Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on influenza vaccine coverage among hospital healthcare workers and nosocomial influenza in the Netherlands, 2009 to 2011. [Outbreaks due to respiratory syncytial virus and influenzavirus A/H3N in institutionalized aged. Role of immunological status to influenza vaccine and possible implication of caregivers in the transmission]. Intensive surveillance for infections in a three-year study of nursing home patients. Influenza vaccination of healthcare workers in acute-care hospitals: a case-control study of its effect on hospital-acquired influenza among patients The measurement of influenza vaccine coverage among health care workers. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized 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 novel approach to improve influenza vaccination rates among health care professionals: a prospective randomized controlled trial. Randomised active programs on healthcareworkers’ flu vaccination in geriatric health care settings in France: The VESTA study The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities. The efficacy of influenza vaccination in healthcare workers in a tropical setting: a prospective investigator blinded observational study. Factors influencing uptake of influenza vaccination among hospital-based health care workers. A comparison of self-report and health care provider data to assess surveillance definitions of influenza-like illness in outpatients. Effectiveness of influenza vaccination in prevention of influenza-like illness among inhabitants of old folk homes. Effect of influenza vaccine status on winter mortality in Spanish community-dwelling elderly people during 2002-2005 influenza periods. 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
Nosocomial influenza is a large burden in hospitals . Despite recommendations from the World Health Organization to vaccinate healthcare workers against influenza , vaccine uptake remains low in most European countries . We performed a pragmatic cluster r and omised controlled trial in order to assess the effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital healthcare workers ( HCWs ) and on  in-patient morbidity . We included hospital HCWs of three intervention and three control University Medical Centers ( UMCs ) , and 3,367 patients . An implementation programme was offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and patient morbidity . In 2009/10 , the coverage of seasonal , the first and second dose of p and emic influenza vaccine  as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs ( all p<0.05 ) . At the internal medicine departments of the intervention group with higher vaccine coverage compared to the control group , nosocomial influenza and /or pneumonia was recorded in 3.9 % and 9.7 % of patients of intervention and control UMCs , respectively ( p=0.015 ) . Though potential bias could not be completely ruled out , an increase in vaccine coverage was associated with decreased patient in-hospital morbidity from influenza and /or pneumonia OBJECTIVES Report of epidemiological , clinical and virological data collected from the prospect i ve surveillance of febrile episodes observed in aged residents of a long-stay care unit of 33 beds , at the University Hospital of Saint-Etienne , during the 1997 - 1998 winter season . METHODS Systematic collection of clinical and biological data from febrile patients ( > or = 38 degrees C ) on a form , including virological findings obtained from a nasal swab and paired serum specimens . RESULTS From 38 patients ( 37 of them having been vaccinated against influenza in October 1997 ) , 18 febrile episodes were recorded in 16 subjects , including 3 respiratory syncytial virus infections and a late-occurring outbreak ( March 1998 ) of influenza due to a A/H3N2 strain ( 15 cases , 14 of them virologically confirmed ) . No death was noted after the influenza outbreak . In 8 of the 9 tested patients with influenza , " protective " titres of antibodies directed towards the hemagglutinin of the vaccinal strain were present by radial hemolysis test three months before the beginning of the outbreak . During the influenza outbreak , the attack rate of symptomatic infection was 45.5 % in elderly and 47.5 % in healthcare workers ( mainly unvaccinated ) . The occurrence of the first cases in the latter suggests their possible role in the transmission of the virus to the aged . CONCLUSION This study underlines the epidemic circulation of multiple respiratory viruses during the same winter season in long-stay care facilities , the occurrence of clinical influenza infections in vaccinated patients exhibiting protective antibody titres and the role of unvaccinated healthcare workers in the propagation of influenza in institutionalised aged The authors report the results of a 3-year ( August 1984-May 1987 ) prospect i ve study of intensive surveillance for nursing home-associated infections in 666 patients in a 300-bed nursing home in San Diego , California . Ninety-three percent ( 666 of 714 ) of the eligible subjects enrolled ; 75 % were women . The mean age of the subjects was 81.6 years .  Lengths of stay ranged from 1 day to 1,025 days , with a mean of 166 days ; the cumulative length of stay for all subjects was 110,746 days ( 303 years ) . Operational definitions that were heavily dependent on evaluation of clinical signs and symptoms were used by nurse practitioners in weekly or biweekly assessment s of all patients to identify infections . The overall incidence of nursing home-associated infection was 7.1 infections/1,000 patient-days . Many of the infections would not have been recognized by persons less skilled than nurse practitioners . Among the 788 nursing home-associated infections identified , 362 ( 47 % ) were in the respiratory tract ( 286 lower respiratory and 76 upper respiratory ) ; 200 ( 25 % ) were associated with skin and subcutaneous and mucous membranes ; 140 ( 18 % ) were symptomatic urinary tract infections ; 13 ( 2 % ) were bacteremia ; and 73 ( 9 % ) were other infections Background In acute-care hospitals , no evidence of a protective effect of healthcare worker ( HCW ) vaccination on hospital-acquired influenza ( HAI ) in patients has been documented . Our study objective was to ascertain the effectiveness of  influenza vaccination of HCW on HAI among patients . Methods A nested case-control investigation was implemented in a prospect i ve surveillance study of influenza-like illness ( ILI ) in a tertiary acute-care university hospital . Cases were patients with virologically-confirmed influenza occurring ≥ 72 h after admission , and controls were patients with ILI presenting during hospitalisation with negative influenza results after nasal swab testing . Four controls per case , matched per influenza season ( 2004 - 05 , 2005 - 06 and 2006 - 07 ) , were r and omly selected . Univariate and multivariate conditional logistic regression models were fitted to assess factors associated with HAI among patients . Results In total , among 55 patients analysed , 11 ( 20 % ) had laboratory-confirmed HAI . The median HCW vaccination rate in the units was 36 % . The median proportion of vaccinated HCW in these units was 11.5 % for cases vs. 36.1 % for the controls ( P = 0.11 ) ; 2 ( 20 % ) cases and 21 ( 48 % ) controls were vaccinated against influenza in the current season ( P = 0.16 ) . The proportion of ≥ 35 % vaccinated HCW in short-stay units appeared to protect against HAI among patients ( odds ratio = 0.07 ; 95 % confidence interval 0.005 - 0.98 ) , independently of patient age , influenza season and potential influenza source in the units . Conclusions Our observational study indicates a shielding effect of more than 35 % of vaccinated HCW on HAI among patients in acute-care units . Investigations , such as controlled clinical trials , are needed to vali date the benefits of HCW vaccination on HAI incidence in patients BACKGROUND Annual influenza vaccination is recommended for health care workers in both the United States and Canada . Estimations of vaccine coverage are commonly used to evaluate these vaccination programs . PURPOSE We identify , discuss , and illustrate challenges including definitions of health care worker ( HCW ) , selection of indicators , and data sources in the estimation of staff influenza  vaccination coverage rates . METHODS To illustrate the impact of the factors we discuss , we created a data base of a simulated pool of HCWs that included varying proportions of permanent , casual , and contract staff under differing scenarios of staff turnover and differing probabilities of individuals being vaccinated . The Excel 97 r and om number generator ( Microsoft ) was used to r and omly allocate the HCW to different strata under differing staff turnover rates and to design ate individuals as being vaccinated . RESULTS The nature of the staff targeted in the program policy has a large impact on the estimations of vaccine coverage . Different indicators provide data that might be useful for different purpose s. The counts in the numerator and denominator of a period prevalence may be useful for estimation of the total workload required of the vaccination program . An incidence density might be useful as an indicator of the efficiency of the program in " capturing " staff for vaccination . The indicator that may be easiest is the point prevalence . CONCLUSION Program evaluators must think carefully when planning to estimate staff vaccination coverage to avoid invalid comparisons of estimates over time and place . State or province-wide targets for health care worker ( HCW ) vaccination may be meaningless unless appropriate criteria for the calculation of influenza vaccination rates are developed and specified 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 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 Although influenza is the leading infections cause of death in the United States , only 40 % of health care workers ( HCW ) comply with Centers for Disease Control and Prevention recommendation for routine influenza vaccination . METHODS This study investigated a novel approach for improving influenza vaccination rates among HCW . Eight hundred employees we selected , 200 each from the following 4 categories : professional staff , resident physicians , registered nurses , and licensed practical nurses . Subjects were r and omly assigned to receive ( 1 ) no intervention , ( 2 ) a letter explaining the importance of influenza vaccine for HCW , ( 3 ) a ticket activated with influenza vaccine administration for a raffle of a free Caribbean vacation for 2 , or ( 4 ) both the educational letter and the raffle ticket . We compared the proportion of employees receiving vaccination and participating in the raffle across groups . RESULTS The influenza vaccination rate for all study subjects was 41 % . The number of subjects receiving vaccine did not differ by occupation ( P = .87 ) or intervention group ( P = .66 ) . CONCLUSIONS This study provides no evidence to support the use of mailed educational letters or a single large raffle prize incentive as a means to boost hospital employee influenza vaccination rates Background Because of a lack of efficacy of influenza vaccination in elderly population , there are still numerous outbreaks in geriatric health care setting s. The health care workers ( HCW ) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care setting s. However , the rates of vaccinated HCWs are still low in France . The French Geriatric Infection Risk Institute ( ORIG ) performed the VESTA study , a three-phase multicentre to identify factors limiting vaccination in HCWs , and to develop and implement active programs promoting HCWs influenza vaccination . Objectives To implement multicenter programs to enhance HCW influenza vaccination . Design It was a cluster r and omised interventional studies . Setting 43 geriatric health care setting s ( GHCSs ) , long term care and rehabilitation care setting s in France . Participants 1814 Health care workers from 20 GHCSs in the interventional group and 2,435 health care workers in 23 GHCSs in the control group . InterventionAfter the failure of a first educational program giving scientific information and . tested during the 2005–06 flu season in 43 HCSs , a second program was design ed with the help of marketing experts , one year after Program 1 . The objectives were to involve HCWs in the creation of “ safety zones ” , and to give personal satisfaction . Program 2 was tested during the 2006–07 season . 20 of the 24 HCSs from the Program 1 cluster were included in the Program 2 cluster ( 1,814 HCWs ) , and 16 of the 19 HCSs from the Control 1 cluster , plus 7 new HCSs with interest in participating , were included in the Control 2 cluster ( 23 HCSs ; 2,435 HCWs ) . Measurements The efficacy of each program was assessed by calculating and comparing the percentage of vaccinated HCWs , from all HCSs taken together , in the program and control clusters . Results Program 1 failed to increase the HCW vaccination coverage rate ( VCR ) ( Program 1 : 34 % ; Control 1 : 32 % ; p>0.05 ) , ) . Program 2 increased the VCR in HCWs ( Program 2 : 44 % ; Control 2 : 27 % ; Chi2 test , p<0.001 ) regardless their occupational group but only in the non previous vaccinated subgroup . Conclusions In geriatric health care centres in France , an active multicenter program giving personal satisfaction and taking into account the profile of non-vaccinated HCWs was more effective in promoting flu vaccination than a scientifically factual information program . HCW involvement is required in program implementation in order to avoid rejection of top-down information 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 INTRODUCTION Influenza vaccine has been shown to be highly effective in temperate regions with well-defined seasonal influenza . Healthcare workers ( HCWs ) are advised to receive regular influenza vaccination to protect themselves and their patients . However , there are limited data on the efficacy of influenza vaccine in HCWs in the tropics . MATERIAL S AND METHODS In this observational , investigator blinded cohort study , bi-monthly question naires recording influenza-like illness ( ILI ) episodes and medical leave were administered to 541 HCWs at the Singapore National University Hospital and KK Women 's and Children 's Hospital from 2004 to 2005 .  ILI was defined according to a st and ard symptom score . RESULTS Baseline characteristics were comparable in both the vaccinated and non-vaccinated groups . Overall , the relative risk of self-reported ILI in vaccinated HCWs was 1.13 [ 95 % confidence interval ( CI ) , 0.98 - 1.13 ; P=0.107 ] ; medical leave taken was lower in the vaccinated group [ mean 0.26+/-0.6 days per visit , compared with 0.30+/-0.5 days in the non-vaccinated group ( P=0.40 ) ] . Because of the reported Northern Hemisphere 2003/04 vaccine mismatch , we stratified the cohort and determined that the group which received a matched vaccine had a relative risk of ILI of 0.49 ( 95 % CI , 0.37 - 0.66 ; P<0.001 ) , achieving a vaccine efficacy of 51 % . Mean medical leave decreased significantly in HCWs who received the matched vaccine , compared with those who did not receive vaccination ( 0.13+/-0.3 vs 0.30+/-0.5 ; P<0.001 ) and with HCWs vaccinated with mismatched strains ( 0.13+/-0.3 vs 0.39+/-0.9 ; P=0.01 ) . CONCLUSIONS A well-matched influenza vaccine is effective in preventing ILI and reducing sickness absence in healthcare workers in tropical setting s. Efforts need to be made to increase influenza vaccination rates and to improve the currently available vaccines BACKGROUND Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients , but uptake of voluntary vaccination among health care workers remains low . AIMS Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust . METHODS A structured , self-administered question naire was mailed to a r and om sample of health care workers based in the acute services sector of a UK National Health Service Trust , 6 months following a voluntary immunization programme  implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000 - 2001 . The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note . RESULTS Five hundred and fifty-one health care workers ( 53 % ) responded to the question naire and influenza vaccination  was accepted by 150 ( 28 % ) . The occupational health poster strongly influenced the decision to accept vaccination [ odds ratio ( OR ) = 11.01 ; 95 % confidence interval ( CI ) = 2.13 - 56.80 ; P < 0.0001 ] . Other significant influences included female sex ( OR = 9.11 ; 95 % CI = 1.26 - 65.72 ) and perceived risk of contracting flu without the vaccine ( OR = 7.70 ; 95 % CI = 1.44 - 41.05 ) . Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake . CONCLUSION Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination .  Future campaigns should also emphasize the positive benefits to patients of health care worker immunization , with readily accessible information regarding side-effects available from all sources OBJECTIVE Several surveillance definitions of influenza-like illness ( ILI ) have been proposed , based on the presence of symptoms . Symptom data can be obtained from patients , medical records , or both . Past research has found that agreements between health record data and self-report are variable depending on the specific symptom . Therefore , we aim ed to explore the implication s of using data on influenza symptoms extracted from medical records , similar data collected prospect ively from out patients , and the combined data from both sources as predictors of laboratory-confirmed influenza . METHODS Using data from the Hutterite Influenza Prevention Study , we calculated : 1 ) the sensitivity , specificity and predictive values of individual symptoms within surveillance definitions ; 2 ) how frequently surveillance definitions correlated to laboratory-confirmed influenza ; and 3 ) the predictive value of surveillance definitions . RESULTS Of the 176 participants with reports from participants and medical records , 142 ( 81 % ) were tested for influenza and 37 ( 26 % ) were PCR positive for influenza . Fever ( alone ) and fever combined with cough and /or sore throat were highly correlated with being PCR positive for influenza for all data sources . ILI surveillance definitions , based on symptom data from medical records only or from both medical records and self-report , were better predictors of laboratory-confirmed influenza with higher odds ratios and positive predictive values . DISCUSSION The choice of data source to determine ILI will depend on the patient population , outcome of interest , availability of data source , and use for clinical decision making , research , or surveillance The aims of the study were to determine the attack rate of influenza-like illness among inhabitants of five old folk homes nationwide using influenza vaccine as a probe and the effectiveness of influenza vaccination in prevention of influenza-like illness . We conducted a nonr and omized , single-blind placebo control study from June 2003 to February 2004 . VAXIGRIP(R ) 2003 Southern hemisphere formulation was used . Among 527 subjects , the attack rates of influenza-like illness in the influenza vaccine group were 6.4 , 4.6 and 2.4 % during the first , second and third 2-month periods , respectively . The attack rates of influenza-like illness in the placebo group were 17.7 , 13.8 and 10.1 % . Influenza vaccination reduced the risk of contracting influenza-like illness by between 14 , and 45 % . The vaccine effectiveness in reducing the occurrence of influenza-like illness ranged from 55 to 76 % , during the 6-month study followup . The presence of cerebrovascular diseases significantly increased the risk of influenza-like illness ( p < 0.005 ) . Vaccine recipients had fewer episodes of fever , cough , muscle aches , runny nose ( p < 0.001 ) and experience fewer sick days due to respiratory illness . Subjects who received influenza vaccination had clinical ly and statistically significant reductions in the attack rate of influenza-like illness . Our data support influenza vaccination of persons with chronic diseases and > 50 year olds living in institutions This study assessed the relationship between the reception of conventional inactivated influenza vaccine and winter mortality in a prospect i ve cohort that included 11,240 Spanish community-dwelling elderly individuals followed from January 2002 to April 2005 . Annual influenza vaccine status was a time-varying condition and primary outcome was all-cause death during study period . Multivariable Cox proportional-hazard models adjusted by age , sex and co-morbidity were used to evaluate vaccine effectiveness . Influenza vaccination was associated with a significant reduction of 23 % in winter mortality risk during overall influenza periods . The attributable mortality risk in non-vaccinated people was 24 deaths per 100,000 persons-week within influenza periods , the prevented fraction for the population was 14 % , and one death was prevented for every 239 annual vaccinations ( ranging from 144 in Winter 2005 to 1748 in Winter 2002 ) 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
Healthcare workers may transmit influenza to patients .
OBJECTIVES To identify all r and omised controlled trials ( RCTs ) and non- RCTs assessing the effects of vaccinating healthcare workers on the incidence of laboratory-proven influenza , pneumonia , death from pneumonia and admission to hospital for respiratory illness in those aged 60 years or older resident in long-term care institutions ( LTCIs ) .