Talbot Thomas R, Bradley Suzanne E, Cosgrove Sara E, Ruef Christian, Siegel Jane D, Weber David J
Department of Medicine, Vanderbilt University School of Medicine, A-2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA.
Infect Control Hosp Epidemiol. 2005 Nov;26(11):882-90. doi: 10.1086/502512.
Influenza causes substantial morbidity and mortality annually, particularly in high-risk groups such as the elderly, young children, immunosuppressed individuals, and individuals with chronic illnesses. Healthcare-associated transmission of influenza contributes to this burden but is often under-recognized except in the setting of large outbreaks. The Centers for Disease Control and Prevention has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984 and for all HCWs since 1993. The rationale for these recommendations is to reduce the chance that HCWs serve as vectors for healthcare-associated influenza due to their close contact with high-risk patients and to enhance both HCW and patient safety. Despite these recommendations as well as the effectiveness of interventions designed to increase HCW vaccination rates, the percentage of HCWs vaccinated annually remains unacceptably low. Ironically, at the same time that campaigns have sought to increase HCW vaccination rates, vaccine shortages, such as the shortage during the 2004-2005 influenza season, present challenges regarding allocation of available vaccine supplies to both patients and HCWs. This two-part document outlines the position of the Society for Healthcare Epidemiology of America on influenza vaccination for HCWs and provides guidance for the allocation of influenza vaccine to HCWs during a vaccine shortage based on influenza transmission routes and the essential need for a practical and adaptive strategy for allocation. These recommendations apply to all types of healthcare facilities, including acute care hospitals, long-term-care facilities, and ambulatory care settings.
流感每年都会导致大量发病和死亡，尤其是在老年人、幼儿、免疫功能低下者以及患有慢性病的高危人群中。医疗保健机构内的流感传播加剧了这一负担，但除了在大规模暴发的情况下，这种传播往往未得到充分认识。自1984年以来，美国疾病控制与预防中心建议直接接触患者的医护人员每年接种流感疫苗，自1993年起建议所有医护人员接种。这些建议的依据是，医护人员因与高危患者密切接触，有可能成为医疗保健机构内流感的传播媒介，通过接种疫苗可降低这种可能性，同时提高医护人员和患者的安全性。尽管有这些建议，以及旨在提高医护人员接种率的干预措施具有有效性，但每年接种疫苗的医护人员比例仍低得令人无法接受。具有讽刺意味的是，在开展提高医护人员接种率活动的同时，疫苗短缺问题，如2004 - 2005年流感季节出现的短缺，给向患者和医护人员分配现有疫苗供应带来了挑战。这份分为两部分的文件概述了美国医疗保健流行病学学会对医护人员接种流感疫苗的立场，并基于流感传播途径以及对实用且适应性强的分配策略的迫切需求，为疫苗短缺期间向医护人员分配流感疫苗提供指导。这些建议适用于所有类型的医疗保健机构，包括急症医院、长期护理机构和门诊护理机构。
