title: Influenza in workplaces: transmission, workers' adherence to sick leave advice and European sick leave recommendations.
abstract: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives.
  
  
  
  This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza.
  
  
  
  A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries.
  
  
  
  Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20-25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9-33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza.
  
  
  
  During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness.
authors.affiliation: Division of Infectious Disease Control, Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Nydalen, Oslo, Norway christina.hansen.edwards@fhi.no.
authors.forename: Christina Hansen
authors.initials: CH
authors.lastname: Edwards
authors.affiliation: Department of Mathematics, University of Rome Tor Vergata Via Ricerca Scientifica, Rome, Italy.
authors.forename: Gianpaolo Scalia
authors.initials: GS
authors.lastname: Tomba
authors.affiliation: Division of Infectious Disease Control, Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Nydalen, Oslo, Norway Oslo Group for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Birgitte Freiesleben
authors.initials: BF
authors.lastname: de Blasio
mesh_terms: D005060:Europe / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018582:Sick Leave / Q000706:statistics & numerical data*; D017132:Workplace / Q000706:statistics & numerical data*