Kicking off Infection Control Week on Oct. 18, employees signed a “clean hands pledge,” part of Hopkins Hospital’s flu prevention strategy this winter.

Last year, even with extensive vaccination efforts, Hopkins Hospital was slammed with nearly 300 cases of influenza by Christmas. So this year, when the news arrived that nearly half of the country’s expected flu vaccine supply was no longer available, it hit hard.

Hopkins Medicine moved quickly to establish an influenza task force. Coordinating efforts at JHH, JH Bayview Medical Center and Howard County General Hospital, the task force has been working to secure as much vaccine as possible to cover high-risk health care workers and patients, and to develop prevention strategies for keeping the flu in check when it arrives. (Bayview has already seen one confirmed case and another that’s likely.)

“We have two very high-risk populations: health care workers and acutely ill patients,” says Trish Perl, director of hospital epidemiology and infection control. (Perl is leading the task force with infection control expert Sara Cosgrove.) “If we can’t adequately vaccinate those populations, and we have a bad flu season this winter, it could create a SARS-like situation.”

The problem arose in early October, when a manufacturing plant owned by Chiron was shut down by the British equivalent of the Food and Drug Administration, rendering unusable its 46 to 48 million doses.

Aventis Pasteur, which, like Chiron, makes a killed injectable vaccine, produced 55.4 million doses this year—only half of the nation’s expected 100 million. Of those, 33 million have already been distributed. The Centers for Disease Control is now working with Aventis to redistribute the remaining 22 to 24 million to the most needy, including groups who take care of patients. Hopkins may receive some of these doses.

A third company, MedImmune, planned this year to distribute 1.5 million doses of a live, attenuated version of the vaccine (FluMist) that is sprayed into the nose. (MedImmune now will produce an additional 2 million doses.)

Still, 25,000 doses—practically all of the flu vaccine Johns Hopkins normally purchases—were ordered from Chiron. Those doses were intended for patients and employees at Hopkins Hospital, Pharmaquip, Bayview Medical Center, University Health Services, JH Community Physicians, and the Kennedy Krieger Institute. Now they are simply not available.

On learning of the shortage, Hopkins immediately requested 12,000 doses of FluMist from MedImmune and 20,000 doses from Aventis. Although the Aventis order is uncertain, Hopkins has received 14,000 doses of FluMist. Those will be used for health care workers. Any killed vaccine will be reserved for employees who cannot receive FluMist, and for patients.

Hopkins also contacted the city and state health departments and the CDC to review the options for acute and chronic health facilities. In mid-October, Maryland’s Department of Health and Mental Hygiene announced a proposal for a voluntary redistribution plan among the state’s hospitals, to channel the remaining vaccine to where it is needed most.

Meanwhile, all high-risk employees were urged to get vaccinated elsewhere. Hopkins even agreed to reimburse those who do so, up to $20 if their insurance didn’t cover the cost (see sidebar).

Perl’s influenza task force is also promoting other important flu-busting methods, such as an enhanced version of last year’s highly effective “Cover Your Sneeze, Please” campaign. The clever, nurse-coined mantra reminds health care workers, patients and visitors to use the tissues, wall-mounted dispensers of waterless hand-washing gel (Purell), and masks provided in waiting areas and throughout patient care sections.

Last month’s launch of the Hand Hygiene Pledge campaign—designed to educate employees about the simple, infection-cutting technique of hand-washing by having them sign a clean-hands pledge—underscored its importance. And this year, Hopkins will take it a step further by providing personal bottles of the hand-washing gel to all health care workers.

In preparation for a potentially difficult winter, the influenza task force is putting together a strategy that will funnel patients with respiratory complaints into one area of the hospital—called “cohorting”—where vaccinated employees will care for them. Hopkins has also ordered 12 times the amount of antiviral drugs used last year, so all cases of the flu can be treated quickly and effectively.

—Lindsay Roylance

The Flu and You Who should be vaccinated? Studies show that vaccinating health care workers against influenza can slash patient mortality in half. With that in mind, Hopkins will prioritize vaccinating health care workers, beginning with those who have daily direct patient contact and those at risk for exposure to influenza in the clinical laboratories. When more vaccine becomes available, the campaign will be expanded to include additional employees. For the most recent updates on vaccination schedules, go to insidehopkinsmedicine.org/flu. How will I be reimbursed if I got a flu shot elsewhere? If you got your flu shot elsewhere, Hopkins will reimburse you for up to $20 if you aren’t covered by your insurer. Go to insidehopkinsmedicine.org/flu for details. Let your supervisor know if you were vaccinated. How can I prevent getting the flu if I haven't been vaccinated? The influenza virus is a respiratory illness that is spread when someone who has it sneezes, coughs or speaks. Avoid close contact with anyone who has the flu and wash your hands frequently with soap and water or an alcohol-based hand cleaner. What should I do if I get the flu? Flu symptoms come on abruptly and are more severe than those of colds. They include a high fever, cough, sore throat, runny or stuffy nose, and muscle aches. If you get the flu, stay home from work to avoid infecting others. Sneeze into a tissue, and wash your hands with soap and water or an alcohol-based cleaner. There are four types of antiviral medications that can reduce the duration of the flu. See your doctor (or call Occupational Health at 410-955-6211) within two days of when symptoms appear to find out if antiviral medicine is right for you.