Skip to main content Accessibility help
×
Home

Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages

Published online by Cambridge University Press:  21 June 2016

Thomas R. Talbot
Affiliation:
Departments of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Suzanne F. Bradley
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, and the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Sara E. Cosgrove
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Christian Ruef
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, Hospital Epidemiology Unit, University Hospital of Zurich, Zurich, Switzerland
Jane D. Siegel
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
David J. Weber
Affiliation:
Departments of Medicine and Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Corresponding
E-mail address:

Abstract

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.

Type
SHEA Position Paper
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below.

References

1.Thompson, WW, Shay, DK, Weintraub, E, et al.Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003;289:179186.CrossRefGoogle ScholarPubMed
2.Thompson, WW, Shay, DK, Weintraub, E, et al.Influenza-associated hospitalizations in the United States. JAMA 2004;292:13331340.CrossRefGoogle Scholar
3.Munoz, FM, Campbell, JR, Atmar, RL, et al.Influenza A virus outbreak in a neonatal intensive care unit. Pediatr Infect Dis J 1999;18:811815.CrossRefGoogle Scholar
4.Meibalane, R, Sedmak, GV, Sasidharan, P, Garg, P, Grausz, JP. Outbreak of influenza in a neonatal intensive care unit./Pediatr 1977;91:974976.CrossRefGoogle Scholar
5.Bauer, CR, Elie, K, Spence, L, Stern, L. Hong Kong influenza in a neonatal unit. JAMA 1973;223:12331235.CrossRefGoogle Scholar
6.Cunney, RJ, Bialachowski, A, Thornley, D, Smaili, FM, Pennie, RA. An outbreak of influenza A in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2000;21:449454.CrossRefGoogle Scholar
7.Sagrera, X, Ginovart, G, Raspali, F, et al.Outbreaks of influenza A virus infection in neonatal intensive care units. Pediatr Infect Dis J 2002;21:196200.CrossRefGoogle ScholarPubMed
8.Maltezou, HC, Drancourt, M. Nosocomial influenza in children. J Hosp Infect 2003;55:8391.CrossRefGoogle ScholarPubMed
9.Serwint, JR, Miller, RM, Korsch, BM. Influenza type A and B infections in hospitalized pediatric patients: who should be immunized? Am J Dis Child 1991;145:623626.CrossRefGoogle Scholar
10.Slinger, R, Dennis, P. Nosocomial influenza at a Canadian pediatric hospital from 1995 to 1999: opportunities for prevention. Infect Control Hosp Epidemiol 2002;23:627629.CrossRefGoogle Scholar
11.Hall, CB, Douglas, RG Jr. Nosocomial influenza infection as a cause of intercurrent fevers in infants. Pediatrics 1975;55:673677.Google ScholarPubMed
12.Wenzel, RP, Deal, EC, Hendley, JO. Hospital-acquired viral respiratory illness on a pediatric ward. Pediatrics 1977;60:367371.Google ScholarPubMed
13.Mauch, TJ, Bratton, S, Myers, T, Krane, E, Gentry, SR, Kashtan, CE. Influenza B virus infection in pediatric solid organ transplant recipients. Pediatrics 1994;94:225229.Google Scholar
14.Weinstock, DM, Eagan, J, Malak, SA, et al.Control of influenza A on a bone marrow transplant unit. Infect Control Hosp Epidemiol 2000;21:730732.CrossRefGoogle Scholar
15.Whimbey, E, Elting, LS, Couch, RB, et al.Influenza A virus infections among hospitalized adult bone marrow transplant recipients. Bone Marrow Transplant 1994;13:437440.Google Scholar
16.Malavaud, S, Malavaud, B, Sandres, K, et al.Nosocomial outbreak of influenza virus A (H3N2) infection in a solid organ transplant department. Transplantation 2001;72:535537.CrossRefGoogle Scholar
17.Horcajada, JP, Pumarola, T, Martinez, JA, et al.A nosocomial outbreak of influenza during a period without influenza epidemic activity. Eur Respirf 2003;21:303307.CrossRefGoogle Scholar
18.Barlow, G, Nathwani, D. Nosocomialinfluenzainfection. Lancent 2000;355:1187.CrossRefGoogle Scholar
19.Sartor, C, Zandotti, C, Romain, F, et al.Disruption of services in an internal medicine unit due to a nosocomial influenza outbreak. Infect Control Hosp Epidemiol 2002;23:615619.CrossRefGoogle Scholar
20.Van Voris, LP, Belshe, RB, Shaffer, JL. Nosocomial influenza B virus infection in the elderly. Ann Intern Med 1982;96:153158.CrossRefGoogle ScholarPubMed
21.Bean, B, Rhame, FS, Hughes, RS, Weiler, MD, Peterson, LR, Gerding, DN. Influenza B: hospital activity during a community epidemic. Diagn Microbiol Infect Dis 1983;1:177183.CrossRefGoogle Scholar
22.Morens, DM, Rash, VM. Lessons from a nursing home outbreak of influenza A. Infect Control Hosp Epidemiol 1995;16:275280.CrossRefGoogle ScholarPubMed
23.Nabeshima, A, Ikematsu, H, Yamaga, S, Hayashi, J, Hara, H, Kashiwagi, S. An outbreak of influenza A (H3N2) among hospitalized geriatric patients [in Japanese]. Kansenshogaku Zasshi 1996;70:801807.CrossRefGoogle Scholar
24.Everts, RJ, Hanger, HC, Jennings, LC, Hawkins, A, Sainsbury, R. Outbreaks of influenza A among elderly hospital inpatients. N Z Med J 1996;109:272274.Google ScholarPubMed
25.Staynor, K, Foster, G, McArthur, M, McGeer, A, Petrie, M, Simor, AE. Influenza A outbreak in a nursing home: the value of early diagnosis and the use of amantadine hydrochloride. Can J Infect Control 1994;9:109111.Google Scholar
26.Drinka, PJ, Gravenstein, S, Krause, P, Nest, L, Dissing, M, Shult, P. Reintroduction of influenza A to a nursing building. Infect Control Hosp Epidemiol 2000;21:732735.CrossRefGoogle ScholarPubMed
27.Kempe, A, Hall, CB, MacDonald, NE, et al.Influenza in children with cancer. J Pediatr 1989;115:3339.CrossRefGoogle ScholarPubMed
28.Schepetiuk, S, Papanaoum, K, Qiao, M. Spread of influenza A virus infection in hospitalised patients with cancer. Aust N Z J Med 1998;28:475476.CrossRefGoogle ScholarPubMed
29.Berg, HF, Van Gendt, J, Rimmelzwaan, GF, Peeters, MF, Van Keulen, P. Nosocomial influenza infection among post-influenza-vaccinated patients with severe pulmonary diseases. J Infect 2003;46:129132.CrossRefGoogle ScholarPubMed
30.Weingarten, S, Friedlander, M, Rascon, D, Ault, M, Morgan, M, Meyer, RD. Influenza surveillance in an acute-care hospital. Arch Intern Med 1988;148:113116.CrossRefGoogle Scholar
31.Harper, SA, Fukuda, K, Uyeki, TM, Cox, NJ, Bridges, CB. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2005;54:140.Google Scholar
32.Nichol, KL, Lind, A, Margolis, KL, et al.The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med 1995;333:889893.CrossRefGoogle ScholarPubMed
33.Bridges, CB, Thompson, WW, Meitzer, MI, et al.Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomized controlled trial, JAMA 2000;284:16551663.CrossRefGoogle ScholarPubMed
34.Govaert, TM, Thijs, CT, Masurel, N, Sprenger, MJ, Dinant, GJ, Knottnerus, JA. The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA 1994;272:16611665.CrossRefGoogle ScholarPubMed
35.Feery, BJ, Evered, MG, Morrison, EI. Different protection rates in various groups of volunteers given subunit influenza virus vaccine in 1976. J Infect Dis 1979;139:237241.CrossRefGoogle ScholarPubMed
36.Carman, WF, Elder, AG, Wallace, LA, et al.Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:9397.CrossRefGoogle ScholarPubMed
37.Potter, J, Stott, DJ, Roberts, MA, et al.Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175:16.CrossRefGoogle ScholarPubMed
38.Saxen, H, Virtanen, M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779783.CrossRefGoogle ScholarPubMed
39.Wilde, JA, McMillan, JA, Serwint, J, Butta, J, O'Riordan, MA, Steinhoff, MC. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281:908913.CrossRefGoogle ScholarPubMed
40.Saigado, CD, Giannetta, ET, Hayden, FG, Farr, BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004;25:923928.CrossRefGoogle Scholar
41.Monto, AS, Davenport, FM, Napier, JA, Francis, T Jr. Modification of an outbreak of influenza in Tecumseh, Michigan by vaccination of schoolchildren. J Infect Dis 1970;122:1625.CrossRefGoogle ScholarPubMed
42.Reichert, TA, Sugaya, N, Fedson, DS, Glezen, WP, Simonsen, L, Tashiro, M. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med 2001;344:889896.CrossRefGoogle ScholarPubMed
43.Longini, IM Jr, Halloran, ME. Strategy for distribution of influenza vaccine to high-risk groups and children. Am J Epidemiol 2005;161:303306.CrossRefGoogle ScholarPubMed
44.Piedra, PA, Cagiani, MJ, Kozinetz, CA, et al.Herd immunity in adults against influenza-related illnesses with use of the trivalent-live attenuated influenza vaccine (CATV-T) in children. Vaccine 2005;23:15401548.CrossRefGoogle Scholar
45.Hurwitz, ES, Haber, M, Chang, A, et al.Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. JAMA 2000;284:16771682.CrossRefGoogle ScholarPubMed
46.Department of Health and Human Services. Prevention and control of influenza: recommendation of the Immunization Practices Advisory Committee, Centers for Disease Control. Ann Intern Med 1984;101:218222.CrossRefGoogle Scholar
47.Recommendations for prevention and control of influenza. Recommendations of the Immunization Practices Advisory Committee. Centers for Disease Control, Department of Health and Human Services. Ann Intern Med 1986;105:399404.CrossRefGoogle Scholar
48.National Foundation for Infectious Diseases. Improving Influenza Vaccination Rates in Healthcare Workers: Strategies to Increase Protection for Workers and Patients. Bethesda, MD: National Foundation for Infectious Diseases; 2004. Available at www.nfid.org. Accessed September 2, 2005.Google Scholar
49.McKibben, L, Horan, T, Tokars, JI, et al.Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Am J Infect Control 2005;33:217226.CrossRefGoogle ScholarPubMed
50.Manuel, DG, Henry, B, Hockin, J, Naus, M. Health behavior associated with influenza vaccination among healthcare workers in long-term-care facilities. Infect Control Hosp Epidemiol 2002;23:609614.CrossRefGoogle ScholarPubMed
51.Steiner, M, Vermeulen, LC, Mullahy, J, Hayney, MS. Factors influencing decisions regarding influenza vaccination and treatment: a survey of healthcare workers. Infect Control Hosp Epidemiol 2002;23:625627.CrossRefGoogle ScholarPubMed
52.Ballada, D, Biasio, LR, Cascio, G, et al.Attitudes and behavior of health care personnel regarding influenza vaccination. Eur J Epidemiol 1994;10:6368.CrossRefGoogle ScholarPubMed
53.Weingarten, S, Riedinger, M, Bolton, LB, Miles, P, Ault, M. Barriers to influenza vaccine acceptance: a survey of physicians and nurses. Am J Infect Control 1989;17:202207.CrossRefGoogle ScholarPubMed
54.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;25:933940.CrossRefGoogle ScholarPubMed
55.Lester, RT, McGeer, A, Tomlinson, G, Detsky, AS. Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol 2003;24:839844.CrossRefGoogle ScholarPubMed
56.Beguin, C, Boland, B, Ninane, J. Health care workers: vectors of influenza virus? Low vaccination rate among hospital health care workers. Am J Med Qual 1998;13:223227.CrossRefGoogle ScholarPubMed
57.Nichol, KL, Hauge, M. Influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 1997;18:189194.CrossRefGoogle ScholarPubMed
58.Martinello, RA, Jones, L, Topai, JE. Correlation between healthcare workers' knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol 2003;24:845847.CrossRefGoogle ScholarPubMed
59.Smedley, J, Palmer, C, Baird, J, Barker, M. A survey of the delivery and uptake of influenza vaccine among health care workers. Occup Med (Lond) 2002;52:271276.CrossRefGoogle ScholarPubMed
60.Heimberger, T, Chang, HG, Shaikh, M, Crotty, L, Morse, D, Birkhead, G. Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated? Infect Control Hosp Epidemiol 1995;16:412415.CrossRefGoogle Scholar
61.Qureshi, AM, Hughes, NJ, Murphy, E, Primrose, WR. Factors influencing uptake of influenza vaccination among hospital-based health care workers. Occup Med (Lond) 2004;54:197201.CrossRefGoogle ScholarPubMed
62.Mah, MW, Hagen, NA, Pauling-Shepard, K, et al.Understanding influenza vaccination attitudes at a Canadian cancer center. Am J Infect Control 2005;33:243250.CrossRefGoogle Scholar
63.Foy, HM, Cooney, MK, Allan, ID, Albrecht, JK. Influenza B in households: virus shedding without symptoms or antibody response. Am J Epidemiol 1987;126:506515.CrossRefGoogle ScholarPubMed
64.Elder, AG, O'Donnell, B, McCruden, EA, Symington, IS, Carman, WF. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:12411242.CrossRefGoogle Scholar
65.Occupational Safety & Health Administration. Bloodborne Pathogens and Needlestick Prevention. Standard 1910.1030. Washington, DC: Occupational Safety & Health Administration; 2003. Available at www.osha.gov/SLTC/bloodbornepathogens/standards.html. Accessed August 23, 2005.Google Scholar
66.Chance, J, Williamson, S. A user-friendly approach to improving healthcare worker influenza vaccination compliance. Am J Infect Control 2005;33:E62.CrossRefGoogle Scholar
67.Trape-Cardoso, M, Divinere, M, Barnosky, S. Improving compliance with influenza vaccination for hospital healthcare workers from high-risk areas: a 6-year analysis. Am J Infect Control 2005;33:E89.CrossRefGoogle Scholar
68.Thomas, DR, Winsted, B, Koontz, C. Improving neglected influenza vaccination among healthcare workers in long-term care. J Am Geriatr Soc 1993;41:928930.CrossRefGoogle ScholarPubMed
69.Ohrt, CK, McKinney, WP. Achieving compliance with influenza immunization of medical house staff and students: a randomized controlled trial. JAMA 1992;267:13771380.CrossRefGoogle ScholarPubMed
70.Sartor, C, Tissot-Dupont, H, Zandotti, C, Martin, F, Roques, P, Drancourt, M. Use of a mobile cart influenza program for vaccination of hospital employees. Infect Control Hosp Epidemiol 2004;25:918922.CrossRefGoogle ScholarPubMed
71.Bryant, KA, Stover, B, Cain, L, Levine, GL, Siegel, J, Jarvis, WR. Improving influenza immunization rates among healthcare workers caring for high-risk pediatric patients. Infect Control Hosp Epidemiol 2004;25:912917.CrossRefGoogle ScholarPubMed
72.Centers for Disease Control and Prevention. Interventions to increase influenza vaccination of health-care workers: California and Minnesota. MMWR 2005;54:196199.Google ScholarPubMed
73.Mahoney, FJ, Stewart, K, Hu, H, Coleman, P, Alter, MJ. Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Arch Intern Med 1997;157:26012605.CrossRefGoogle ScholarPubMed
74.The Leapfrog Group. Leapfrog Hospital Quality and Safety Survey. Washington, DC: The Leapfrog Group; 2005. Available at www.leapfroggroup.org/for_hospitals. Accessed August 25, 2005.Google ScholarPubMed
75.Poland, GA, Tosh, P, Jacobson, RM. Requiring influenza vaccination for health care workers: seven truths we must accept. Vaccine 2005;23:22512255.CrossRefGoogle ScholarPubMed
76.Bearman, G, Fuentes, L, Van Vorenkamp, JL, Drusin, LM. Vaccination without documentation: influenza immunization among medical residents at a tertiary-care medical center. Infect Control Hosp Epidemiol 2003;24:626628.CrossRefGoogle Scholar
77.Cooper, L, Rosenbaum, P, Mackie, K, Winkler, A, Cosgrove, SE, Perl, TM. Respiratory etiquette, surveillance, and feedback: tools to manage respiratory illness in healthcare facilities. Presented at the 14th Annual Meeting of the Society for Healthcare Epidemiology of America; April 9-12, 2005; Los Angeles, CA.Google Scholar
78.Centers for Disease Control and Prevention. Updated interim influenza vaccination recommendations: 2004-05 influenza season. MMWR 2004;53:11831184.Google ScholarPubMed
79.Centers for Disease Control and Prevention. Tiered use of inactivated influenza vaccine in the event of a vaccine shortage. MMWR 2005;54:749750.Google ScholarPubMed
80.Centers for Disease Control and Prevention. Update: influenza vaccine supply and recommendations for prioritization during the 2005-06 influenza season. MMWR 2005;54:850.Google ScholarPubMed
81.Manning, A. Flu vaccine maker Chiron gets second dose of bad news. USA Today. July 21, 2005:D7.Google Scholar
82.Centers for Disease Control and Prevention. Updated recommendations from the Advisory Committee on Immunization Practices in response to delays in supply of influenza vaccine for the 2000-01 season. MMWR 2000;49:888892.Google ScholarPubMed
83.Rajput, V, Bekes, CE. Ethical issues in hospital medicine. Med Clin North Am 2002;86:869886.CrossRefGoogle Scholar
84.Moser, MR, Bender, TR, Margolis, HS, Noble, GR, Kendal, AP, Ritter, DG. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol 1979;110:16.CrossRefGoogle ScholarPubMed
85.Schulman, JL. Experimental transmission of influenza virus infection in mice: IV. Relationship of transmissibility of different strains of virus and recovery of airborne virus in the environment of infector mice. J Exp Med 1967;125:479488.CrossRefGoogle ScholarPubMed
86.Schulman, JL. The use of an animal model to study transmission of influenza virus infection. Am J Public Health Nations Health 1968;58:20922096.CrossRefGoogle Scholar
87.Garner, JS. Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:5380.CrossRefGoogle ScholarPubMed
88.Bridges, CB, Kuehnert, MJ, Hall, CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis 2003;37:10941101.Google ScholarPubMed
89.Saigado, CD, Farr, BM, Hall, KK, Hayden, FG. Influenza in the acute hospital setting. Lancet Infect Dis 2002;2:145155.CrossRefGoogle Scholar
90.Influenza Virus Vaccine, Live Intranasal Flu Mist [package insert]. Gaithersburg, MD: Medlmmune Vaccines, Inc.; 2003.Google Scholar
91.Cosgrove, SE, Fishman, NO, Talbot, TR, et al.Strategies for use of a limited influenza vaccine supply. JAMA 2005;293:229232.CrossRefGoogle ScholarPubMed
92.Talbot, TR, Crocker, DD, Peters, J, et al.Duration of virus shedding after trivalent intranasal live attenuated influenza vaccination in adults. Infect Control Hosp Epidemiol 2005;26:494500.CrossRefGoogle ScholarPubMed
93.Cha, TA, Kao, K, Zhao, J, Fast, PE, Mendelman, PM, Arvin, A. Genotypie stability of cold-adapted influenza virus vaccine in an efficacy clinical trial. J Clin Microbiol 2000;38:839845.Google Scholar
94.Vesikari, T, Karvonen, A, Korhonen, T, et al.A randomized, double-blind, placebo-controlled trial of the safety, transmissibility and phe-notypic stability of a live, attenuated, cold-adapted influenza virus vaccine (CAIV-T) in children attending day care. Presented at the 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, IL.Google Scholar
95.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53:136.Google ScholarPubMed
96.Centers for Disease Control and Prevention. Respiratory Hygiene/Cough Etiquette in Healthcare Settings. Atlanta, GA: Centers for Disease Control and Prevention; 2004. Available at www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm. Accessed August 26,2005.Google Scholar
97.Treanor, J, Keitei, W, Belshe, R, et al.Evaluation of a single dose of half strength inactivated influenza vaccine in healthy adults. Vaccine 2002;20:10991105.CrossRefGoogle Scholar
98.Belshe, RB, Newman, FK, Cannon, J, et al.Serum antibody responses after intradermal vaccination against influenza. N Engl J Med 2004;351:22862294.CrossRefGoogle ScholarPubMed
99.Kenney, RT, Frech, SA, Muenz, LR, Villar, CP, Glenn, GM. Dose sparing with intradermal injection of influenza vaccine. N Engl J Med 2004;351:22952301.CrossRefGoogle ScholarPubMed
100.Kroff, T, Heckard, R. Taking charge of the demand side when short-supplied: prioritized distribution of the 2004-2005 influenza vaccine to members in common of a designated high-priority group of healthcare workers. Am J Infect Control 2005;33:E92.CrossRefGoogle Scholar

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 27 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 27th January 2021. This data will be updated every 24 hours.

Hostname: page-component-898fc554b-t2lmn Total loading time: 0.572 Render date: 2021-01-27T02:03:12.579Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *