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Volume 18, Number 8—August 2012
CME ACTIVITY - Synopsis

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

Gayle P. DolanComments to Author , Rebecca M. 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 A1

Characteristics of primary studies of the vaccination of HCWs to protect patients at risk for acute respiratory disease*

Study Study design Setting Intervention/exposure No. HCWs No. patients Primary outcome in patient population Duration of follow-up (no. influenza seasons)
Carman et al., 2000 (24) Cluster RCT Geriatric hospitals, Scotland Routine offer of vaccination or no offer 1,217 in intervention arm (620 vaccinated); not stated for control arm 749 in intervention arm; 688 in control arm All-cause mortality 6 mo (1)
Potter et al., 1997 (25) Cluster RCT Geriatric hospitals, Scotland Stratified by policy for patient vaccination; randomized to routine offer of influenza vaccine to HCWs or no vaccination of HCWs 1,078 in intervention arm (440 HCWs, (of which 67% vaccinated), in vaccinated patient group, and 638 HCWs, (of which 57% vaccinated), in nonvaccinated patient group); not stated for control arm 490 patients in HCW intervention arm (230 patients in vaccinated patient group and 260 in nonvaccinated patient group); 544 in control arm (283 in vaccinated patient group and 261 in nonvaccinated patient group) All-cause mortality 5 mo (1)
Lemaitre et al., 2009 (26) Cluster RCT Nursing homes, France Promotional influenza vaccination campaign or provision of routine information 989 in intervention arm (678 vaccinated); 1,015 in control arm 1,722 intervention arm; 1,678 control arm Al-cause mortality 2.5 mo (1)
Hayward et al., 2006 (27) Cluster RCT Care homes, England Staff influenza vaccination policy or policy of not actively promoting vaccination Year 1: 1,610 in intervention arm (570 vaccinated); 1,674 in control arm. Year 2: 1,726 in intervention arm (517 vaccinated); 1,766 in control arm Year 1: 1,233 intervention arm; 1,371 control arm. Year 2: 1,270 intervention arm; 1,391 control arm. All-cause mortality 8 mo (2)
Oshitani et al., 2000 (28) Prospective cohort Nursing homes/ geriatric health service facilities, Japan Staff and patient influenza vaccination 7,459 (1,532 vaccinated) 12,784 (3,933 vaccinated) residents in 149 facilities ILI cases 3 mo (1)
Kanaoka et al., 2010 (29) Cross-sectional study Long-term care facility, Japan Influenza vaccination of staff and patients 179–188 over 7-y period (vaccination coverage 79%–91%) 180–185 over 7-y period (vaccination coverage 45%–72%) Influenza cases Seven 6-mo periods (7)
Ando et al., 2010 (30) Cross-sectional study Hemodialysis clinics, Japan Staff influenza vaccination coverage 691–1,221 over 6-mo period (vaccination coverage 45%–87%) 2,881–5,055 over 6-mo period (vaccination coverage not reported) ILI cases 6 mo (1)
Engels et al., 2005 (31) Ecologic Pediatric hospital, unknown Staff influenza vaccination Not stated. Vaccination coverage reported as negligible in 1999–2002 (before implementation); 48% in 2002 and 47% in 2003 (after implementation). Not stated Laboratory-diagnosed influenza Exact duration not clear (3)
Weinstock et al., 2000 (32) Ecologic Adult oncology hospital, United States Staff influenza vaccination with concurrent promotional campaign Not clear. 1,457 vaccinated before implementation 1997–98 (12% of bone marrow transplant HCWs) and 1,956 vaccinated after implementation in 1998–99 (58% of bone marrow transplant HCWs) Not stated Laboratory-confirmed influenza 7 mo (1)
Saito et al., 2002 (33) Prospective cohort Care home, Japan Staff and patient influenza vaccination Year 1: 440 (154 vaccinated). Year 2: 517 (360 vaccinated) Year 1: 699 (331 vaccinated). Year 2: 930 (743 vaccinated) ILI cases 8 mo (2)
Munford et al., 2008 (34) Ecologic Extended-care unit, Canada Staff influenza vaccination with concurrent promotional campaign Numbers unknown. Vaccination coverage was 39% in 2005–06 (before implementation) 84% in 2006–07 and 83% in 2007–08 (after implementation) Not specified. Reported to be ≈150 residents in unit ILI cases Exact duration not clear (3)
Shugarman et al., 2006 (35) Cross-sectional study Not stated; assumed care homes, United States Staff and patient influenza vaccination coverage 301 homes with 28,174 staff. Categorized as high uptake where >55% coverage and low where uptake <55%. 301 homes with 30,371 patients. Categorized as high uptake where >89% coverage, low where <89% coverage. ILI clusters 8 mo (1)
Monto et al., 2004 (36) Observational with case–control comparison Nursing homes, United States Staff influenza vaccination coverage Not stated (mean vaccination coverage 32%) Not stated (31 homes with mean of 136 residents and mean vaccination coverage 76%) Laboratory-diagnosed influenza outbreaks 5 mo (1)
Stevenson et al., 2001 (37) Cross-sectional study Long-term elderly care facilities, Canada Staff and patient influenza vaccination coverage Not reported (1,270 facilities responded in 1991, 430 in 1995, and 380 in 1999) Not reported (1,270 facilities responded in 1991, 430 in 1995, and 380 in 1999) ILI outbreaks (1)

*HCW, health care worker; RCT, randomized controlled trial; ILI, influenza-like illness.

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