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Volume 18, Number 8—August 2012

CME ACTIVITY

Vaccination of Health Care Workers to Protect Patients at Increased Risk for Acute Respiratory Disease

Gayle P. DolanComments to Author , Rebecca C. Harris, Mandy Clarkson, Rachel Sokal, Gemma Morgan, Mitsuru Mukaigawara, Hiroshi Horiuchi, Rachel Hale, Laura Stormont, Laura Béchard-Evans, Yi-Sheng Chao, Sergey Eremin, Sara Martins, John S. Tam, Javier Peñalver, Arina Zanuzdana, and Jonathan S. Nguyen-Van-Tam

Author affiliations: University of Nottingham, Nottingham, UK (G.P. Dolan, R. Hale, J.S. Nguyen-Van-Tam); World Health Organization, Geneva, Switzerland (R.C. Harris, M. Mukaigawara, L. Stormont, Laura Béchard-Evans, Y.-S. Chao, S. Eremin, S. Martins, J.S. Tam, J. Peñalver); National Health Service Derbyshire County, Chesterfield, UK (M. Clarkson, R. Sokal); Health Protection Agency South West, Gloucester, UK (G. Morgan); Tokyo Medical Dental University, Tokyo, Japan (H. Horiuchi); and University of Bielefeld, Bielefeld, Germany (A. Zanuzdana)

Main Article

Table A2

Cases and consultations for clinically diagnosed influenza and ILI in a review of the vaccination of HCWs to protect patients at risk for acute respiratory disease*

Outcome measure, study Study design Method of assessment Measure of effect in patient population Effect estimate (95% CI)
Clinically defined ILI
Potter et al. (25) Cluster RCT Defined as temperature >37.0°C plus >1 of the following symptoms: new-onset cough, coryza, sore throat, malaise, headache or muscle pains. Reported by nurse. OR, nonvaccinated and vaccinated patients 0.57 (0.34–0.94)†
OR, vaccinated patients 0.24 (0.10–0.59)†
OR, nonvaccinated patients 0.86 (0.461.61)†
Lemaitre et al. (26) Cluster RCT Defined as temperature >37.8°C plus onset or worsening of respiratory symptoms. Method of reporting not stated. OR 0.69 (0.52–0.91), p = 0.007
Hayward et al. (27) Cluster RCT Defined as fever >37.8°C or deterioration, plus onset or worsening of respiratory symptoms. Reported by lead nurse. Rate difference, epidemic period 1 –0.09 (–0.14 to –0.03, p = 0.004
Rate difference, epidemic period 2 0.00 (0.06 to 0.06, p = 0.93)
Rate difference, nonepidemic period 1 0.00 (0.05 to 0.05, p = 0.93)
Rate difference, nonepidemic period 2 0.03 (0.07 to 0.12, p = 0.57)
Thomas et al. (19) Pooled data Risk ratio, adjusted for clustering 0.71 (0.58–0.88), p = 0.0018
Saito et al. (33) Prospective cohort Defined as sudden onset of fever of >37.8°C for >1 d and >1 of the following signs and symptoms: cough, sore throat, coryza. Routine assessment by nursing staff. RR, middle compared with low HCW vaccination rate, season 1 0.90 (0.491.65), p = 0.7
RR, high compared with low HCW vaccination rate, season 1 0.19 (0.10–0.36), p<0.001
RR, middle compared with low HCW vaccination rate, season 2 0.36 (0.17–0.75), p<0.01
RR, high compared with low HCW vaccination rate. season 2 0.51 (0.251.04), p = 0.07
Oshitani et al. (28) Prospective cohort Definition not provided. Mandatory reporting by survey. OR, exposure to vaccinated staff compared with unvaccinated staff 0.28 (0.23–0.32)†
Kanaoka et al. (29) Cross-sectional Defined as symptoms of ILI with a positive antigen test or symptoms of ILI with a negative antigen test but clinical diagnosis by multiple clinicians. Method of reporting not stated. Spearman rank correlation, hospital personnel vaccination coverage and no. influenza cases r = 0.379, p = 0.459
General practitioner consultations for ILI
Hayward et al. (27) Cluster RCT Reporting by lead nurse Rate difference, epidemic period 1 –0.07 (–0.12 to –0.02), p = 0.002
Rate difference, epidemic period 2 0.01 (0.07 to 0.05), p = 0.77
Rate difference, nonepidemic period 1 0.01 (0.06 to 0.041), p = 0.74
Rate difference, nonepidemic period 2 0.00 (0.08 to 0.08), p = 0.95
Thomas et al. (19) Pooled data OR, adjusted for clustering 0.48 (0.33–0.69), p<0.001

*ILI, influenza-like illness; HCW, health care worker; RCT, randomized controlled trial; OR, odds ratio; RR, relative risk. Boldface indicates statistical significance. Shaded fields represent pooled data.
†p value not reported.

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