BMJ  2006;333:1241 (16 December), doi:10.1136/bmj.39010.581354.55 (published 1 December 2006)

Research

Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial

¹ University College London Centre for Infectious Disease Epidemiology, Department of Primary Care and Population Sciences, London NW3 2PF, ² Westminster Healthcare, Leatherhead, Surrey, ³ Medical Research Council Epidemiology Resource Centre, Southampton General Hospital, ⁴ Health Protection Agency Centre for Infections, London

Objective To determine whether vaccination of care home staff against influenza indirectly protects residents.

Design Pair matched cluster randomised 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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Should healthcare workers have the swine flu vaccine?

Rachel Jordan and Andrew Hayward
BMJ 2009 339: b3398. [Extract] [Full Text]

Patient care drives mandatory vaccination

Stephen B Lambert
BMJ 2008 337: a2588. [Extract] [Full Text]

Should influenza immunisation be mandatory for healthcare workers? No

David Isaacs and Julie Leask
BMJ 2008 337: a2140. [Extract] [Full Text]

Should influenza immunisation be mandatory for healthcare workers? Yes

Charles M Helms and Philip M Polgreen
BMJ 2008 337: a2142. [Extract] [Full Text]

Flu vaccine for staff protects care home residents
BMJ 2006 333: 0. [Full Text] [PDF]

New beginnings

Fiona Godlee
BMJ 2006 333: 0. [Extract] [Full Text] [PDF]

US Highlights

Douglas Kamerow
BMJ 2006 333: 0. [Extract] [Full Text]

Influenza in elderly people in care homes

Rachel E Jordan and Jeremy I Hawker
BMJ 2006 333: 1229-1230. [Extract] [Full Text] [PDF]

CONSORT statement: extension to cluster randomised trials

Marion K Campbell, Diana R Elbourne, and Douglas G Altman
BMJ 2004 328: 702-708. [Extract] [Full Text] [PDF]

Functional disability and antibody response to influenza vaccine in elderly patients in a Dutch nursing home

E J Remarque, H J M Cools, T J Boere, R J van der Klis, N Masurel, and G J Ligthart
BMJ 1996 312: 1015. [Extract] [Full Text]

This article has been cited by other articles:

• Mossad, S. B. (2009). Influenza in long-term care facilities: Preventable, detectable, treatable. Cleveland Clinic Journal of Medicine 76: 513-521 [Abstract] [Full text]  
• Jordan, R., Hayward, A. (2009). Should healthcare workers have the swine flu vaccine?. BMJ 339: b3398-b3398 [Full text]  
• Wang, L., Jason, X. N., Upshur, R. E.G. (2009). Determining use of preventive health care in Ontario: Comparison of rates of 3 maneuvers in administrative and survey data. cfp 55: 178-179.e5 [Abstract] [Full text]  
• Anikeeva, O., Braunack-Mayer, A., Rogers, W. (2009). Requiring Influenza Vaccination for Health Care Workers. AJPH 99: 24-29 [Abstract] [Full text]  
• Lambert, S. B (2008). Patient care drives mandatory vaccination. BMJ 337: a2588-a2588 [Full text]  
• Isaacs, D., Leask, J. (2008). Should influenza immunisation be mandatory for healthcare workers? No. BMJ 337: a2140-a2140 [Full text]  
• Helms, C. M, Polgreen, P. M (2008). Should influenza immunisation be mandatory for healthcare workers? Yes. BMJ 337: a2142-a2142 [Full text]  
• Sacks, H. S (2007). Encouraging influenza vaccination for nursing home staff reduced mortality and influenza like illness in the residents. Evid. Based Med. 12: 81-81 [Full text]  
• (2007). Influenza Vaccine for Nursing Home Staff Benefits Patients. JWatch General 2007: 4-4 [Full text]  
• Jordan, R. E, Hawker, J. I (2006). Influenza in elderly people in care homes. BMJ 333: 1229-1230 [Full text]  

Rapid Responses:

Read all Rapid Responses

First, do no harm- the vaccination of healthcare professionals

Jaykar R. Panchmatia
bmj.com, 19 Dec 2006 [Full text]

Preventing influenza outbreaks in care homes

Shailendra Kapoor
bmj.com, 21 Dec 2006 [Full text]

Increasing influenza immunization rates in care home staff

S Kapoor
bmj.com, 29 Dec 2006 [Full text]

Online poll

Find out more >>