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

The article by Hayward et al (1) clearly showed that vaccinating care
home staff against influenza can reduce deaths in residents. Besides
decreasing morbidity and mortality in residents immunization of care home
staff against influenza has numerous other benefits, including decreased
absenteeism amongst care staff (2), decreased staffing problems (3) and
decreased costs of hospitalization of residents and thus financial savings
for the care home.(4)

Clearly efforts to increase immunization rates amongst health care
workers have failed so far. New innovative measures need to be implemented
urgently. Some measures that are more likely to succeed include:

A. Offering free vaccinations

B. Offering gift incentives.

C. Frequent in-services and presentations to increase awareness among
health care workers about influenza. It has been shown that the fear of
side effects is the most common reason health care workers refuse
immunizations. The fear of acquiring influenza from the vaccine itself is
the most often cited reason.(5)

D. Offering vaccinations in easily accessible areas such as the nursing
home floors or cafeterias or setting up mobile “units” to administer
vaccines.

E. Offering the vaccine at the same time as other mandatory tests such as
annual tuberculosis screening has been shown to increase immunization
rates.(6)

Mandatory vaccination is another consideration and should be given
serious thought given the fact that voluntary immunization rates amongst
health care staff are as low as 38 %.(7) Some of the US states such a
Pennsylvania already require mandatory influenza vaccination for health
care workers employed in long term care homes. Past experience has clearly
shown that requiring mandatory vaccinations such as Hepatitis B for health
care workers has clearly worked despite initial resistance. In fact in the
near future mandatory annual influenza vaccination might be the final and
definitive way to approach this problem.

1. Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J,
et al. Effectiveness of an influenza vaccine programme for care home staff
to prevent death, morbidity, and health service use among residents:
cluster randomised controlled trial. BMJ 2006; Dec 16;333(7581):1241.

2. Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, et
al. The effectiveness of vaccination against influenza in healthy, working
adults. N Engl J Med 1995; Oct 5;333(14):889-93.

3. Canning HS, Phillips J, Allsup S. Health care worker beliefs about
influenza vaccine and reasons for non-vaccination--a cross-sectional
survey. J Clin Nurs 2005; Sep;14(8):922-5.

4. Boersma B, Rhames T, Keegan JM. Additional cost savings of an
effective employee influenza program on prevention of nosocomial
influenza. Am J Infect Control 1999; Apr;27(2):177-8.

5. Heininger U, Bachler M, Schaad UB. Attitudes of pediatricians
regarding influenza self-immunization: a survey in a Swiss university
children's hospital. Pediatr Infect Dis J 2003; May;22(5):391-4.

6. Steiner M, Vermeulen LC, Mullahy J, Hayney MS. Factors influencing
decisions regarding influenza vaccination and treatment: a survey of
healthcare workers. Infect Control Hosp Epidemiol 2002; Oct;23(10):625-7.

7. King WD, Woolhandler SJ, Brown AF, Jiang L, Kevorkian K,
Himmelstein DU, et al. Brief report: Influenza vaccination and health care
workers in the United States. J Gen Intern Med 2006; Feb;21(2):181-4.

Competing interests:
None declared