title: Importance of employee vaccination against influenza in preventing cases in long-term care facilities.
abstract: OBJECTIVE
  Employees of long-term care facilities (LTCFs) who have contact with residents should be vaccinated against influenza annually to reduce influenza incidence among residents. This investigation estimated the magnitude of the benefit of this recommendation.
  
  
  METHODS
  The New Mexico Department of Health implemented active surveillance in all of its 75 LTCFs during influenza seasons 2006-2007 and 2007-2008. Information about the number of laboratory-confirmed cases of influenza and the proportion vaccinated of both residents and direct-care employees in each facility was collected monthly. LTCFs reporting at least 1 case of influenza (defined alternately by laboratory confirmation or symptoms of influenza-like illness [ILI]) among residents were compared with LTCFs reporting no cases of influenza. Regression modeling was used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between employee vaccination coverage and the occurrence of influenza outbreaks. Covariates included vaccination coverage among residents, the staff-to-resident ratio, and the proportion of filled beds.
  
  
  RESULTS
  Seventeen influenza outbreaks were reported during this 2-year period of surveillance. Eleven of these were laboratory confirmed (n = 21 residents) and 6 were defined by ILI (n = 40 residents). Mean influenza vaccination coverage among direct-care employees was 51% in facilities reporting outbreaks and 60% in facilities not reporting outbreaks (P = .12). Increased vaccination coverage among direct-care employees was associated with fewer reported outbreaks of laboratory-confirmed influenza (aOR, 0.97 [95% CI, 0.95-0.99]) and ILI (aOR, 0.98 [95% CI, 0.96-1.00]).
  
  
  CONCLUSIONS
  High vaccination coverage among direct-care employees helps to prevent influenza in LTCFs.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Aaron-Wendelboe@ouhsc.edu
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Wendelboe
authors.forename: Catherine
authors.initials: C
authors.lastname: Avery
authors.forename: Bernardo
authors.initials: B
authors.lastname: Andrade
authors.forename: Joan
authors.initials: J
authors.lastname: Baumbach
authors.forename: Michael G
authors.initials: MG
authors.lastname: Landen
mesh_terms: D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008134:Long-Term Care / Q000706:statistics & numerical data; D009516:New Mexico / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D018571:Sentinel Surveillance; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines