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Vaccine X. 2019 Jul 11;2:100036. doi: 10.1016/j.jvacx.2019.100036. eCollection 2019 Aug 9.
A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence.
Jenkin DC1, Mahgoub H2, Morales KF3, Lambach P4, Nguyen-Van-Tam JS1.
Author information
1 Health Protection and Influenza Research Group (WHO Collaborating Centre), University of Nottingham School of Medicine, United Kingdom. 2 East of England Health Protection Team, Public Health England, United Kingdom. 3 Sierra Strategy Group, Evian les Baines, France. 4 World Health Organization, Geneva, Switzerland.
Abstract
Introduction:
The World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a 'whole-of-system' perspective to consider possible benefits for HWs, employers and patients.
Methods:
We executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases.
Results:
Of 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination.
Conclusions:
The evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients.
KEYWORDS:
GAVI, the global alliance for vaccines and immunization; HW, health workers; Health worker; Healthcare; ILI, influenza like illness; Influenza; LTCF, long-term care facility(ies); NNV, number needed to vaccinate; OR, odds ratio; Policy; RCTs, randomised controlled trials; RR, relative risk; Transmission; Vaccine; WHO, World Health organization; cRCTs, clustered randomised controlled trials
PMID: 31384750 PMCID: PMC6668237 DOI: 10.1016/j.jvacx.2019.100036
Free PMC Article
A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence.
Jenkin DC1, Mahgoub H2, Morales KF3, Lambach P4, Nguyen-Van-Tam JS1.
Author information
1 Health Protection and Influenza Research Group (WHO Collaborating Centre), University of Nottingham School of Medicine, United Kingdom. 2 East of England Health Protection Team, Public Health England, United Kingdom. 3 Sierra Strategy Group, Evian les Baines, France. 4 World Health Organization, Geneva, Switzerland.
Abstract
Introduction:
The World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a 'whole-of-system' perspective to consider possible benefits for HWs, employers and patients.
Methods:
We executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases.
Results:
Of 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination.
Conclusions:
The evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients.
KEYWORDS:
GAVI, the global alliance for vaccines and immunization; HW, health workers; Health worker; Healthcare; ILI, influenza like illness; Influenza; LTCF, long-term care facility(ies); NNV, number needed to vaccinate; OR, odds ratio; Policy; RCTs, randomised controlled trials; RR, relative risk; Transmission; Vaccine; WHO, World Health organization; cRCTs, clustered randomised controlled trials
PMID: 31384750 PMCID: PMC6668237 DOI: 10.1016/j.jvacx.2019.100036
Free PMC Article