Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. Promoting uptake of influenza vaccination among health care workers: a randomized controlled trial. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial A New Approach to Improving Healthcare Personnel Influenza Immunization Programs: A Randomized Controlled Trial Healthcare-associated influenza in Canadian hospitals from 2006 to 2012. Influenza vaccine uptake among staff in care homes in Nottinghamshire: a random cluster sample survey. Seasonal influenza vaccination coverage and its determinants among nursing homes personnel in western France Nursing home medical staff organization: correlates with quality indicators. The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities. A Worksite Influenza Immunization Program Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. Effects of a multi-faceted program to increase influenza vaccine uptake among health care workers in nursing homes: A cluster randomised controlled trial. Influenza A among hospital personnel and patients. Implications for recognition, prevention, and control. Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing? Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients Absenteeism among hospital staff during an influenza epidemic: implications for immunoprophylaxis. Effectiveness of an intervention campaign on influenza vaccination of professionals in nursing homes: A cluster-randomized controlled trial. Workplace Interventions and Vaccination-Related Attitudes Associated With Influenza Vaccination Coverage Among Healthcare Personnel Working in Long-Term Care Facilities, 2015‒2016 Influenza Season. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study
OBJECTIVES To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents . DESIGN Pair-matched cluster-r and omized trial . SETTING Forty nursing homes matched for size , staff vaccination coverage during the previous season , and resident disability index . PARTICIPANTS All persons aged 60 and older residing in the nursing homes . INTERVENTION Influenza vaccine was administered to volunteer staff after a face-to-face interview . No intervention took place in control nursing homes . MEASUREMENTS The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community . Secondary endpoints were rates of hospitalization and influenza-like illness ( ILI ) in residents and sick leave from work in staff . RESULTS Staff influenza vaccination rates were 69.9 % in the vaccination arm versus 31.8 % in the control arm . Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm ( odds ratio=0.86 , P=.08 ) , although multivariate-adjusted analysis showed 20 % lower mortality ( P=.02 ) , and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents ( correlation coefficient=-0.42 , P=.007 ) . In the vaccination arm , significantly lower resident hospitalization rates were not observed , but ILI in residents was 31 % lower ( P=.007 ) , and sick leave from work in staff was 42 % lower ( P=.03 ) . CONCLUSION These results support influenza vaccination of staff caring for institutionalized elderly people In a r and omized controlled trial , an intensive promotional campaign failed to increase the uptake of vaccination against influenza among health care workers . The uptake of vaccination was low Objective To determine whether vaccination of care home staff  against influenza indirectly protects residents . Design Pair matched cluster r and omised controlled trial . Setting Large private chain of UK care homes during the winters of 2003 - 4 and 2004 - 5 . Participants Nursing home staff ( n=1703 ) and residents ( n=2604 ) in 44 care homes ( 22 intervention homes and 22 matched control homes ) . Interventions Vaccination offered to staff in intervention homes but not in control homes . Main outcome measures The primary outcome was all cause mortality of residents . Secondary outcomes were influenza-like illness and health service use in residents . Results In 2003 - 4 vaccine coverage in full time staff was 48.2 % ( 407/884 ) in intervention homes and 5.9 % ( 51/859 ) in control homes . In 2004 - 5 uptake rates were 43.2 % ( 365/844 ) and 3.5 % ( 28/800 ) . National influenza rates were substantially below average in 2004 - 5 . In the 2003 - 4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes ( rate difference −5.0 per 100 residents , 95 % confidence interval −7.0 to −2.0 ) and in influenza-like illness ( P=0.004 ) , consultations with general practitioners for influenza-like illness ( P=0.008 ) , and admissions to hospital with influenza-like illness ( P=0.009 ) . No significant differences were found in 2004 - 5 or during periods of no influenza activity in 2003 - 4 . Conclusions Vaccinating care home staff against influenza can prevent deaths , health service use , and influenza-like illness in residents during periods of moderate influenza activity . Trial registration National Research Register N0530147256 Background Healthcare personnel influenza immunization rates  remain sub-optimal . Following multiple studies and expert consultations , the “ Successful Influenza Immunization Programs for Healthcare Personnel : A Guide for Program Planners ” was produced . This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations . Methods A sample of 26 healthcare organizations across six Canadian provinces ( ON , MB , NS , BC , SK , NL ) was r and omized to Intervention ( n=13 ) or Control groups ( n=13 ) . Baseline influenza immunization rates were obtained for 2008–2009 ; the study groups were followed over two subsequent influenza seasons . The Intervention group received the Guide , facilitation support through workshops for managers and ongoing support . The Control groups conducted programs as usual . The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment question naire . Findings Twenty-six organizations agreed to participate . 35 % ( 9/26 ) of sites were acute care hospitals , 19 % ( 5/26 ) continuing care , long-term care organizations or nursing homes , and 46 % ( 12/26 ) were mixed acute care hospitals and long-term care or regional health authorities . The median rate of influenza immunization among healthcare personnel for the Intervention group was 43 % , 44 % , and 51 % at three points in time respectively , and in the Control group : 62 % , 57 % , and 55 % respectively . No significant differences were observed between the groups at the three points in time . However , there was a 7 % increase in the median rates between the Baseline Year and Year Two in the Intervention group , and a 6 % decrease in the Control group over the same time period , which was statistically significant ( 0.071 versus -0.058 , p < 0.001 ) . Interpretation This pragmatic r and omized trial of the Guide with facilitation of its implementation improved  healthcare personnel immunization rates , but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized . Trial Registration Clinical Trials.gov OBJECTIVE To determine trends , patient characteristics , and outcome of patients with healthcare-associated influenza in Canadian hospitals . DESIGN Prospect i ve surveillance of laboratory-confirmed influenza among hospitalized adults was conducted from 2006 to 2012 . Adults with positive test results at or after admission to the hospital were assessed . Influenza was considered to be healthcare associated if symptom onset was equal to or more than 96 hours after admission to a facility or if a patient was readmitted less than 96 hours after discharge or admitted less than 96 hours after transfer from another facility . Baseline characteristics of influenza patients were collected . Patients were reassessed at 30 days to determine the outcome . SETTING Acute care hospitals participating in the Canadian Nosocomial Infection Surveillance Program . RESULTS A total of 570 ( 17.3 % ) of 3,299 influenza cases were healthcare associated ; 345 ( 60.5 % ) were acquired in a long-term care facility ( LTCF ) , and 225 ( 39.5 % ) were acquired in an acute care facility ( ACF ) . There was year-to-year variability in the rate and proportion of cases that were healthcare associated and variability in the proportion that were acquired in a LTCF versus an ACF . Patients with LTCF-associated cases were older , had a higher proportion of chronic heart disease , and were less likely to be immunocompromised compared with patients with ACF-associated cases ; there was no significant difference in 30-day all-cause and influenza-specific mortality . CONCLUSIONS Healthcare-associated influenza is a major component of the burden of disease from influenza in hospitals , but the proportion of cases that are healthcare associated varies markedly from year to year , as does the proportion of healthcare-associated infections that are acquired in an ACF versus an LTCF OBJECTIVES To establish uptake of influenza vaccine amongst care home clinical staff in Greater Nottingham , and to investigate what could be done to improve vaccine uptake in this group . STUDY DESIGN Postal question naire surveys were used . In the first instance , a total sample survey was used . In the second instance , a sample of care home staff was surveyed , r and omized at the care home level . METHODS A postal question naire completed by care home matrons was used to obtain a preliminary estimate of staff vaccine uptake . Individual staff question naires were then used to vali date this finding , and measure attitudes , beliefs and behaviours associated with vaccination . RESULTS Vaccine uptake among those working in care homes with nursing was found to be low . Vaccine uptake was higher in homes with a policy recommending vaccination of staff . Most respondents who had received vaccination reported that they had done so because of an existing medical condition , rather than because of being a healthcare worker . A statistically significant relationship ( P=0.02 ) was found between individuals ' reported beliefs on how well they could resist influenza and their vaccination status . CONCLUSIONS All care homes for the elderly should have a vaccination policy which recommends staff vaccination . Educational campaigns , vaccination in the workplace and free provision of the influenza vaccine may help to improve vaccine uptake in this group Background Influenza-associated deaths is an important risk for the elderly in nursing homes ( NHs ) worldwide . Vaccination coverage among residents is high but poorly effective due to immunosenescence . Hence , vaccination of personnel is an efficient way to protect residents . Our objective was to quantify the seasonal  influenza vaccination ( IV ) coverage among NH for elderly workers and identify its determinants in France . Methods We conducted a cross-sectional study in March 2016 in a r and omized sample of NHs of the Ille-et-Vilaine department of Brittany , in western France . A st and ardized question naire was administered to a r and omized sample of NH workers for face-to-face interviews . General data about the establishment was also collected . Results Among the 33 NHs surveyed , IV coverage for the 2015–2016 season among permanent workers was estimated at 20 % ( 95 % Confidence Interval ( CI ) 15.3%–26.4 % ) ranging from 0 % to 69 % depending on the establishments surveyed . Moreover , IV was associated with having previously experienced a “ severe ” influenza episode in the past ( Prevalence Ratio 1.48 , 95 % CI 1.01–2.17 ) , and varied by professional categories ( p < 0.004 ) with better coverage among administrative staff . Better knowledge about influenza prevention tools was also correlated ( p < 0.001 ) with a higher IV coverage . Individual perceptions of vaccination benefits had a significant influence on the IV coverage ( p < 0.001 ) . Although IV coverage did not reach a high rate , our study showed that personnel considered themselves sufficiently informed about IV . Conclusions IV coverage remains low in the NH worker population in Ille-et-Vilaine and also possibly in France . Strong variations of  IV coverage among NHs suggest that management and working environment play an important role . To overcome vaccine “ hesitancy ” , specific communication tools may be required to be adapted to the various NH professionals to improve influenza prevention OBJECTIVES Little is known about the relationship between how medical care is organized and delivered in nursing homes . Taking a lead from the acute care arena , we hypothesize that nursing home medical staff organization ( NHMSO ) is an important predictor of clinical outcomes in the nursing home . METHODS A total of 202 usable surveys from a 2-wave survey process using the Dillman Method were returned from medical directors who were r and omly selected from the AMDA membership and were asked to fill out a survey on the structure of medical organization in their primary nursing home practice . Quality measures that are likely to be affected by physician practice patterns were culled from NH Compare and OSCAR data sets and matched to the physician surveys , ie , long stay residents ' prevalence of pain , restraint use , catheter use , pressure ulcers , pneumococcal vaccination , influenza vaccination , presence of advanced directives , prescription of antibiotics , and prevalence of depression . RESULTS Using a series of hierarchical multiple regressions , significant R(2 ) changes were found when the medical staff organization dimensions were added in the regressions after controlling for nursing home structural characteristics for the following outcomes : pneumococcal vaccination and restraint use . Near significant findings were noted for pain prevalence among long-stay residents , catheter use , and prevalence of pressure ulcers . CONCLUSIONS This study is the first to demonstrate a relationship between medical staff organizational dimensions and clinical outcomes in the nursing home setting and as such represents an initial " proof of concept . " NHMSO should be considered as a potentially important mediating or moderating variable in the quality of care equation for nursing homes OBJECTIVES We examined barriers to influenza vaccination among long-term care facility ( LTCF ) health care workers in Southern California and developed simple , effective interventions to improve influenza vaccine coverage of these workers . METHODS In 2002 , health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine . Results were used to develop 2 interventions , an educational campaign and Vaccine Day ( a well-publicized day for free influenza vaccination of all employees at the worksite ) . Seventy facilities were recruited to participate in an intervention trial and r and omly assigned to 4 study groups . RESULTS The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage ( 53 % coverage ; prevalence ratio [PR]=1.45 ; 95 % confidence interval [CI]=1.24 , 1.71 , compared with 27 % coverage in the control group ) . Vaccine Day alone was also effective ( 46 % coverage ; PR= 1.41 ; 95 % CI=1.17 , 1.71 ) . The educational campaign alone was not effective in improving coverage levels ( 34 % coverage ; PR=1.18 ; 95 % CI=0.93 , 1.50 ) . CONCLUSION Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day Using a r and omized , retrospective case control survey approach , this study compared emplyees immunized ( cases ) to a group of non immunized employees ( controls ) between the months of October and December 1994 . In May 1995 , a self administered question naire  was distributed to employees working at the Hanford nuclear reservation located in eastern Washington State . Bivariate analysis included chi-square tests to study the association between influenza vaccine and rates of influenza like illness and related complications , rates of employee absenteeism , rates of physician visits , use of prescribed medication , and rates of hospitalization . To assess the economic benefits associated with vaccination , analysis included estimating the direct and indirect costs associated with immunization and influenza like illnesses , and complications related to influenza like illnesses . Responses to the survey result ed in 789 employees in the vaccinated group and 931 employees in the nonvaccinated group . As compared to vaccinated employees , nonvaccinated employees reported significantly higher rates of episodes of influenza like illness ( 78 per 100 compared to 59 per 100 , p < 0 ) , influenza related complications ( 8.0 compared to 5.0 , p < .01 ) , lost work days ( 63 per 100 compared to 35 per 100 , p < 0 ) , use of prescription medication ( 18.6 per 100 compared to 8.7 per 100 , p < 0 ) , physician visits ( 18.6 per 100 compared to 8.7 per 100 , p < 0 ) , and inpatient hospital . Cost savings were estimated to be $ 83.84 per person vaccinated . The results of this study suggest this worksite influenza vaccination program produced significant health related and economic benefit to employee participants and their employers CONTEXT Although the cost-effectiveness and cost-benefit of influenza vaccination are well established for persons aged 65 years or older , the benefits for healthy adults younger than 65 years are less clear . OBJECTIVE To evaluate the effectiveness and cost-benefit of influenza vaccine in preventing influenza-like illness ( ILI ) and reducing societal costs of ILI  among healthy working adults . DESIGN Double-blind , r and omized , placebo-controlled trial conducted during 2 influenza seasons . SETTING AND PARTICIPANTS Healthy adults aged 18 to 64 years and employed full-time by a US manufacturing company ( for 1997 - 1998 season , n = 1184 ; for 1998 - 1999 season , n = 1191 ) . INTERVENTIONS For each season , participants were r and omly assigned to receive either trivalent inactivated influenza vaccine ( n = 595 in 1997 - 1998 and n = 587 in 1998 - 1999 ) or sterile saline injection ( placebo ; n = 589 in 1997 - 1998 and n = 604 in 1998 - 1999 ) . Participants in 1997 - 1998 were rer and omized if they participated in 1998 - 1999 . MAIN OUTCOME MEASURES Influenza-like illnesses and associated physician visits and work absenteeism reported in biweekly question naires by all participants , and serologically confirmed influenza illness among 23 % of participants in each year ( n = 275 in 1997 - 1998 ; n = 278 in 1998 - 1999 ) ; societal cost of ILI per vaccinated vs unvaccinated person . RESULTS For 1997 - 1998 and 1998 - 1999 , respectively , 95 % ( 1130/1184 ) and 99 % ( 1178/1191 ) of participants had complete follow-up , and 23 % in each year had serologic testing . In 1997 - 1998 , when the vaccine virus differed from the predominant circulating viruses , vaccine efficacy against serologically confirmed influenza illness was 50 % ( P = .33 ) . In this season , vaccination did not reduce ILI , physician visits , or lost workdays ; the net societal cost was $ 65.59 per person compared with no vaccination . In 1998 - 1999 , the vaccine and predominant circulating viruses were well matched . Vaccine efficacy was 86 % ( P = .001 ) , and vaccination reduced ILI , physician visits , and lost workdays by 34 % , 42 % , and 32 % , respectively . However , vaccination result ed in a net societal cost of $ 11.17 per person compared with no vaccination . CONCLUSION Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI , lost workdays , and physician visits during years when the vaccine and circulating viruses are similar , but vaccination may not provide overall economic benefits in most years . JAMA . 2000;284:1655 - 1663 Despite the recommendation of the Dutch association of nursing home physicians ( NVVA ) to be immunized against influenza , vaccine uptake among HCWs in nursing homes remains unacceptably low . Therefore we conducted a cluster r and omised controlled trial among 33 Dutch nursing homes to assess the effects of a systematic ally developed multi-faceted intervention program on  influenza vaccine uptake among HCWs . The intervention program result ed in a significantly higher , though moderate , influenza vaccine uptake among HCWs in nursing homes . To take full advantage of this measure , either the program should be adjusted and implemented over a longer time period or m and atory influenza vaccination should be considered An outbreak of influenza A/Philippines H3N2 at a 1156-bed Veterans Administration Hospital involved 118 hospital personnel and 49 patients . Prospect i ve surveillance methods that had been established within the hospital were not useful in identifying the number of involved individuals . Community indicators of influenza , which were review ed retrospectively , would not have identified circulating influenza in this population . Control of the outbreak was accomplished using a creative approach that immunized over a third of the physician and nursing staff . This immunization program was successfully used in subsequent years to increase personnel compliance with the Immunization Practice s Advisory Committee recommendations to annually immunize hospital personnel We conducted a national cross-sectional survey to investigate  vaccination coverage ( VC ) in health care personnel ( HCP ) working in clinics and hospitals in France . We used a two-stage stratified r and om sampling design to select 1127 persons from 35 health care setting s. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor . A total of 183 physicians , 110 nurses , 58 nurse-assistants and 101 midwives were included .  VC for compulsory  vaccinations  was 91.7 % for hepatitis B , 95.5 % for the booster dose of diphtheria-tetanus-polio ( DTP ) , 94.9 % for BCG . For non-compulsory vaccinations , coverage was 11.4 % for the 10 year booster of the DTP pertussis containing vaccine , 49.7 % for at least one dose of measles , 29.9 % for varicella and 25.6 % for influenza . Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors , nor in surgeons and anaesthesiologists compared to physicians working in medicine . Young HCP were better vaccinated for pertussis and measles ( p<0.01 ) , and those working in an obstetric or a paediatric ward were better vaccinated for influenza and pertussis ( p<0.01 ) . HCP are overall well covered by compulsory vaccinations , whereas VC for non-compulsory vaccinations is very insufficient . The vaccination policy regarding these latter vaccinations should be reinforced in France BACKGROUND Vaccination of health-care workers has been cl aim ed to prevent nosocomial influenza infection of elderly patients in long-term care . Data are , however , limited on this strategy . We aim ed to find out whether vaccination of health-care workers lowers mortality and the frequency of virologically proven influenza in such patients . METHODS In a parallel-group study , health-care workers in 20 long-term elderly-care hospitals ( range 44 - 105 patients ) were r and omly offered  or not offered influenza vaccine  ( cluster r and omisation , stratified for policy for vaccination of patients and hospital size ) . All deaths among patients were recorded over 6 months in the winter of 1996 - 97 . We selected a r and om sample of 50 % of patients for virological surveillance for influenza , with combined nasal and throat swabs taken every 2 weeks during the epidemic period . Swabs were tested by tissue culture and PCR for influenza viruses A and B. FINDINGS Influenza vaccine uptake in health-care workers was 50.9 % in hospitals in which they were routinely offered vaccine , compared with 4.9 % in those in which they were not . The uncorrected rate of mortality in patients was 102 ( 13.6 % ) of 749 in vaccine hospitals compared with 154 ( 22.4 % ) of 688 in no-vaccine hospitals ( odds ratio 0.58 [ 95 % CI 0.40 - 0.84 ] , p=0.014 ) . The two groups did not differ for proportions of patients positive for influenza infection ( 5.4 % and 6.7 % , respectively ) ; at necropsy , PCR was positive in none of 17 patients from vaccine hospitals and six ( 20 % ) of 30 from no-vaccine hospitals ( p=0.055 ) . INTERPRETATION Vaccination of health-care workers was associated with a substantial decrease in mortality among patients . However , virological surveillance showed no associated decrease in non-fatal influenza infection in patients BACKGROUND Influenza and pneumococcal pneumonia are serious health problems among elderly people and a major cause of death in long-term care facilities . We describe the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities over the last decade . METHODS Cross-sectional surveys consisting of question naires  mailed to all Canadian residential long-term care facilities for elderly people in 1991 and to a r and om sample of respondents in 1995 and 1999 . RESULTS The response rates were 83 % ( 430/515 ) in 1995 and 75 % ( 380/506 ) in 1999 . In 1999 the mean reported rates of influenza vaccination  were 83 % among residents and 35 % among staff , and the mean rate of  pneumococcal vaccination  among residents was 71 % ; all 3 rates were significantly higher than those in 1991 . The rates were also higher in facilities with an infection control practitioner than in those without such an individual ( 88 % v. 82 % for influenza vaccination among residents [ p < 0.001 ] , 42 % v. 35 % for influenza vaccination among staff [ p = 0.008 ] and 75 % v. 63 % for pneumococcal vaccination among residents [ p < 0.001 ] ) . Obtaining consent for vaccination on admission to the facility was associated with higher influenza and pneumococcal vaccination rates among residents ( p = 0.04 and p < 0.001 respectively ) . Facilities with higher influenza vaccination rates among residents and staff reported lower rates of influenza outbreaks ( p = 0.08 and 0.03 respectively ) . Despite recommendations from the National Advisory Committee on Immunization , only 50 % of the facilities had policies for amantadine prophylaxis during influenza A outbreaks . Amantadine was judged effective in controlling 76 % of the influenza A outbreaks and was discontinued because of side effects in 3 % of the residents . INTERPRETATION Influenza and pneumococcal vaccination rates among residents and staff in Canadian long-term care facilities have increased over the last decade but remain suboptimal . Vaccination of residents and staff against influenza is associated with a reduced risk of influenza outbreaks .  Amantadine is effective in controlling influenza outbreaks in long-term care facilities Abstract Vaccination of health care workers ( HCWs ) is recommended as a strategy for preventing influenza in elderly patients in long-term care . However , there have been no controlled studies to show whether this approach is effective . During the winter of 1994–1995 , 1059 patients in 12 geriatric medical long-term-care sites , r and omized for vac.cination of HCWs , were studied . In hospitals where HCWs were offered vaccination , 653 ( 61 % ) of 1078 were vaccinated . Vaccination of HCWs was associated with reductions in total patient mortality from 17 % to 10 % ( odds ratio [ OR ] , 0.56 ; 95 % confidence interval [ CI ] , 0.40–0.80 ) and in influenza-like illness ( OR , 0.57 ; 95 % CI , 0.34–0.94 ) . Vaccination of patients was not associated with significant effects on mortality ( OR , 1.15 ; 95 % CI , 0.81–1.64 ) . Results of this study support recommendations for vaccination against influenza of HCWs in long-term geriatric care . Vaccination of frail elderly long-term-care patients may not give clinical ly worthwhile benefits The 1980 - 81 epidemic of  influenza A/Bangkok 79  was responsible for increased absenteeism ( 1.7 times the rate for the corresponding period of the subsequent nonepidemic year ) among selected hospital staff in Winnipeg 's Health Sciences Centre . Retrospective study of employment records for 25 of the centre 's largest departments showed excess sick-leave costs of about $ 24 500 during the 2-week period of peak absenteeism that included the epidemic . Although the centre was sampling prospect ively for the virus the first positive results became available too late for chemoprophylactic measures to have been effective . The greater increase in absenteeism among nursing staff caring for patients with chronic respiratory disease and nurses working on general medical or pediatric acute infection/isolation wards suggested that these groups be targeted for influenza vaccination in hospitals BACKGROUND Seasonal influenza has a major individual and collective impact , especially among the elderly living in nursing homes . To prevent infection by influenza viruses , vaccination of residents and professionals is an essential measure . However , while the vaccination rates of residents are generally high ( > 85 % ) , rates among professionals are generally approximately 20 % . To evaluate the effectiveness of an intervention campaign on the improvement of the influenza vaccination rate of professionals , a regional intervention study was proposed for nursing homes during the 2014 - 15 season . METHODS Cluster-r and omized controlled trial ( with a nursing home representing a cluster ) . In the intervention group , a campaign on influenza vaccination was offered to staff , combining different teaching aids in a multimodal approach . In the control group , no intervention was proposed . The primary endpoint was the rate of influenza vaccination among staff . Before and after the study , professionals were asked to complete short question naires on their perceptions of influenza vaccination . A multilevel analysis was carried out to compare the vaccination rates between the 2 groups and their evolution before/after the winter period . RESULTS A total of 32 nursing homes were r and omized , and 6 were excluded .  Initial vaccination rates were 27.6 % in the intervention group and 24.2 % in the control group ( p = 0.16 ) . After the study , these rates increased to 33.7 % and 22.9 % , respectively , which was a relative difference of + 22.1 % in the intervention group compared to -5.4 % in the control group , p = 0.0025 . CONCLUSIONS Despite professionals ' reluctance to be vaccinate , participation in a promotional campaign with a pragmatic approach has increased the rate of influenza vaccination . The approach will be offered to all nursing homes in the region after revision of the tools to enhance their ease of use and pedagogical messages focused on the direct benefits to professionals OBJECTIVES Influenza vaccination of healthcare personnel working in long-term care ( LTC ) facilities can reduce influenza-related morbidity and mortality among healthcare personnel and among resident population s who are at increased risk for complications from influenza and who may respond poorly to vaccination . The objective of this study was to investigate workplace interventions and healthcare personnel vaccination-related attitudes associated with higher influenza vaccination coverage among healthcare personnel working in LTC facilities . SETTING AND PARTICIPANTS Data were obtained from an online survey of healthcare personnel conducted in April 2016 among a nonprobability sample of 2258 healthcare personnel recruited from 2 preexisting national opt-in Internet panels . Respondents were asked about influenza vaccination status , workplace vaccination policies and interventions , and their attitudes toward vaccination . Analyses were restricted to the 332 healthcare personnel who worked in nursing homes , assisted living facilities , or other LTC facilities . MEASURES Logistic regression models were used to assess the independent associations between each workplace intervention and higher influenza vaccination coverage compared with referent levels , controlling for occupation , age , and race/ethnicity . Prevalence ratios were calculated under the assumption of simple r and om sampling . RESULTS Approximately 77 % of healthcare personnel working in LTC facilities reported  receiving influenza vaccination  in the 2015‒2016 influenza season . Influenza vaccination was independently associated with an employer vaccination requirement ( prevalence ratio ( PR ) [ 95 % confidence interval ] = 1.28 [ 1.11 , 1.47 ] ) , being offered free onsite vaccination ( PR = 1.20 [ 1.04 , 1.39 ] ) , and employers publicizing vaccination coverage level to employees ( PR = 1.24 [ 1.09 , 1.41 ] ) . Vaccination was most highly associated with a combination of 3 or more workplace interventions . Most healthcare personnel working in LTC facilities reported positive attitudes toward the safety and effectiveness of influenza vaccination . CONCLUSIONS / IMPLICATION S Implementing employer vaccination interventions in LTC facilities , including employer vaccination requirements and free on-site influenza vaccination that is actively promoted , could increase influenza vaccination among healthcare personnel BACKGROUND Estimates of influenza-associated mortality are important for national and international decision making on public health priorities . Previous estimates of 250 000 - 500 000 annual influenza deaths are out date d. We up date d the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999 - 2015 . METHODS We estimated country-specific influenza-associated respiratory excess mortality rates ( EMR ) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data . To extrapolate estimates to countries without data , we divided countries into three analytic divisions for three age groups ( < 65 years , 65 - 74 years , and ≥75 years ) using WHO Global Health Estimate ( GHE ) respiratory infection mortality rates . We calculated mortality rate ratios ( MRR ) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates . To calculate death estimates for individual countries within each age-specific analytic division , we multiplied r and omly selected mean annual EMRs by the country 's MRR and population . Global 95 % credible interval ( CrI ) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year . We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods . FINDINGS EMR-contributing countries represented 57 % of the global population . The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years , 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years , and 17·9 to 223·5 per 100 000 for people older than 75 years . We estimated that 291 243 - 645 832 seasonal influenza-associated respiratory deaths ( 4·0 - 8·8 per 100 000 individuals ) occur annually . The highest mortality rates were estimated in sub-Saharan Africa ( 2·8 - 16·5 per 100 000 individuals ) , southeast Asia ( 3·5 - 9·2 per 100 000 individuals ) , and among people aged 75 years or older ( 51·3 - 99·4 per 100 000 individuals ) . For 92 countries , we estimated that among children younger than 5 years , 9243 - 105 690 influenza-associated respiratory deaths occur annually . INTERPRETATION These global influenza-associated respiratory mortality estimates are higher than previously reported , suggesting that previous estimates might have underestimated disease burden . The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated . FUNDING None
Healthcare workers ( HCWs ) in long-term care facilities ( LTCFs ) can represent a source of influenza infection for the elderly .
While flu vaccination coverage ( VC ) is satisfactory in the elderly , HCWs are less likely to be vaccinated .
There is no definitive evidence on which types of healthcare system-based interventions at LTCFs would be more useful in improving the vaccination uptake among HCWs .