title: Influenza vaccination for healthcare workers who work with the elderly.
abstract: BACKGROUND
  Healthcare workers' (HCWs) influenza rates are unknown, but may be similar to the general public and they may transmit influenza to patients.
  
  
  OBJECTIVE
  To identify studies of vaccinating HCWs and the incidence of influenza, its complications and influenza-like illness (ILI) in individuals >/= 60 in long-term care facilities (LTCFs).
  
  
  METHODS
  We searched CENTRAL (The Cochrane Library 2009, issue 3), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2009), EMBASE (1974 to 2009) and Biological Abstracts and Science Citation Index-Expanded.
  
  
  METHODS
  Randomised controlled trials (RCTs) and non-RCTs of influenza vaccination of HCWs caring for individuals >/= 60 in LTCFs and the incidence of laboratory-proven influenza, its complications or ILI.
  
  
  METHODS
  Two authors independently extracted data and assessed risk of bias.
  
  
  RESULTS
  We identified four cluster-RCTs (C-RCTs) (n = 7558) and one cohort (n = 12742) of influenza vaccination for HCWs caring for individuals >/= 60 in LTCFs. Pooled data from three C-RCTs showed no effect on specific outcomes: laboratory-proven influenza, pneumonia or deaths from pneumonia. For non-specific outcomes pooled data from three C-RCTs showed HCW vaccination reduced ILI; data from one C-RCT that HCW vaccination reduced GP consultations for ILI; and pooled data from three C-RCTs showed reduced all-cause mortality in individuals >/= 60.
  
  
  CONCLUSIONS
  No effect was shown for specific outcomes: laboratory-proven influenza, pneumonia and death from pneumonia. An effect was shown for the non-specific outcomes of ILI, GP consultations for ILI and all-cause mortality in individuals >/= 60. These non-specific outcomes are difficult to interpret because ILI includes many pathogens, and winter influenza contributes < 10% to all-cause mortality in individuals >/= 60. The key interest is preventing laboratory-proven influenza in individuals >/= 60, pneumonia and deaths from pneumonia, and we cannot draw such conclusions.The identified studies are at high risk of bias.Some HCWs remain unvaccinated because they do not perceive risk, doubt vaccine efficacy and are concerned about side effects. This review did not find information on co-interventions with HCW vaccination: hand washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, anti-virals, and asking HCWs with ILI not to work. We conclude there is no evidence that vaccinating HCWs prevents influenza in elderly residents in LTCFs. High quality RCTs are required to avoid risks of bias in methodology and conduct, and to test these interventions in combination.
authors.affiliation: Department of Medicine, University of Calgary, UCMC, #1707-1632 14th Avenue, Calgary, Alberta, Canada, T2M 1N7.
authors.forename: Roger E
authors.initials: RE
authors.lastname: Thomas
authors.forename: Tom
authors.initials: T
authors.lastname: Jefferson
authors.forename: Toby J
authors.initials: TJ
authors.lastname: Lasserson
mesh_terms: D000328:Adult; D000368:Aged; D006282:Health Personnel; D006707:Homes for the Aged; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control / Q000635:transmission*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D015164:Vaccines, Inactivated / Q000008:administration & dosage
chemical_list: D007252:Influenza Vaccines; D015164:Vaccines, Inactivated