A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers

Abstract

BackgroundInfluenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW.MethodsWe conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings.ResultsThirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness.DiscussionOur findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.

Influenza vaccination in health-care workers: an evaluation of an on-site vaccination strategy to increase vaccination uptake in HCWs of a South Italy Hospital

“…Although there are no specific studies on the cost-effectiveness of the on-site clinic, HCWs immunization programs in the hospital environment are recognized as effective in reducing the costs related to the disease, especially regarding the costs associated to work absenteeism. 15 For these reasons, future studies have to examine the question of the benefit/cost of the on-site offer.…”

“…Influenza vaccination in HCWs has cost-effectiveness benefits, as it reduces work absenteeism, as asserted by a 2018 metanalysis, 15 so Public Health decision makers should improve the annual vaccination campaign to obtain the dual objective of preventing the risk of infection for the HCWs and the patients and of saving funding reducing direct and indirect costs associated to the disease. Probably, in the Italian and Apulian context, governmental institutions should implement policies of strong recommendation of seasonal influenza vaccine for health professionals, especially for the ones in contact with patients at risk of complications.…”

Influenza Vaccination in Italian Healthcare Workers (2018–2019 Season): Strengths and Weaknesses. Results of a Cohort Study in Two Large Italian Hospitals

“…Indeed, it is well recognized that, compared with non-vaccination, annual influenza vaccination is cost-effective or cost-saving in several settings and population groups [45][46][47]. In particular, studies conducted on HCWs have shown that seasonal influenza vaccination reduces absenteeism from work during the epidemic period and, consequently, determines a reduction in the direct and indirect costs of influenza [13,48]. In this context, tailor-made pro-vaccination awareness-raising campaigns aimed at increasing vaccine coverage are to be regarded as priority interventions.…”

Recommendations for Mandatory Influenza Vaccinations for Health Care Personnel From AMDA's Infection Advisory Subcommittee

“…16e18 A meta-analysis examining the effects of influenza vaccination on HCP found that absenteeism from ILI was reduced substantially (risk ratio ¼ 0.62), as was the duration of being absent from work (risk ratio ¼ 0.82). 19 Unfortunately, PALTC HCP have been found to consistently have lower rates of influenza vaccination than HCP in all other settings. During the 2017e2018 influenza season, the CDC found that although 78% of HCP respondents reported receiving an influenza vaccine, HCP in PALTC had the lowest rate of only 67% vaccinated.…”