have become commonplace and the value of which are supported by the literature including pneumococcal and tetanus vaccinations. Despite there only being 0.16 cases of tetanus per one million population [38], vaccination for tetanus from the ED has occurred since the beginning of the specialty with 27,738,000 doses being given between 1992 and 2000 [39]. The ED has a front-line role in combating vaccine preventable illness. In fact due to recent increases in the number of pertussis cases, the CDC recommended TDAP in lieu of Td for those requiring tetanus vaccination as part of wound management [40]. This approach has been found to be both beneficial and cost effective [41]. ED vaccination strategies have been shown to be successful, reimbursable and are advocated by several major clinical practice advisory groups. This represents a cost-effective opportunity to address the wellbeing of an underserved population, without disrupting work flow. Grants/financial support None. Declaration of competing interest The author has no conflicts of interest to disclose. References [1] Murphy S, Xu J, Kochanek K, Arias E. Mortality in the United States. National Center for Health Statistics; 2017. https://www.cdc.gov/nchs/products/databriefs/db328. htm Published 2018. Accessed November 28, 2019. [2] Prevention CfDCa. Vaccine-preventable adult diseases. https://www.cdc.gov/ vaccines/adults/vpd.html. Published 2016. Accessed November 28, 2019. [3] Molinari NA, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007;25(27): 5086–96. [4] Prevention CfDCa. Estimates of influenza vaccination coverage among adults— United States, 2017–18 flu season. FluVaxView web site. https://www.cdc.gov/flu/ fluvaxview/coverage-1718estimates.htm, Accessed date: 28 November 2019. [5] Slobodkin D, Kitlas J, Zielske P. Opportunities not missed–systematic influenza and pneumococcal immunization in a public inner-city emergency department. Vaccine 1998;16(19):1795–802. [6] ACEP. Immunization of adults and children in the emergency department. https:// www.acep.org/patient-care/policy-statements/immunization-of-adults-andchildren-in-the-emergency-department/. Published 2015. Accessed November 28, 2019. [7] Bridges CB, Fukuda K, Cox NJ, Singleton JA. Advisory committee on immunization P. prevention and control of influenza. Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 2001;50(RR-4):1–44. [8] Prevention and control of influenza: recommendations of the advisory committee on immunization practices (ACIP), MMWR Recomm Rep 1997;46(RR-9):1–25. [9] Fiore AE, Shay DK, Broder K, et al. Prevention and control of influenza: recommendations of the advisory committee on immunization practices (ACIP), 2008. MMWR Recomm Rep 2008;57(RR-7):1–60. [10] Smetana J, Chlibek R, Shaw J, Splino M, Prymula R. Influenza vaccination in the elderly. Hum Vaccin Immunother 2018;14(3):540–9. [11] Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med 2007;357(14):1373–81. [12] Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003;348(14):1322–32. [13] Gurfinkel EP, Leon de la Fuente R, Mendiz O, Mautner B. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) study. Eur Heart J 2004;25(1):25–31.
[14] Schull MJ, Mamdani MM, Fang J. Influenza and emergency department utilization by elders. Acad Emerg Med 2005;12(4):338–44. [15] Institute of Medicine Committee on the Future of Emergency Care in the USHS. The future of emergency care in the United States health system. Ann Emerg Med 2006; 48(2):115–20. [16] Sills MR, Hall M, Fieldston ES, et al. Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States. Emerg Infect Dis 2011;17(9): 1685–91. [17] Graham J, Shirm S, Storm E, Lyle K, Linam WM, Romero J. Challenges and solutions: pandemic 2009 H1N1 influenza a in a pediatric emergency department. Am J Disaster Med 2011;6(4):211–8. [18] Sugerman D, Nadeau KH, Lafond K, et al. A survey of emergency department 2009 pandemic influenza a (H1N1) surge preparedness–Atlanta, Georgia, July-October 2009. Clin Infect Dis 2011;52(Suppl. 1):S177–82. [19] Miroballi Y, Baird JS, Zackai S, et al. Novel influenza a(H1N1) in a pediatric health care facility in New York City during the first wave of the 2009 pandemic. Arch Pediatr Adolesc Med 2010;164(1):24–30. [20] Sills MR, Hall M, Simon HK, et al. Resource burden at children's hospitals experiencing surge volumes during the spring 2009 H1N1 influenza pandemic. Acad Emerg Med 2011;18(2):158–66. [21] Silka PA, Geiderman JM, Goldberg JB, Kim LP. Demand on ED resources during periods of widespread influenza activity. Am J Emerg Med 2003;21(7):534–9. [22] Menec VH, Black C, MacWilliam L, Aoki FY. The impact of influenza-associated respiratory illnesses on hospitalizations, physician visits, emergency room visits, and mortality. Can J Public Health 2003;94(1):59–63. [23] Schull MJ, Mamdani MM, Fang J. Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med 2004;44(1):61–7. [24] Martinello RA, Jones L, Topal JE. Correlation between healthcare workers' knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol 2003;24 (11):845–7. [25] Tapiainen T, Bar G, Schaad UB, Heininger U. Influenza vaccination among healthcare workers in a university children's hospital. Infect Control Hosp Epidemiol 2005;26 (11):855–8. [26] McEwen M, Farren E. Actions and beliefs related to hepatitis B and influenza immunization among registered nurses in Texas. Public Health Nurs 2005;22(3):230–9. [27] Venkat A, Hunter R, Hegde GG, Chan-Tompkins NH, Chuirazzi DM, Szczesiul JM. Perceptions of participating emergency nurses regarding an ED seasonal influenza vaccination program. J Emerg Nurs 2012;38(1):22–9. [28] Casalino E, Ghazali A, Bouzid D, et al. Emergency department influenza vaccination campaign allows increasing influenza vaccination coverage without disrupting time interval quality indicators. Intern Emerg Med 2018;13(5):673–8. [29] Fernandez WG, Oyama L, Mitchell P, et al. Attitudes and practices regarding influenza vaccination among emergency department personnel. J Emerg Med 2009;36 (2):201–6. [30] LaVela SL, Smith B, Weaver FM, Legro MW, Goldstein B, Nichol K. Attitudes and practices regarding influenza vaccination among healthcare workers providing services to individuals with spinal cord injuries and disorders. Infect Control Hosp Epidemiol 2004;25(11):933–40. [31] Toy WC, Janosky JE, Laird SB. Influenza immunization of medical residents: knowledge, attitudes, and behaviors. Am J Infect Control 2005;33(8):473–5. [32] Yassi A, Murdzak C, Cheang M, Tran N, Aoki FY. Influenza immunization: knowledge, attitude and behaviour of health care workers. Can J Infect Control 1994;9(4):103–8. [33] Polis MA, Smith JP, Sainer D, Brenneman MN, Kaslow RA. Prospects for an emergency department-based adult immunization program. Arch Intern Med 1987;147 (11):1999–2001. [34] Polis MA, Davey VJ, Collins ED, Smith JP, Rosenthal RE, Kaslow RA. The emergency department as part of a successful strategy for increasing adult immunization. Ann Emerg Med 1988;17(10):1016–8. [35] Taylor AVE, Elizalde M, Li-Brubacher J. Influenza and pneumococcal disease vaccinations: is there a role for prevention in the emergency department. BCMJ 2018;60(2): 116–20. [36] Marcozzi D, Carr B, Liferidge A, Baehr N, Browne B. Trends in the contribution of emergency departments to the provision of hospital-associated health care in the USA. Int J Health Serv 2018;48(2):267–88. [37] Rhodes KV, Gordon JA, Lowe RA. Preventive care in the emergency department, part I: clinical preventive services–are they relevant to emergency medicine? Society for Academic Emergency Medicine public health and education task force preventive services work group. Acad Emerg Med 2000;7(9):1036–41. [38] Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV. Tetanus surveillance– United States, 1998–2000. MMWR Surveill Summ 2003;52(3):1–8. [39] Pallin DJ, Muennig PA, Emond JA, Kim S, Camargo CA, Jr. Vaccination practices in U.S. emergency departments, 1992-2000. Vaccine. 2005;23(8):1048–1052. [40] Prevention CfDCa. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older—Advisory Committee on Immunization Practices (ACIP). Morbidity and mortality weekly report web site. https://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6125a4.htm. Published 2012. Accessed November 28, 2019. [41] Talbird SE, Graham J, Mauskopf J, Masseria C, Krishnarajah G. Impact of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine use in wound management on health care costs and pertussis cases. J Manag Care Spec Pharm 2015;21(1):88–99 [99a-c].
Please cite this article as: B.J. Grattan, Should we be vaccinating our patients against influenza?, American Journal of Emergency Medicine, https:// doi.org/10.1016/j.ajem.2019.12.057