Don’t delay, vaccinate now

Flu shot procrastinators be forewarned: monitoring data suggests an earlier-than-usual influenza season poised to peak in time for the holidays.

Although flu activity typically spikes between late December and February, the Centers for Disease Control and Prevention's (CDC) national influenza-like illness (ILI) surveillance map is starting to light up like holiday decorations. Through mid-November, two states (Louisiana and Oklahoma) reported widespread flu activity, while a handful of southern states weren't faring much better with regional activity.

If trends continue, this could be the earliest start to flu season since 2014-15, and that's cause for concern, especially among those putting off a flu vaccine. In fact, by this time last year, most Americans (60%) hadn't received an annual flu vaccination—the best way to protect against, or at least dull, this serious respiratory illness. But the CDC hopes to prompt action among these procrastinators.

This week, Dec. 3-9, is the CDC's National Influenza Vaccination Week, reminding Americans that it's never too late to get a flu vaccine. That said, sooner is better than later as it can take up to two weeks for the body to develop sufficient antibodies after being vaccinated. Even then, the flu vaccine contains a limited number of expected flu types, and reports suggest one influenza A strain—H3N2—might give this year's vaccine some trouble. Some reports give the vaccine's effectiveness against H3N2 at only 10%, while its effectiveness against other flu strains is much higher, 50 to 70%, per that report.

Protect against common viral infections

Consequently, it's imperative that optometry practices hedge against the virulent season by ensuring all doctors and staff have received their annual flu shots, as well as adhering to simple, effective infection control procedures.

The CDC Advisory Committee on Immunization Practices, and the Healthcare Infection Control Practices Advisory Committee, recommends that all U.S. health care workers, including doctors of optometry and their staff, get vaccinated annually against flu considering the amount of close interactions doctors have with patients. To date, the CDC's 2016-17 survey of health care personnel shows 78.6% of respondents reported receiving a vaccination this season. However, vaccination coverage was lowest (45.8%) among health care personnel at locations that didn't require or promote vaccinations.

David Krumholz, O.D., a professor at State University of New York College of Optometry and author of Infection Control in Optometric Practice, continuing education available through the AOA's Paraoptometric Resource Center, says infection transmission requires a series of conditions to be met, but can quickly be disrupted through simple precautions, including vaccination.

"As primary health care providers, doctors of optometry should encourage all patients to get a flu shot if they haven't already done so," Dr. Krumholz says. "This is especially important with the elderly as the flu has significant morbidity and even mortality in this population. However, it is important in patients of all ages so they don't transmit the disease to someone else if they get sick."

In addition to encouraging flu vaccinations, consider these CDC recommendations for limiting flu's spread in the office:

1. Minimize exposure. When scheduling appointments throughout flu season, encourage patients to stay home if they have symptoms of respiratory infections. Discourage employees' 'presenteeism,' or working while sick, and reinforce respiratory hygiene or cough/sneeze etiquette to limit transmission.
2. Follow standard precautions. These are the foundational elements to infection control, including following proper hand hygiene and wearing gloves if encountering potentially infectious material. When it comes to handwashing, make sure to vigorously scrub hands for at least 15 seconds, use disposable paper towels and supplement with alcohol or glycerin gels as needed.
3. Identify transmission hotpots. Standard cleaning and disinfection procedures are adequate for minimizing flu infection. Consider all the instruments and equipment that may contact contagious hosts, including phoropters, slit lamps, exam chairs, condensing lenses, etc. All these resources must be cleaned, disinfected or sterilized between patients to eliminate cross-contamination. The type of surface material determines whether sterilization or disinfection is appropriate.
4. Monitor flu activity. Be aware of potential flu activity in your community or region so as to be prepared for the seasonal peak. The CDC's Flu Activity & Surveillance web page offers week-by-week information regarding ILI and confirmed flu cases.

Consider setting an example and policy at your optometric office by encouraging everyone to be vaccinated against flu, and find more information about common infections seen in the optometric practice.