Authors' objectives:

The aim of this study is to review systematically the evidence on the effectiveness of protecting people at high risk of significant morbidity and mortality (particularly the elderly), by vaccinating health care workers (HCWs) including hospital staff, institutional care staff and community health staff against influenza.

Authors' results and conclusions: Two cluster randomised studies were found to measure the effects on high-risk patients of vaccination of health care workers, and 27 other studies were used to provide data on important contributory issues. From the two cluster RCTs, mortality in high risk patients was reported as significantly lower (13.6% v 22.4%-odds ratio 0.58 95% CI 0.4-0.84, p=0.014 and 10% v 17%, p=0.013) in hospitals where there was a policy of HCW vaccination compared to those where there was no such policy. No cost-effectiveness studies examining the indirect costs were identified but the two most relevant studies considering direct costs only suggested that a cost saving would be likely. This was confirmed in a simple economic model which indicated that the programme would be cost saving by approximately 12 per vaccinee under the base-case scenario.

Authors' recommendations: Two clinical trials suggest that vaccination of HCW would be clinically effective in reducing mortality in high-risk groups. The policy is also likely to be cost-saving, or in the worst case highly cost-effective. In order for a policy of vaccinating healthcare workers to be implemented effectively, it will be important to overturn the perceived barriers to vaccination, especially to convince healthcare workers of the benefits to themselves and patients, and of the favourable adverse event profile. The vaccination will need to be delivered in a convenient way eg mobile cart and the whole programme more heavily promoted, implemented and monitored. Evidence available to this review suggests that based on reasonable estimates of the key parameters a vaccination policy of HCW would be effective and probably cost-saving.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2004/eswi.pdf

Year Published: 2004

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham