Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients

Abstract

Vaccination of health care workers (HCWs) is recommended as a strategy for preventing influenza in elderly patients in long-term care. However, there have been no controlled studies to show whether this approach is effective. During the winter of 1994-1995, 1059 patients in 12 geriatric medical long-term-care sites, randomized for vaccination of HCWs, were studied. In hospitals where HCWs were offered vaccination, 653 (61%) of 1078 were vaccinated. Vaccination of HCWs was associated with reductions in total patient mortality from 17% to 10% (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.40-0.80) and in influenza-like illness (OR, 0.57; 95% CI, 0.34-0.94). Vaccination of patients was not associated with significant effects on mortality (OR, 1.15; 95% CI, 0.81-1.64). Results of this study support recommendations for vaccination against influenza of HCWs in long-term geriatric care. Vaccination of frail elderly long-term-care patients may not give clinically worthwhile benefits.

A Successful Strategy for Increasing the Influenza Vaccination Rate of Healthcare Workers without a Mandatory Policy Outside of the United States: A Multifaceted Intervention in a Japanese Tertiary Care Center

“…32,33 After years of voluntary efforts in the US that have resulted in stagnant vaccination rates, increasing numbers of facilities are turning to mandatory programs because they have had a great impact in enhancing the HCW vaccination rate. Although mandatory vaccination guidelines may vary by state and US medical organizations, 17,34 its use remains of interest in the United States.…”

Infections in Residents of Nursing Homes

“…Results of three recent studies have shown that staff immunization reduced mortality by 40%. The effective staff member vaccination rates in these three studies were 60%, 51%, and 48% [18][19][20]. Yet, influenza vaccination coverage among health care workers remains suboptimal.…”

Mandatory seasonal influenza vaccination or masking of British Columbia health care workers: Year 1

“…22 For instance, while all-cause mortality was used as the primary outcome in all four trials, it was argued that influenza incidence (laboratory-confirmed) and influenza-specific mortality are more appropriate. [8][9][10][11] In fact, a Cochrane Database Systematic Review did not identify an effect of HCW vaccination on laboratory-confirmed influenza or related complications (lower respiratory tract infections and hospitalization) in elderly patients. 24 Second, the trials did not explicitly describe important cointerventions (i.e., handwashing, early detection of influenza among patients presenting with an influenza-like illness, and prompt use of antivirals.)…”

“…7 Four randomized controlled studies in chronic care settings have demonstrated a 20%-40% reduction in patient mortality rates by improving HCW vaccination rates. [8][9][10][11] According to the British Columbia Centre for Disease Control, increasing the proportion of HCWs who receive influenza vaccination by 40% would lower the annual mortality (attributed to influenza) of nursing home residents from 1.3% to 0.5%. 12 There is conflicting evidence specifically demonstrating a reduction in influenza transmission due to HCW vaccination.…”