Vaccinating healthcare workers against influenza to protect the vulnerable—Is it a good use of healthcare resources?: A systematic review of the evidence and an economic evaluation
Introduction
Appropriate policies for healthcare not only require information about effectiveness, safety and cost-effectiveness, but also need adequate implementation. Influenza is an important public health problem and it causes significant mortality particularly in the elderly and high-risk groups [1]. An obvious policy is to vaccinate those most at risk and most countries in Europe and North America have such programmes [2]. Although the benefit of vaccination is well documented [3], [4], there remains significant influenza-associated morbidity and mortality in the high-risk. A complementary approach to protecting the vulnerable could be to provide indirect protection by vaccinating others to reduce transmission of influenza. Vaccination of children has been shown to have the potential to reduce morbidity and mortality in others [5]. Healthcare workers (HCWs) can cause outbreaks in patients in the healthcare setting [6]. Although the World Health Organisation recommends that HCWs should be vaccinated against influenza [1], policy in Europe is variable and uptake poor (less than 25%) [2], [7].
Research was commissioned by the European Scientific Working Group on Influenza (ESWI) to look at the effectiveness and cost-effectiveness of vaccinating HCWs as an indirect means of protecting high-risk patients against influenza. This paper integrates the findings from systematic reviews looking at the effectiveness, cost-effectiveness and factors affecting uptake, and an economic evaluation.
Section snippets
Search strategy
We searched electronic databases (Cochrane library, CINAHL, NHSEED, HEED, DARE, MEDLINE and EMBASE to June 2004), Internet sites, registers of trials, citation lists and contacted experts. No language restrictions were applied. (Full details available on request.)
Key words used: influenza; health personnel; health care worker; health worker; care giver; physician; medical staff; nurses; nursing home; homes for the aged; residential home; vaccination; influenza vaccine.
Inclusion criteria
Studies were included if
Results
We identified 493 studies relating to vaccinating healthcare workers. Eighteen met the inclusion criteria [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27] (see Fig. 1). Details of the studies are given in Table 1.
Key results
The evidence for the indirect protection of patients at high-risk for influenza and factors influencing vaccine uptake by HCWs have not previously been the subject of systematic reviews. Our review suggests that vaccination of HCWs against influenza protects HCWs and provides indirect protection to the high-risk. It is cost-effective and indeed probably cost saving.
Limitations and strengths
Only two trials examined the impact of immunising HCWs against influenza on high-risk patients [10], [11]. Sparse information on
Acknowledgements
This paper was commissioned by the European Scientific Working Group on Influenza and is based on a report available from the University of Birmingham: http://www.pcpoh.bham.ac.uk/publichealth/wmhtac/reports.htm#REP_Reports. We thank the following: Dr Fujian Song, Dr Rod Taylor, and Professor Nick Freemantle for their statistical and methodological advice; Dr Iain Blair (Communicable Disease) and Dr Richard Harling (influenza vaccine trials) for their expert specialist advice; Dr John Edmunds
References (53)
- et al.
Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries
Vaccine
(2003) - et al.
Universal vaccination of children against influenza: are there indirect benefits to the community?: a systematic review of the evidence
Vaccine
(2006) - et al.
Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial
Lancet
(2000) Influenza and hepatitis B vaccine acceptance: a survey of health care workers
Am J Infect Control
(1991)- et al.
Influenza vaccination status among health care professionals for prevention of nosocomial infection to hospitalized elderly patients
Serodiagnosis Immunother Infect Dis
(1990) - et al.
Prevention and early treatment of influenza in health adults
Vaccine
(2000) - et al.
Economic costs of influenza-related work absenteeism
Value Health
(2003) - et al.
Cost-effectiveness study on influenza prevention in Hong Kong
Health Policy
(2001) - et al.
Requiring influenza vaccination for health care workers: seven truths we must accept
Vaccine
(2005) - World Health Organisation. Influenza vaccines. WHO position paper. Weekly epidemiological record...
The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature
Ann Intern Med
Influenza vaccination in Europe: an inventory of strategies to reach target populations and optimize vaccination uptake
Eurosurveillance
Methods for evaluation area-wide and organisational-based interventions in health and health care: a systematic review
Health Technol Assess
Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients
J Infect Dis
Effectiveness of influenza vaccine in health care professionals: a randomized trial
JAMA
Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers
Pediatr Infect Dis J
Do hospital employees benefit from the influenza vaccine? A placebo-controlled clinical trial
J Gen Intern Med
Promoting uptake of influenza vaccination among health care workers: a randomized controlled trial
J Public Health Med
Evaluation of an influenza vaccination program for nursing home staff
Can J Public Health
A novel staff vaccination strategy [letter]
Infect Control Hosp Epidemiol
Influenza immunization: improving compliance of healthcare workers
Infect Control Hosp Epidemiol
Improving neglected influenza vaccination among healthcare workers in long-term care
J Am Geriatr Soc
Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated?
Infect Control Hosp Epidemiol
Cited by (206)
Economic evaluation of seasonal influenza vaccination in elderly and health workers: A systematic review and meta-analysis
2022, eClinicalMedicineCitation Excerpt :Of those, six studies21,29,31-33,38 assessed TIV alone, while five studies18,22,24,30,35 assessed both TIV and QIV. Eighteen studies18–25,27–30,32,34–38 (85·7%) compared influenza vaccination to no vaccination, while three studies (14·2%)26,31,33 compared influenza vaccination to current practice. One study29 compared different vaccine administration with no vaccination.
Engaging Nursing Assistants to Enhance Receptivity to the Coronavirus Disease 2019 Vaccine
2021, Journal of the American Medical Directors AssociationThe transmission of the influenza virus from patient to emergency physician: No flu for you
2020, American Journal of Emergency MedicineHealthcare workers’ knowledge, beliefs, and coverage regarding vaccinations in critical care units in Italy
2019, VaccineCitation Excerpt :Healthcare workers (HCWs) are one of the most at-risk groups for acquiring infectious diseases and transmitting them to other hospital staff and to patients [1,2]. Their vaccination is an important public health measure for infection control to reduce lost of work productivity and employee absenteeism, and related morbidity and mortality particularly among high-risk patients [3–5]. A variety of strategies to improve disease awareness, to address concerns about vaccine safety and effectiveness, and to increase vaccine accessibility have been recommended to improve vaccine coverage among HCWs [1,2,5,6].
- ✠
Deceased.