Hosting an On-Site Flu Clinic: How to Make Flu Immunization Convenient for Your Employees

1. Hosting an On-Site Flu Clinic: How to Make Flu Immunization Convenient for Your Employees Vaccinate for Life. The Texas Department of State Health Services Immunization Branch Adolescent/Adult Immunization Program 800-252-9152 www.ImmunizeTexas.com

2. Presentation Objectives • Agency Wellness Coordinator’s will be able to: • Explain the benefits of employee influenza vaccination programs. • Assess the need and capacity for an on-site influenza vaccination program. • Identify potential contract agencies for on-site influenza vaccination programs. • Screen potential contractors for quality and appropriateness of medical care.

3. Sudden onset symptoms of flu include : fever (usually high) headache extreme tiredness dry cough sore throat runny or stuffy nose muscle aches Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults Flu Symptoms Complications of Flu: Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

4. The Impact of Flu • Every year in the United States, on average: • 5% to 20% of the population gets the flu; • more than 200,000 people are hospitalized from flu-related complications; and • about 36,000 people die from flu-related causes. • Some people, such as older people, young children, and people with certain health conditions (such as asthma, diabetes, or heart disease), are at high risk for serious flu complications. Source: http://www.cdc.gov/flu/keyfacts.htm

5. Impact of Flu at the Workplace • Lost productivity by employee out sick and by those filling in the gap. • Average number of days away from the office is 2-4 days (if not hospitalized). • Hospitalized employees away from work for 1-2 weeks. • Employees with children more likely to contract the flu (if not vaccinated).

6. Assessing the Need • Questions your agency needs to ask before hiring a contractor: • Do you want to hold an Employee Immunization Clinic? • Do your employees want a clinic? • Is the clinic open to the employee’s family members?

7. Assessing the Need • More questions your agency needs to ask before hiring a contractor: • Are you planning to contract out the clinic? • If you are contracting the clinic out, are there any special circumstances required for you to do so? • Are there agencies in the area which you could hire for their services?

8. Identify Potential Contract Agencies • Home health agencies. • Local health agencies such as a hospital, group medical practice, or health department. • Other medical service organizations who specialize in giving vaccines to companies.

9. Screening potential contractors for quality and appropriateness of medical care. • Finding the least expensive is not always the best idea. • Ask the following questions when approaching a potential contractor:

10. Potential Contractor Questions • Do you conduct Employee immunization clinics on site? • How long have you been doing this type of clinic? • Who are some of the agencies you have conducted clinics for? (Local References) • Who is your Medical Director and where are they licensed? • Do they have privileges to practice in Texas?

11. Potential Contractor Questions • What vaccines are you able to administer? • What is the charge per shot (to the employee)? • Is there a price break for larger number of persons receiving shots? • Would you be able to vaccinate the employee’s family members? (what ages) • How many employees/family members could you vaccinate in what period of time?

12. Potential Contractor Questions • Are you able to schedule our agency for an immunization clinic by________? • Who will be administering the shots? • What are their credentials? (they all must be licensed in Texas) • How will the cold chain be maintained? • Do you have Standing Delegating Orders and can you submit a copy for examination?

13. Potential Contractor Questions • What emergency arrangements will be made? • Will you be responsible for set up and tear down on the day of the clinic? • How will payment need to be made?

14. Questions? For further technical assistance contact: Susan Belisle, RN, BSN Nurse Consultant Immunization Branch 512-458-7111 ext 3802 susan.belisle@dshs.state.tx.us

15. Recommended Adult Vaccines

16. Vaccines For Adults Td/Tdap Influenza Shingles/Zoster Varicella Pnuemococcal Adult and Adolescent Immunization Program Who Should Get The Following Vaccines?

17. Vaccines For Adults Adult and Adolescent Immunization Program Who Should Get The Following Vaccines? • HPV • MMR • Meningococcal • Hepatitis A • Hepatitis B

18. Vaccine Adverse Event Reporting System (VAERS)

19. VAERS Background • US postlicensure vaccine safety surveillance • Collects voluntary reports of adverse events following immunization • Co-managed by CDC and the Food and Drug Administration (FDA) • Healthcare providers are encouraged to report clinically significant adverse events after vaccination* • Anyone can submit a report to VAERS • Receives ~23,000 reports per year (2005-2008 average) • Data publicly available *Clinically significant means of concern to the healthcare provider or vaccinee/ care giver or other VAERS reporter; www.vaers.hhs.gov

20. VAERS Strengths • Can detect very rare adverse events • Generates hypotheses • Helps identify new and/or rare adverse events following immunization • Helps determine if further investigations are needed • Monitors trends of already known adverse events • Monitors vaccine lot safety

21. VAERS Limitations • Risk of underreporting • Stimulated reporting due to media attention and other factors • Possibly incomplete and inaccurate data on report form • Lack of availability of denominator data • No information on number of persons vaccinated • No information on background rates of adverse events in the population • VAERS generally cannot determine if an adverse event was coincidental or caused by a vaccine

22. Report any clinically significant adverse event following immunization (www.vaers.hhs.gov) Adverse event of concern to the healthcare provider or vaccinee/caregiver or other VAERS reporter The National Childhood Vaccine Injury Act of 1986 mandates that healthcare providers report specific adverse events that occur after immunization for some vaccines.* Events listed in the vaccine package insert Events listed in the Table of Reportable Events http://vaers.hhs.gov/pdf/ReportableEventsTable.pdf What to Report to VAERS *The National Childhood Vaccine Injury Act does not apply to 2009 H1N1 vaccines

23. What to Report to VAERS (cont.) demographics • Submit reports of adverse events, even when not sure whether the vaccine caused the adverse event • Include as much information as possible in the report (e.g., vaccination location, date, vaccine type, lot number and dose number) • Reports with incomplete information accepted • Report as soon as possible but no time limit on reporting AE vax

24. VAERS definition of “Serious” Reports* • Death • Life-threatening illness • Hospitalization • Prolonged existing hospitalization • Persistent or significant disability • Certain other medically important conditions *Code of Federal Regulations Title 21 (21CFR 314.80) Box 8 of VAERS form

25. VAERS Reports*Serious and Non-Serious • 8% of VAERS reports are “Serious”* • Most frequent serious adverse events** • Fever • Vomiting • Headache • Dyspnea • Convulsions • Pain • Diarrhea • Weakness • 92% of VAERS reports are “Non-Serious” • Most frequent adverse events** • Local reactions • Fever • Rashes or itching • Headache • Dizziness *Data from 91,669 VAERS reports received during 2005 through 2008 Source: VAERS http://vaers.hhs.gov/index , CDC Wonder http://wonder.cdc.gov/ ** A vaccinee may have had more than one adverse event listed in the report