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Can a universal influenza immunization program reduce emergency department volume?

Published online by Cambridge University Press:  21 May 2015

Dianne Groll  and
Bonnie Henry
Dianne Groll*
Affiliation:
Angada 3, ICU Research Group, Queen’s University, Kingston, Ont.
Bonnie Henry
Affiliation:
Toronto, Ont.
*
Kingston General Hospital, 76 Stuart St., Kingston ON K7L 2V7; 613 549-6666 x6289, [email protected]

Abstract:

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Objectives:

In 2000 the Ontario Minister of Health and Long-Term Care announced a universal influenza immunization program for Ontario, Canada. The 2 objectives of this $38-million program were to decrease seasonal impact of influenza on emergency department (ED) visits and to decrease the number and severity of influenza cases. This paper examines the correlation between population influenza rates and ED visits in 5 tertiary care hospitals in Ontario over a 5-year period (1996–2001).

Methods:

In this retrospective, observational study, we determined the total number of ED visits during the study period, by month, at 5 tertiary care hospitals in 3 Ontario cities Kingston, London and Ottawa). Detailed ED diagnoses were captured for Kingston, and provincial and national population-based influenza rates were obtained from Health Canada for the 5-year study period. Correlation and regression analyses were used to determine the relationship of influenza rates and ED volumes. “Influenza season” is defined in this study as November 1st to March 31st of each year.

Results:

There was no significant correlation between influenza rates and ED volumes, with Pearson correlation coefficients (r) of 0.22 (p = 0.72), 0.33 (p = 0.59) and 0.27 (p = 0.66) at the Kingston, London and Ottawa study sites, respectively. Data from the Kingston hospitals showed that, during influenza season, acute respiratory diagnoses accounted for only 4.4% of ED visits and influenza for only 0.34% of visits. Multiple linear regression analysis showed that the ED diagnosis of influenza was not significantly related to ED volume. During the influenza season after the universal immunization campaign, ED visits increased at all sites.

Conclusion:

Based on this study, a universal influenza immunization campaign is unlikely to affect ED volume.

Keywords

influenzavaccinationemergency departmentvolume
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 4 , July 2002 , pp. 245 - 251
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Ontario invests $38 million to ease emergency room pressures with universal vaccination program [press release]. Toronto (ON): Govt of Ontario; 2000 July 25. Available: www1.newswire.ca/government/ontario/english/releases/july2000/25/ (accessed 2002 June 4).Google Scholar
2.Persistent flu plagued Ontario [television program]. “CBC Front Page News.” Toronto (ON): Canadian Broadcasting Corporation; 2000 Jan 6.Google Scholar
3.Ontario launches free flu shot program [press release]. Toronto (ON): Govt of Ontario; 2001 Oct 5. Available: www1.newswire.ca/government/ontario/english/releases/October2001/05/ (accessed 2002 June 4).Google Scholar
4.National Advisory Committee on Immunization. Statement on influenza vaccination for the 1997–1998 season. Can Commun Dis Rep 1997;23:July 1.Google Scholar
5.National Advisory Committee on Immunization. Statement on influenza vaccination for the 1996–1997 season. Can Commun Dis Rep 1996;22:June 15.Google Scholar
6.National Advisory Committee on Immunization. Statement on influenza vaccination for the 2001–2002 season. Can Commun Dis Rep 2001;27:Aug 1.Google Scholar
7.National Advisory Committee on Immunization. Statement on influenza vaccination for the 1999–2000 season. Can Commun Dis Rep 1999;25:June 1.Google Scholar
8.National Advisory Committee on Immunization. Statement on influenza vaccination for the 1998–1999 season. Can Commun Dis Rep 1998;24:July 1.Google Scholar
9.Influenza in Canada: 1995–1996 season. Can Commun Dis Rep 1996;22–23:Dec 1.Google Scholar
10.World Health Organization. Influenza activity: United States and worldwide, 1999–2000 season, and composition of the 2000–01 influenza vaccine. Morbid Mortal Wkly Rep 2000;49:375–81.Google Scholar
11.World Health Organization. Influenza activity: United States, 1999–2000 season. Morbid Mortal Wkly Rep 2000;49:53–7.Google Scholar
12.World Health Organization. Influenza activity: United States, 1998–1999 season. Morbid Mortal Wkly Rep 1999;48:177–81.Google Scholar
13.World Health Organization. Influenza activity: United States and worldwide, 1997–98 season, and composition of the 1998–99 influenza vaccine. Morbid Mortal Wkly Rep 1998;47:280–4.Google Scholar
14.World Health Organization. Influenza activity: United States, 1996–97 season. Morbid Mortal Wkly Rep 1997;46:325–30.Google Scholar
15.World Health Organization. Influenza activity: United States, 1995–96 season. Morbid Mortal Wkly Rep 1996;45:326–30.Google Scholar
16.Hospital Report Research Collaborative. Hospital report 2001: emergency department care. Toronto (ON): Ont Hospital Association and the Govt of Ontario, editors; Dec 2001. Available: www.hospitalreport.ca/HospitalReport2001EDReport.htm (accessed 2002 June 4).Google Scholar
17.Chan, BTB, Schull, MJ, Schultz, SE.Atlas Report. Emergency department services in Ontario: 1993–2000. Toronto (ON): Institute for Clinical Evaluative Sciences; 2001. Available: www.ices.on.ca/PDFs/AtlasReports/EDreport.pdf (accessed 2002 June 4).Google Scholar
18.Russell, ML, Maxwell, CJ.The prevalence and correlates of influenza vaccination among a home care population. Can J Public Health 2000;91:441–4.CrossRefGoogle ScholarPubMed
19.Buxton Bridges, C, Thompson, WW, Meltzer, MI.Effectiveness and cost–benefit of influenza vaccination of healthy working adults: a randomized controlled trial. JAMA 2000; 284:1655–63.Google Scholar
20.Monto, AS.Preventing influenza in healthy adults — the evolving story. JAMA 2000;284:1699–700.Google Scholar
21.Patriarca, PA, Strikas, RA.Influenza vaccine for healthy adults? N Engl J Med 1995;333:933–4.CrossRefGoogle ScholarPubMed
22.Schabas, RE.Mass vaccination in Ontario: a sensible move. CMAJ 2001;164:36–7.Google ScholarPubMed
23.Demicheli, V.Mass influenza vaccination in Ontario: Is it worthwhile? CMAJ 2001;164:38–9.Google Scholar
24.Demicheli, V, Jefferson, T, Rivetti, D, Deeks, J.Prevention and early treatment of influenza in healthy adults. Vaccine 2000;18: 957–1030.CrossRefGoogle ScholarPubMed
25.Nichol, KL.Cost–benefit analysis of a strategy to vaccinate healthy working adults against influenza. Arch Intern Med 2001;161:749–59.CrossRefGoogle ScholarPubMed
26.Kumpulainen, V, Makela, M.Influenza vaccination among healthy employees: a cost–benefit analysis. Scand J Infect Dis 1997;29:181–5.Google Scholar
27.Hurwitz, ES, Haber, M, Chang, A, Shope, T, Teo, S, Ginsberg, M, et al. Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. JAMA 2000;284:1677–82.Google Scholar
28.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;344:889–96.CrossRefGoogle ScholarPubMed
29.Wright, P.Influenza in the family. N Engl J Med 2000;343:1331–2.CrossRefGoogle ScholarPubMed
30.McIntosh, K, Lieu, T.Is it time to give influenza vaccine to healthy infants? N Engl J Med 2000;342:275–6.CrossRefGoogle ScholarPubMed
31.Sokhandan, M, McFadden, ER Jr, Huang, YT, Mazanec, MB.The contribution of respiratory viruses to severe exacerbations of asthma in adults. Chest 1995;107:1570–4.CrossRefGoogle ScholarPubMed
32.Kelen, GD, Scheulen, JJ, Hill, PM.Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. Acad Emerg Med 2001; 8:1095–100.CrossRefGoogle ScholarPubMed
33.Velianoff, GD.Overcrowding and diversion in the emergency department: the health care safety net unravels. Nurs Clin North Am 2002;37:59–66.CrossRefGoogle ScholarPubMed
34.Baer, RB, Pasternack, JS, Zwemer, FL Jr. Recently discharged inpatients as a source of emergency department overcrowding. Acad Emerg Med 2001;8:1091–4.CrossRefGoogle ScholarPubMed
35.Schneider, S, Zwemer, F, Doniger, A, Dick, R, Czapranski, T, Davis, E.Rochester, New York: a decade of emergency department overcrowding. Acad Emerg Med 2001;8:1044–50.Google Scholar
36.Schull, MJ, Szalai, JP, Schwartz, B, Redelmeier, DA.Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;8:1037–43.Google Scholar
37.Foster, DA, Talsma, A, Furumoto-Dawson, A, Ohmit, SE, Margulies, JR, Arden, NH, et al. Influenza vaccine effectiveness in preventing hospitalization for pneumonia in the elderly. Am J Epidemiol 1992;136:296–307.CrossRefGoogle ScholarPubMed
38.Gross, PA, Hermogenes, AW, Sacks, HS, Lau, J, Levandowski, RA.The efficacy of influenza vaccine in elderly persons: a meta-analysis and review of the literature. Ann Intern Med 1995;123:518–27.Google Scholar
39.Govaert, TM, Thijs, CT, Masurel, N, Sprenger, MJ, Dinant, GJ, Knottnerus, JA.The efficacy on influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA 1994;272:1661–5.Google Scholar
40.Nichol, KL, Lind, A, Margolis, KL, Von Sternberg, T.The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994; 331:778–84.CrossRefGoogle ScholarPubMed
41.Iezzoni, LI.Risk adjustment for measuring healthcare outcomes. 2nd ed. Chicago (IL): Health Administration Press; 1997.Google Scholar
42.Duclos, P, Hatcher, J.Epidemiology of influenza vaccination in Canada. Can J Public Health 1993;84:311–5.Google ScholarPubMed