title: Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial.
abstract: OBJECTIVE
  To determine whether vaccination of care home staff against influenza indirectly protects residents.
  
  
  METHODS
  Pair matched cluster randomised controlled trial.
  
  
  METHODS
  Large private chain of UK care homes during the winters of 2003-4 and 2004-5.
  
  
  METHODS
  Nursing home staff (n=1703) and residents (n=2604) in 44 care homes (22 intervention homes and 22 matched control homes).
  
  
  METHODS
  Vaccination offered to staff in intervention homes but not in control homes.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  National Research Register N0530147256.
authors.affiliation: University College London Centre for Infectious Disease Epidemiology, Department of Primary Care and Population Sciences, London NW3 2PF. a.hayward@pcps.ucl.ac.uk
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hayward
authors.forename: Richard
authors.initials: R
authors.lastname: Harling
authors.forename: Sally
authors.initials: S
authors.lastname: Wetten
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.forename: Susan
authors.initials: S
authors.lastname: Munro
authors.forename: Julia
authors.initials: J
authors.lastname: Smedley
authors.forename: Shahed
authors.initials: S
authors.lastname: Murad
authors.forename: John M
authors.initials: JM
authors.lastname: Watson
mesh_terms: D000368:Aged; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000401:mortality / Q000517:prevention & control*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009784:Occupational Diseases / Q000517:prevention & control*; D016272:Occupational Health; D016896:Treatment Outcome
chemical_list: D007252:Influenza Vaccines