Influenza

Sherri, Michelle, Katie, Carola, and Magdalena

Influenza Influenza by Sherri, Michelle, Katie, Carola, and Magdalena1Who is Affected by Influenza?People 65 years and older are at greater risk of serious complications from the flu compared with young, healthy adults (CDC, 2012).

It's estimated that 90 percent of seasonal flu-related deaths and more than 60 percent of seasonal flu-related hospitalizations in the United States each year occur in people 65 years and older (CDC, 2012).

All ages can be affected by influenza, although there are greater risks for the elderly population of suffering serious complications from influenza when compared to young healthy adults. Immune defenses weaken with age and therefore influenza can have devastating effects on the elderly.

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The statistics show the high percentage of persons aged 65 and older, in the United States as a total, Michigan and surrounding states who were not vaccinated for Influenza in 2011. The issue of unvaccinated elderly adults is a problem that is faced at a national, state, and local level which has need for intervention. Kent County Michigan will be our focus.3Kent County Statistics67 deaths in 2010 from influenza or pneumonia.

85% of deaths were in population aged 65+.

Influenza/pneumonia was listed as 9th for cause of death in 2010. (Kent County Administration, n.d.)

In Kent County, in 2010, there were 67 deaths from influenza or pneumonia virus, 85% of those deaths were among elderly, In 2010, influenza and/or pneumonia was listed as the 9th cause of death.4Problem StatementAdults aged 65 and older in Kent County, Michigan are at risk of hospitalization and death as evidenced by 2010 data revealing that 85% of the deaths in Kent County were related to influenza or pneumonia and occurred in the 65+ population. Statistics also show that 42% of Michigan residents aged 65+ did not receive the flu shot in 2011, which is above the national average. (Kent County Administration, n.d.) (CDC, n.d.)Adults aged 65 and older in Kent County, Michigan are at risk of hospitalization and death as evidenced by 2010 data revealing that 85% of deaths in Kent County were related to influenza or pneumonia and occurred in the 65 and older population. Statistics also show that 42% of Michigan residents aged 65 and older did not receive the flu shot in 2011, which is above the national average.5Best Practices for Primary Prevention of InfluenzaMaximize health and wellness through strategies that are set in place before illness or injury are present (Harkness & DeMarco, 2012. p. 71).

Influenza vaccination for pre-pathogenic stage

Vaccines can prevent outbreaks of disease and save lives. When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak (NIH, 2010).

Maximizing health and wellness through strategies that are set in place before illness or injury are present is the best practice to protect ourselves from viruses- This way we minimize our risk. For example: Receiving the flu vaccine 6

Prevention: First Key to Health

http://doctor2008.files.wordpress.com/2008/09/wash-hands2.jpghttp://tsh.to/img/FluPoster_Website.jpgHand washing and vaccination are two ways that a person can protect themselves from the flu. These are both examples of Primary Prevention.7Best Practices for Secondary Prevention of InfluenzaMinimize impact of disease or injury at early stage of pathogenesis (Harkness & DeMarco, 2012, p. 72).

Screening for Influenza A and B at onset of flu symptoms (fever, chills, temperature, nausea/vomiting) Minimizing the impact of disease is the focus of secondary prevention. This happens at the early stage of illness when signs and symptoms are experienced. In influenza, screening is available to determine the type and severity of the disease. 8Community Change Proposal for Kent CountyProposal to increase the percent of influenza vaccination rates of adults aged 65 and older in Kent County by >15% in the 2013 - 2014 influenza season through education and increased availability of immunizations to prevent hospitalization and death.We have made a proposal for change. Our proposal is to increase the percent of influenza vaccination rates of adults aged 65 and older in Kent County by >15% in the 2013-2014 influenza season through education and increased availability of immunizations to prevent hospitalization and death.

9Resources in the CommunityArea Agency on Aging of Western MichiganKent County Health Care Transportation Resource Directory: A resource guide of transit agencies and community programs offering transportation assistance and information (Kent County Administration, 2013).Existing Locations for Flu VaccinationsKent County Health Department (KCHD) - 5 immunization clinics 7 hospitals in Kent CountyPhysician offices, Long Term Care Facilities (LTCF)Pharmacies, Grocery Stores

Kent county has public transportation resources as well as many vaccination sites and resources to go to for information about the influenza vaccine. Many of the sites are accessible to the elderly population and they provide affordable vaccination throughout the influenza season as a way to improve the health of the community.

10Partnership AgenciesDepartment of Health and Human Services (HHS)Centers for Disease Control and Prevention (CDC)World Health Organization (WHO)National Institutes of Health (NIH)

(Harkness & DeMarco, 2012)Department of health and human services, the centers for disease control and prevention, world health organization, and national institutes of health, all partner to help keep our elderly population vaccinated throughout the year.11Epidemiologic ModelFocuses on health promotion and disease preventionConsiders modifiable risks of acquiring influenzaAnalyzes trends in risk surveillance dataProcesses data collection quantitative morbidity and mortality reportsDetermines staging pre-pathogenic, early pathogenic, and late pathogenic phases of influenzaEstablishes relative risk , consistency, exposure, timing, and plausibilityBuilds coalitions with partnership agencies (Harkness & DeMarco, 2012, p. 69)

The epidemiologic model can be used to explain the difference between Kent Countys influenza vaccination rate and the state benchmark. In 2008, 32.9% of Kent County residents aged 65 and older were not vaccinated from influenza (Kent County Health Department, 2010). In 2010 85% of deaths from influenza were among the elderly population (Kent County Administration, n.d.). These statistics show the high numbers of vulnerability in this population. The data collection is a very clear statement of the amount of progress that needs to be made in this county. Building the coalitions stronger should help the figures reach a healthier end.

12Modifiable RisksVaccinationHuman immune defenses become weaker with age. So influenza can be a very serious disease for people 65 and older (CDC, 2012).

Influenza a vaccine-preventable diseaseInfluenza outbreaks have been associated with low vaccination rates among health healthcare providers (HCP). Immunizing HCP will protect staff, patients, and indirectly reduce disease burden, work absenteeism, and health care costs (CDC, 2006).Modifiable risk factors are those that can be changed to avoid disparity. Vaccination against influenza can prevent illness from the flu virus and is available and recommended to those 6 months of age and older. The major point that needs to be made when addressing this issue with the public is that influenza is a preventable disease. Our society has accepted many of these interventions for health as common place but it is important to reinforce the effectiveness of the vaccination and the frequency that it should be received.

13Unmodifiable Risks Vaccination ShortageFlu cases spike in Kent County - far outpacing last year's tallyHealth officials already have confirmed 112 cases - compared with only five cases at this time last year, the Kent County Health Department reported Thursday, Dec. 27 (www.mlive.com).Many residents have contacted the health department for vaccinations, reporting that their doctors offices and pharmacies have run out of vaccines, health officials said (www.mlive.com). Virus CompositionDue to the constantly changing composition of the flu viruses in circulation, the influenza vaccine must be modified each year to match the current viruses (WHO, 2013).

Unmodifiable risk factors are those that cannot be changed to decrease risk of disparity. A shortage in vaccine is a factor that is not within our control and can be a risk for the influenza virus. The Michigan department of health division of immunizations has partnered with the Flu Advisory Board to create the Influenza Vaccine Exchange Network (IVEN) which is a tool used by licensed professionals to share information about their influenza vaccine inventory to facilitate vaccine redistribution, should shortages or maldistribution occur (State of Michigan,2013). While this is in place, shortages may still occur and resources may take time to replenish. The composition of the vaccines change yearly as well, therefore, if the composition is not correct to protect against the particular influenza then it may not be 100% effective.

14Barriers to Flu ShotsMedical contraindicationFear of side effectsInconvenienceLack of access or transportationFinancial barrierPerceived ineffectiveness of vaccinePerceived unlikelihood of contracting influenzaFear of needles

(CDC, 2006)The existence of barriers is not unnoticed. Many barriers could be overcome by further educational intervention. Some of those that may exist are fear of side effects, inconvenience, perceived ineffectiveness of vaccine, and perceived unlikelihood of contracting influenza. Barriers that may warrant further intervention are lack of transportation, lack of access, and financial barriers.15InterventionsWHO - Target population group of adults age 65 and older.WHY Disease prevention and health promotion.Those vaccinated with flu shot are 60% less likely to need treatment for flu by healthcare provider.WHEN Annually during flu season (October to March). Encourage early vaccination.Reassure that vaccines are monitored by CDC and FDA for safety.HOW Remove financial barriers and provide transportation services when applicable.Determine available insurance for influenza vaccination coverage.Advise that Medicare Part B covers 100% of flu shots.Under the Affordable Care Act, many insurers are required to cover certain preventive services, like the flu vaccine (HHS, n.d.) (HHS, n.d.)By becoming immunized with the influenza vaccine, the likelihood of the elderly needing treatment for influenza drops 60%! This year in the 2013-2014 flu season from the months of October to March, the elderly population should receive the vaccine. Health care transportation services may be available for little or no cost which can help to eliminate the barrier of transportation. Medicare will cover 100% of the costs of the seasonal flu vaccine and under the affordable care act many insurers are now required to cover preventative services which includes the seasonal flu vaccine (HHS, n.d)! This should remove the financial barrier to becoming vaccinated. IT IS IMPORTANT TO NOTE-The classic influenza season is from October to March, but it is important to get vaccinations as early as possible. Especially, those that might be in contact with other individuals that are immuno-compromised or likely to spread bacteria (such as children). It is important to recognize that the influenza vaccination protects those that directly obtain the vaccination and those that they come in contact with. Therefore, it is extremely important for individuals that are in a very social environment (such as a nursing home or assisted living) or are very active in their community (such as attending community lunches or planning committees).16InterventionsWHAT Flu shot (inactivated flu virus) by injection. Provide helpful and accurate education about influenza.Teach about influenza disease viral infection of respiratory tract, types A, B, and C, signs and symptoms, mode of transmission.Inform about reasons for annual vaccinations related to changing types and strains of flu viruses.Inform about risk of acquiring influenza for two weeks after flu shot, the time it takes to develop antibodies against disease. Influenza vaccine contraindicated in severe allergy to chicken eggs, previous reaction to flu shot, moderate to severe illness with fever, history of Guillain-Barre Syndrome.Teach side effects of flu shot: soreness, headache, fever, swelling at injection site, nausea.(HHS, n.d.) By receiving the seasonal influenza vaccine, the elderly population can decrease their likelihood of becoming ill or experiencing injury related to the influenza virus. The Centers for Disease Control and Prevention state that The single best way to protect against the flu is to get vaccinated each year. The elderly should be provided with education when they receive the flu vaccine, which will encourage their participation in yearly vaccination. There are contraindications to vaccination, which may inhibit one from receiving the influenza vaccine and those contraindications on this slide and into the next should be considered. 17InterventionsWHAT ContdAdvise about severe reactions to flu shot: difficulty breathing, hoarseness, hives, swelling around eyes or lips, high fever, racing heart, weakness. Educate on importance of seeking medical attention immediately.Teach principles of prevention - infection control and hand hygiene.WHERE Existing facilities that offer flu shots (Kent County Health Departments 5 immunization clinics, hospitals, physician offices, LTCF, pharmacies, grocery stores).Expand or recruit new locations for immunization clinics Kent County Community Center, churches, schools.Schedule and publicize immunization clinics.Arrange staffing for immunization clinics - Volunteers, translators, and students.Campaign for health care workers to be immunized to indirectly help meet outcomes.(HHS, n.d.)

There are many facilities in Kent County that offer the influenza vaccine to their community, however, those facilities and agencies may not be enough. There is a need to expand or open new locations for immunization clinics and to increase staffing at these locations. Advertising and publicizing immunization clinics within the county may also increase the number of people aged 65 and older who become vaccinated from influenza.18Influenza Reporting and Data CollectionMichigan Care Improvement Registry (MCIR) records vaccine information provided by the facility administering vaccine. (MCIR, n.d.).With MCIR, local health departments have the ability to do population-based immunization level assessments and target their outreach efforts where it's needed (MCIR, n.d.) Influenza is a reportable condition required by state law. KCHD is the reporting agency for physicians, labs, infection control departments, daycares, schools, camps, and emergency departments (Kent County Administration, n.d.)Kent County Health Department also monitors influenza activity at the state, national, and global levels. Information that is collected in Kent County is reported to the state health department. The data is then forwarded to the CDC (Kent County Administration, n.d.).

Michigan Care Improvement Registry will record progress of vaccinations and the CDC will post the statistics annually. Influenza is a communicable disease that is reportable. Any facility caring for an ill person is required by state law to report the illness to the health department. This data is then reported to the CDC.19Analyzing TrendsThe Epidemiology unit is responsible for conducting effective and timely influenza surveillance in Kent County (Kent County Administration, n.d.). Circulating flu viruses are monitored for changes. This helps guide actions of the public health officials. (Kent County Administration, n.d.).Timely (weekly) surveillance updates will be posted on the Kent county website on the Health Departments web page and clinical signs and symptoms of influenza (Kent County Administration, n.d.).

Michigan Disease Surveillance System (MDSS) is a web based communicable disease reporting system that records and tracks influenza cases based on reports from health departments, hospitals, and physicians offices. Epidemiologist use this information to track data at a local and state level to find trends in disease outbreak and need for intervention (State of Michigan, n.d.).

The epidemiology unit of the Kent County Health Department will analyze trends in data provided by the community, and they will provide updates on influenza tracking to their community, found on their website. The Michigan Disease Surveillance System coordinates with local, State and Federal Public Health Agencies to ensure secure analysis of communicable disease information so it may be provided to our communities (State of Michigan, n.d.).20Tracking the OutcomesShort Term Goals

An increase >15% of adults aged 65+ vaccinated for influenza in Kent County for 2013-2014 influenza season.Lowered mortality rate related to influenza.Reduced secondary influenza infections.Decreased hospitalizations and hospital days related to influenza.

Long Term Goal

Meeting the Healthy People 2020 objectives. Goal Increase immunization rates and reduce preventable infectious diseases (HHS, 2013).

We have both short and long term goals- Our short term goals are to see is an increase by greater than 15% of elderly who receive the flu vaccine for the 2013-2014 flu season thus decreasing mortality rates, secondary flu infections, and hospitalizations decrease which are related to the flu virus.Our long term goals will follow those of Healthy People 2020- We support Healthy People 2020 Objective to increase the proportion of adults aged 65 and older who are vaccinated annually against influenza to 90% by year 2020. To set this goal, Healthy People 2020 has taken data from the 2008-2009 influenza season to state a benchmark of 66.6% of adults aged 65 and older in the U.S that received the vaccine (HHS, 2013). Along with initiatives from the U.S government, we hope to help meet the Healthy People 2020 objective.21Intervention EvaluationMeasure of success will be determined by an increased percentage >15% of Kent County residents aged 65+ receiving the flu shot for 2013-2014 flu season compared to the 2012-2013 flu season. Note: 2012-2013 statistics not yet available. The anticipated time frame to evaluate effectiveness of interventions will be at the conclusion of the 2013 2014 influenza season, and once all of the data has been collected and processed by MDSS.An interim outcome may include a survey at immunization sites to help determine barriers that prevent the elderly from receiving their flu shots. Other interventions may be adopted to accommodate the target population.

Nursing intervention is the key factor in meeting our community change proposal outcomes and indirectly meeting the Healthy People 2020 objectives for influenza vaccinations. Our success will be evaluated upon completion of the 2013 2014 influenza season. We anticipate that the percentage of Kent County residents aged 65 years and older receiving the flu shot will increase more than 15% compared to this flu season. We will continue to determine any barriers to flu shots and change interventions if needed.22THE END Thank you This is the end of our presentation. Thank you for viewing!23ReferencesCenters for Disease Control and Prevention (CDC). (2013). Key facts about seasonal flu vaccine. Retrieved April 18, 2013, from http://www.cdc.gov/flu/protect/keyfacts.htmCenters for Disease Control and Prevention (CDC). (2006). Morbidity and mortality weekly report; Influenza vaccination of health-care personnel. Retrieved April 2, 2013, from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htmCenters for Disease Control and Prevention (CDC). (n.d.). Prevalence and Trends Data. Retrieved March 1, 2013, from http://apps.nccd.cdc.gov/brfss/list.asp?cat=IM&yr=2011&qkey=8341&state=AllCenters for Disease Control and Prevention (CDC). (2012). What you should know and do this flu season if you are 65 years and older . Retrieved April 18, 2013 from http://www.cdc.gov/flu/about/disease/65over.htmThe following slides show our references.24ReferencesCenters for Medicare & Medicaid Services. (n.d.) Medicare Part B: Medical Insurance. Retrieved on April 18, 2013 from http://www.medicare.gov/coverage/flu-shots.htmlDoctor2008. (n.d.). Wash hands 2 [poster]. Retrieved from http://doctor2008.files.wordpress.com/2008/09/wash-hands2.jpgHarkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins.Kent County Health Department. (2010). 2008 Behavioral Risk Factor Survey. Retrieved February12, 2013, from http://www.accesskent.com/Health/HealthDepartment/Publications/pdfs/2008BRFS.pdfKent County Administration. (2013). Kent County Health Care Transportation Resource Directory. Retrieved April 18, 2013 fromwww.accesskent.com/Health/.../pdfs/Appendix_C_Trans_Res_Dir.pdf

ReferencesKent County Administration. (n.d.). Monitoring Influenza in Kent County. Retrieved March 1, 2013, from http://www.accesskent.com/Health/CommDisease/Flu/flu_monitoring.htmMichigan Care Improvement Registry (MCIR). (n.d.). Whats new with MCIR?. Retrieved April 18, 2013, from http://www.mcir.org/forms/MCIR%20Brochure%20FINAL%20213-2007.pdfNational Institute of Allergy and Infectious Disease (NIH). (2010, October). Community Immunity (Herd Immunity). Retrieved April 11, 2013, from http://www.niaid.nih.gov/topics/pages/communityimmunity.asxState of Michigan. (2013). Influenza Vaccine Exchange Network. Retrieved from http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_22779-127415--,00.htmlState of Michigan. (n.d.). Michigan Disease Surveillance System (MDSS) Background. Retrieved from http://www.michigan.gov/mdch/0,1607,7-132-2945_5104_31274-96814--,00.htmlReferences ContdThe Scarborough Hospital. (2013). Flu poster_ website [poster]. Retrieved from http://tsh.to/pages/Release-Flu-shot-compliance-gets-major-boostThoms, S. (2012, January 27). Flu cases spike in Kent County - far outpacing last year's tally. Retrieved March 23, 2013, from http://www.mlive.com/news/grand-rapids/index.ssf/2012/12/flu_cases_spike_in_kent_county.htmlThoms, S. (2013, January 30). Kent County Health Department urges residents to get flu vaccine at Thursday clinic. Retrieved March 23, 2013, from http://www.mlive.com/news/grand-rapids/index.ssf/2013/01/kent_county_health_department_4.htmlU.S. Department of Health & Human Services (HHS). (2013). Immunization and infectious diseases. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23U.S. Department of Health & Human Services (HHS). (n.d.). Vaccination & Vaccine Safety. Retrieved April 13, 2013, from http://www.flu.gov/prevention-vaccination/vaccination/27