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Health Officer Order to Implement Vaccination Programs for Health Care Workers During the 2018-2019 Influenza Season
A Health Officer Order has been issued for the 2018-2019 influenza season that requires licensed health care facilities in Monterey County to develop and implement a mandatory influenza vaccination policy and program. The program must require a health care worker to provide evidence of vaccination with an influenza vaccine. If the health care worker is unable to provide such evidence, that worker must wear a surgical mask while working in patient care areas during the influenza season, currently defined as November 1, 2018, through April 30, 2019. Please see the links below for more information.
For additional information about the order, please call 831-755-4503 or 831-755-4683.
Recommendations for Providers During Influenza Season
Current Situation as of September 1, 2018:
- Flu activity is currently low.
- Two cases of A(H1N2v) influenza associated with swine contact at a fair were recently reported in San Luis Obispo County.
Encourage vaccination against influenza. Vaccination offers the best protection against influenza. In accordance with the Advisory Committee on Immunization Practices’ (ACIP) guidance, the Monterey County Health Department recommends administration of the live attenuated influenza vaccine (LAIV, or “nasal spray”) to individuals for whom the vaccine is recommended during the 2018-2019 influenza season.
Consider the early use of antiviral medications. For high-risk individuals presenting with clinically compatible illness, do not delay the use of antiviral medications while confirmatory tests are pending.
Test for influenza when appropriate. Use your clinical judgment to guide testing decisions. Be aware that atypical presentations of influenza may occur (e.g., acute respiratory illness without fever), especially among young children, the elderly, and immunocompromised individuals. Results of any diagnostic test should be evaluated in the context of clinical and epidemiological information.
Reverse transcriptase polymerase chain reaction (RT-PCR) is the most sensitive test for detecting influenza viruses. It has the added ability to subtype influenza A. RT-PCR is available through the Monterey County Public Health Laboratory and most commercial laboratories including Quest Diagnostics and Laboratory Corporation of America. Rapid diagnostic (antigen) tests have the advantage of being readily available at most facilities. However, while specificities are high during times of known influenza activity, the sensitivity of currently available rapid tests is generally low to moderate (range 10% to 80%). As a result, negative rapid test results do not exclude influenza virus infection and should not be used to make treatment or infection control decisions.
Acceptable specimens vary by the type of test. Specimens should be collected as close to illness onset as possible (ideally within 5 days). Nasopharyngeal and nasal specimens generally have higher yield for detection of influenza viruses than throat swab specimens.
Laboratories should submit the following specimens to the Monterey County Public Health Department:
- All specimens (positive or negative) from severe (ICU admission) or fatal cases of respiratory illness among individuals <65 years of age.
- All specimens (positive or negative) from individuals of any age who report contact with swine (inpatient or outpatient) or recent international travel.
Educate your patients about everyday prevention actions like washing their hands, covering coughs and sneezes, and staying home when ill.
- severe influenza (fatal and/or admitted to the ICU) among individuals <65 years of age,
- suspected novel strains of influenza (inpatient or outpatient),
- severe otherwise unexplained respiratory illness among individuals with recent international travel and/or contact with swine, and
- suspected outbreaks of influenza in congregate living facilities, schools, and/or daycares.