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Do Patients Benefit from Healthcare Providers' Influenza Vaccination?

Summary and Comment |
January 23, 2014

Do Patients Benefit from Healthcare Providers' Influenza Vaccination?

  1. Neil M. Ampel, MD

A literature review showed a reduction in all-cause mortality and influenza-like illness among the providers' patients, but the quality of evidence was moderate to very low.

  1. Neil M. Ampel, MD

Although influenza vaccination is recommended for healthcare providers (HCPs) in the U.S. and many other countries, whether it benefits patients remains controversial. The debate stems in part from the quality of evidence in previous studies.

To rectify this situation, researchers at the CDC conducted a review of randomized, controlled trials, cohort studies, and case-control studies published between January 1948 and June 2012 that reported on the association between influenza vaccination of HCPs and morbidity or mortality among patients of healthcare facilities. They evaluated evidence quality using the Grading of Recommendations Assessment, Development and Evaluation system, a methodology employed by more than 60 organizations worldwide. Out of 8790 articles identified by the literature search, only 8 (4 cluster-randomized trials and 4 observational studies) met the authors' inclusion criteria.

In the cluster-randomized trials, HCP vaccination was associated with a 29% (95% confidence interval, 15%–41%) reduction in all-cause mortality and a 42% (95% CI, 27%–54%) reduction in influenza-like illness among patients. Results of the observational studies also showed HCP influenza vaccination to be associated with decreased risk for influenza-like illness in patients. However, the quality of evidence from the randomized trials was only moderate for the effect of HCP vaccination on reducing mortality among patients and was low for reducing influenza-like illness. In addition, the quality of evidence from the observational studies for mortality and influenza-like illness was very low.

Comment

It is sobering that only 8 studies out of more than 8000 were of sufficient relevance and quality to be analyzed and that the strength of the data was no better than moderate. However, as an editorialist points out, we should not be slaves to statistical analysis. Given the known safety and efficacy of influenza vaccination in general, the current study offers additional evidence that we have reached the threshold of evidence regarding the benefit of immunizing healthcare providers to protect susceptible patients.

  • Disclosures for Neil M. Ampel, MD at time of publication Editorial boards Medical Mycology

Citation(s):

Reader Comments (1)

Philip A. Yeon MD, MPH&TM Physician, Infectious Disease, Hospital

I had hoped for a more nuanced editorial. Not all available data is favorable for vaccination of healthcare workers (HCW), (see the Cochrane review: Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions.Thomas RE, Jefferson T, Lasserson TJ.), and Mike Edmond blog comments (Controversies in Hospital Infection Prevention, search for influenza).
Moreover, despite the fact that I do agree with "we should not be slaves of statistical analysis", the alternative leaves the door open for less than optimal science, conflict of interest, and potential harm.
With the current impetus for mandatory HCW vaccination, much better quality data is needed, whilst avoiding harm.
Can I mandate a therapy, and not assume consequences of any harm (note that current legislation effectively bar any lawsuit) ? what should I tell a HCW with GBS? that we have incontrovertible evidence that influenza vaccination is a major benefit for society ? Oddly, other countries with quite advanced medicine, and excellent epidemiologists do not seem to entretain the concept of universal inflenza vaccination, as we do in the U.S, maybe we are smarter?
More data is needed, better quality data is needed, and a more qualified editorial in order.

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