Elsevier

Vaccine

Volume 24, Issue 19, 8 May 2006, Pages 4212-4221
Vaccine

Vaccinating healthcare workers against influenza to protect the vulnerable—Is it a good use of healthcare resources?: A systematic review of the evidence and an economic evaluation

https://doi.org/10.1016/j.vaccine.2005.12.043Get rights and content

Abstract

Influenza causes substantial mortality in high-risk groups despite targeted vaccination programmes. This paper considers whether it is worth vaccinating healthcare workers (HCWs) against influenza to protect high-risk patients in a series of systematic reviews and an economic evaluation. Eighteen studies are included. Vaccination was highly effective in HCWs, with minimal adverse effects. Two trials assessed patient mortality after vaccinating HCWs, both of which showed a reduction. Despite recommendations, less than 25% of HCW in Europe and the UK are vaccinated. Five studies looked at programmes to increase uptake; these produced increases of 5%–45%. Published economic evaluations did not include patient benefit; therefore, an economic evaluation using UK data was undertaken. In the base case, vaccination was cost saving (£12/vaccinee). In the most pessimistic scenario it cost £405/life-year gained. Effective implementation should be a priority.

Introduction

Appropriate policies for healthcare not only require information about effectiveness, safety and cost-effectiveness, but also need adequate implementation. Influenza is an important public health problem and it causes significant mortality particularly in the elderly and high-risk groups [1]. An obvious policy is to vaccinate those most at risk and most countries in Europe and North America have such programmes [2]. Although the benefit of vaccination is well documented [3], [4], there remains significant influenza-associated morbidity and mortality in the high-risk. A complementary approach to protecting the vulnerable could be to provide indirect protection by vaccinating others to reduce transmission of influenza. Vaccination of children has been shown to have the potential to reduce morbidity and mortality in others [5]. Healthcare workers (HCWs) can cause outbreaks in patients in the healthcare setting [6]. Although the World Health Organisation recommends that HCWs should be vaccinated against influenza [1], policy in Europe is variable and uptake poor (less than 25%) [2], [7].

Research was commissioned by the European Scientific Working Group on Influenza (ESWI) to look at the effectiveness and cost-effectiveness of vaccinating HCWs as an indirect means of protecting high-risk patients against influenza. This paper integrates the findings from systematic reviews looking at the effectiveness, cost-effectiveness and factors affecting uptake, and an economic evaluation.

Section snippets

Search strategy

We searched electronic databases (Cochrane library, CINAHL, NHSEED, HEED, DARE, MEDLINE and EMBASE to June 2004), Internet sites, registers of trials, citation lists and contacted experts. No language restrictions were applied. (Full details available on request.)

Key words used: influenza; health personnel; health care worker; health worker; care giver; physician; medical staff; nurses; nursing home; homes for the aged; residential home; vaccination; influenza vaccine.

Inclusion criteria

Studies were included if

Results

We identified 493 studies relating to vaccinating healthcare workers. Eighteen met the inclusion criteria [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27] (see Fig. 1). Details of the studies are given in Table 1.

Key results

The evidence for the indirect protection of patients at high-risk for influenza and factors influencing vaccine uptake by HCWs have not previously been the subject of systematic reviews. Our review suggests that vaccination of HCWs against influenza protects HCWs and provides indirect protection to the high-risk. It is cost-effective and indeed probably cost saving.

Limitations and strengths

Only two trials examined the impact of immunising HCWs against influenza on high-risk patients [10], [11]. Sparse information on

Acknowledgements

This paper was commissioned by the European Scientific Working Group on Influenza and is based on a report available from the University of Birmingham: http://www.pcpoh.bham.ac.uk/publichealth/wmhtac/reports.htm#REP_Reports. We thank the following: Dr Fujian Song, Dr Rod Taylor, and Professor Nick Freemantle for their statistical and methodological advice; Dr Iain Blair (Communicable Disease) and Dr Richard Harling (influenza vaccine trials) for their expert specialist advice; Dr John Edmunds

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