Healthcare Personnel Working with Flu-like Illness

January 19, 2018 by Sophia Chiu, MD, MPH

Most of the United States is experiencing widespread and intense influenza activity. Indicators used to track influenza-like-activity are higher than what was seen during the peak of the 2014-2015 season, the most recent season characterized as being of “high” severity. A NIOSH study recently published in the American Journal of Infection Control found that more than 40 percent of health care personnel with influenza-like-illness (ie, fever and cough or sore throat) continued to work while sick during the 2014-2015 influenza season.

The study used a national opt-in Internet panel survey of 1,914 healthcare personnel during the 2014-15 influenza season. The study found that 414 (22%) respondents had self-reported influenza-like illness. These healthcare workers missed a median of 2 days of work, 57% visited a medical provider for symptoms relief, and 25% were told they had influenza.

Of the 414 healthcare personnel with self-reported influenza-like illness, 183 (41%) reported working during their illness for a median of 3 days. Pharmacists (67%) and physicians (63%) had the highest frequency of working with influenza-like illness. Compared with physicians, a lower proportion of assistants and aides (41%), nonclinical healthcare providers (40%), nurse practitioners/physician assistants (38%), and other clinical healthcare providers (32%) reported working with influenza-like illness.

Working while ill, or presenteeism, increases the likelihood of influenza transmission to coworkers and patients. The five most common reasons cited for working with influenza-like illness were “I could still perform my job duties,” “I wasn’t feeling bad enough to miss work,” “I did not think I was contagious or could make other people sick,” “I have a professional obligation to my coworkers,” and “It is difficult for me to find someone to cover for me.” Healthcare personnel in long-term care settings most frequently cited “I could not afford to lose the pay.”

CDC recommends that personnel be excluded from work until at least 24 hours after they no longer have a fever without the use of anti-pyretics. Workers with respiratory symptoms without fever, or who have ongoing respiratory symptoms, may require evaluation by occupational health. Given that more than half of healthcare personnel with influenza-like illness sought medical attention, clinical encounters are opportunities for medical providers to reinforce recommendations to HCP to refrain from working with influenza-like illness.

For people who have not already received seasonal influenza vaccination, the Centers for Disease Control and Prevention recommends annual vaccination against seasonal influenza for all persons 6 months of age and older who do not have a medical reason for not getting a flu shot, including healthcare providers.

Sophia Chiu, MD, MPH, is a Medical Officer in the NIOSH Division of Surveillance, Hazard Evaluations, and Field Studies.