Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: A randomised controlled trial

The University of Edinburgh, Edinburgh, Scotland, United Kingdom
The Lancet (Impact Factor: 45.22). 02/2000; 355(9198):93-7. DOI: 10.1016/S0140-6736(99)05190-9
Source: PubMed


Vaccination of health-care workers has been claimed to prevent nosocomial influenza infection of elderly patients in long-term care. Data are, however, limited on this strategy. We aimed to find out whether vaccination of health-care workers lowers mortality and the frequency of virologically proven influenza in such patients.
In a parallel-group study, health-care workers in 20 long-term elderly-care hospitals (range 44-105 patients) were randomly offered or not offered influenza vaccine (cluster randomisation, stratified for policy for vaccination of patients and hospital size). All deaths among patients were recorded over 6 months in the winter of 1996-97. We selected a random sample of 50% of patients for virological surveillance for influenza, with combined nasal and throat swabs taken every 2 weeks during the epidemic period. Swabs were tested by tissue culture and PCR for influenza viruses A and B.
Influenza vaccine uptake in health-care workers was 50.9% in hospitals in which they were routinely offered vaccine, compared with 4.9% in those in which they were not. The uncorrected rate of mortality in patients was 102 (13.6%) of 749 in vaccine hospitals compared with 154 (22.4%) of 688 in no-vaccine hospitals (odds ratio 0.58 [95% CI 0.40-0.84], p=0.014). The two groups did not differ for proportions of patients positive for influenza infection (5.4% and 6.7%, respectively); at necropsy, PCR was positive in none of 17 patients from vaccine hospitals and six (20%) of 30 from no-vaccine hospitals (p=0.055).
Vaccination of health-care workers was associated with a substantial decrease in mortality among patients. However, virological surveillance showed no associated decrease in non-fatal influenza infection in patients.

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    • "Vaccination of the healthcare providers with influenza vaccine is recommended by CDC (Center for Disease Control and Prevention) since 1981, and by WHO (World Health Organization) since 2002 [3] [4] [5]. Vaccination of healthcare providers with influenza vaccine reduces the occurrence of diseases like influenza, absence rates and also reduces the infection risk by preventing nosocomial transmission to the patients [6] [7] [8] [9]. "
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    ABSTRACT: Objectives. Pandemic influenza is a contagious disease caused by the new pandemic influenza A H1N1 virus, originated from the genetic combination of human, pig and avian influenza viruses. Our research aimed to determine the level of pandemic influenza vaccination in healthcare providers and the factors influencing this level. Methods. Doctors, midwives and nurses working in primary, secondary and tertiary health institutions in Denizli established the universe of the research. Four nurses visited these health institutions on five workdays between the 4th and 8th of April 2011, informed the healthcare providers that participation to the research was voluntary and handed over data collection forms in the institutions visited. Then, these data collection forms were collected by the same nurses. Research data were analyzed with SPSS package program. Frequency, percentage, chi-square and logistic regression analyses were used in the evaluation. Results. 44.7% of the healthcare providers participating in the study stated that they had been vaccinated with pandemic influenza vaccine. When factors effecting the vaccination decision with pandemic influenza vaccine of the individuals participating the study was evaluated; statistically significant difference between vaccination and occupation (p=0.001), sex (p=0.001), and age (p=0.026) was detected. The proportion of doctors, males and individuals older than 40 years was higher among the vaccinated professionals. Conclusions. It is important to make announcements about vaccination with determination and by taking support from media and non-governmental organizations. Statements and explanations should be released with this in mind and media, and nongovernmental organizations should also take responsibility regarding this matter.
    Full-text · Article · Nov 2015 · The European Research Journal
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    • "Influenza immunization is approximately 60% effective in preventing infection in healthy adults, and also reduces the duration and severity of symptoms when infection occurs [1]. Vaccination of HCW is associated with a reduced mortality in chronic care/long term care homes, as shown in randomized control trials [2] [3] [4] [5], and with reduced hospital-acquired infections in acute care although these studies are of lower quality [6]. "
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    ABSTRACT: A new policy requiring staff in clinical areas to vaccinate or wear a mask was implemented in British Columbia (BC) in the 2012/13 winter. This review assessed the impact of the policy on absenteeism in health care workers. A retrospective cohort study of full-time HCW that worked prior to and during the 2012/13 influenza season in a health authority in BC. The rate of absenteeism due to all cause illness was compared between vaccinated and unvaccinated staff controlling for behaviors outside influenza season. Of the 10079 HCW, 77% were vaccinated. By comparison to absenteeism rates in the pre-influenza season, unvaccinated staff in winter had twice the increase in absenteeism due to all-cause illness than vaccinated staff. After controlling for baseline differences between those vaccinated and unvaccinated, influenza vaccination was associated with reduced absenteeism, saving the Health Authority substantial money. Having regular staff in attendance increases the quality of care. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    Full-text · Article · Feb 2015 · Vaccine
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    • "The Cochrane review, however, did not take influenza like illness (ILI) and all-cause mortality of residents into consideration, The impact of vaccinating HCWs has been discussed in several articles. Potter [13] and Carman [14] took ILI into consideration in their studies and found a significant association between HCWs’ vaccination against influenza and reduced rates of mortality in residents of NHs, showing how important it is to vaccinate HCWs. HCW absence from work owing to influenza is another important issue and has been studied by several authors [13,15-17]. "
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    ABSTRACT: Background WHO has set a goal of 75% vaccination coverage (VC) for seasonal influenza for residents and also recommends immunization for all healthcare workers (HCWs) in nursing homes (NHs). We conducted a cross-sectional study to estimate the VC for seasonal influenza vaccination in Norwegian NHs in 2012/2013 since the VC in NHs and HCWs is unknown. Methods We gathered information from NHs concerning VC for residents and HCWs, and vaccination costs for HCWs, using a web-based questionnaire. We calculated VC among NH residents by dividing the number of residents vaccinated by the total number of residents for each NH. VC among HCWs was similarly calculated by dividing the number of HCWs vaccinated by the total number of HCWs for each NH. The association between VC and possible demographic variables were explored. Results Of 910 NHs, 354 (38.9%) responded. Median VC per NH was 71.7% (range 0-100) among residents and 0% (range 0-100) among HCWs, with 214 (60%) NHs reporting that none of their HCWs was vaccinated. Median VC for HCWs in NHs with an annual vaccination campaign was 0% (range 0-53), compared to when they did not have an annual vaccination campaign 0% (range 0-12); the distributions in the two groups differed significantly (Mann–Whitney U, P = 0.006 two tailed). Conclusion Median influenza VC in Norwegian NHs was marginally lower than recommended among residents and exceptionally low among HCWs. The VC in HCWs was significantly higher when NHs had an annual vaccination campaign. We recommend that NHs implement measures to increase VC among residents and HCWs, including vaccination campaigns and studies to identify potential barriers to vaccination.
    Full-text · Article · May 2014 · BMC Public Health
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