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. Dolan
, 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
, 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-TamTable 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 (0.46–1.61)† | |||
| 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 (0.49–1.65), 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 (0.25–1.04), 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.
