Influenza Vaccination of Health Care Workers
May 15, 1997 3 minutes read
Influenza Vaccination of Health Care Workers
ABSTRACT & COMMENTARY
Synopsis: Morbidity from influenza-like illnesses and mortality from all causes were reduced among residents of long-term care facilities when health care staff participated in an influenza immunization program.
Source: Potter J, et al. J Infect Dis 1997;175:1-6.
Investigators in glasgow, scotland, used 12 long-term care hospitals with 1059 total residents in four groups during the 1994-1995 influenza season to compare the effects of four different strategies of influenza vaccination: immunizing both staff and residents, only staff, only residents, and no immunizations. Outcomes were measured among the residents as overall mortality and tracking of signs and symptoms of influenza-like illness or lower respiratory tract infections. A research nurse was used to confirm the presence of illness and attempt to identify specific pathogens. Functional assessment of the resident participants was also done, and only minimal differences in frailty among the study groups were present.
Results clearly showed reductions in both overall mortality and the incidence of influenza-like illnesses in the resident groups where staff of the facilities participated in a vaccination program (from 17% to 10% mortality), and there was no difference in mortality between the resident groups alone who were offered vaccine or not. These differences persisted even if only deaths from pneumonia were analyzed.
Multivariate analysis combining all variable factors such as age, sex, and frailty also confirmed that a hospital with a policy of not routinely vaccinating staff had significant increased mortality among residents. The incidence of influenza-like illness did show differences depending on both resident and staff vaccination: 5.4% among residents if staff alone were vaccinated, 6.9% if no one was vaccinated, and down to 3% if both staff and residents were vaccinated. Increased age and frailty were also associated with increased patient mortality.
COMMENT BY MARY ELINA FERRIS, MD
Although it might seem self-evident that vaccinating staff in long-term care facilities would result in decreased transmission of influenza in those sites, there has not been clear research in support of this belief until this publication appeared. Recommendations for control of influenza have mainly focused on the elderly, and the U.S. Centers for Disease Control and Prevention has also urged that all health care workers be vaccinated.1 One study of those workers during an influenza epidemic demonstrated that 25% can be infected.2
This research suggests that vaccination efforts might be better spent on the staff than on the patients (who do not always respond immunologically to the vaccinations), although there is benefit to having both vaccinated. This study only focused on the paid staff and not the voluntary workers or the families and visitors of the residents. Even more benefit might be derived from expanding the target group to include all who have contact with the residents.
Another interesting result of the study was the dismal rate of influenza vaccination when no promotional program was in place. When the facility had no policy of routinely offering vaccine to residents, the rate was 0.2% vs. 88.8% in sites where vaccine was given without needing a special request. It would appear from these findings that a change of policy to routinely administer vaccinations to both staff and residents in long-term care facilities would have a very beneficial effect on both overall resident mortality and incidence of influenza-like illnesses. So, why don t we "just do it?"
References
1. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 1996;45 (No. RR-5):1-24.
2. Odelin MF, et al. Gerontology 1993;39:109-116.
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