Effect of Influenza Vaccination of Healthcare Personnel on Morbidity and Mortality Among Patients: Systematic Review and Grading of Evidence

February 28, 2014 at 9:39 pm

Clinical Infectious Diseases January 1, 2014 V.58 N.1 P.50-57

Faruque Ahmed1, Megan C. Lindley1, Norma Allred1, Cindy M. Weinbaum2, and Lisa Grohskopf3

1Immunization Services Division, National Center for Immunization and Respiratory Diseases

2Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases

3Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: Faruque Ahmed, PhD, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-19, Atlanta, GA 30333 (fahmed@cdc.gov).


Influenza vaccination of healthcare personnel (HCP) is recommended in >40 countries. However, there is controversy surrounding the evidence that HCP vaccination reduces morbidity and mortality among patients. Key factors for developing evidence-based recommendations include quality of evidence, balance of benefits and harms, and values and preferences.


We conducted a systematic review of randomized trials, cohort studies, and case-control studies published through June 2012 to evaluate the effect of HCP influenza vaccination on mortality, hospitalization, and influenza cases in patients of healthcare facilities. We pooled trial results using meta-analysis and assessed evidence quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.


We identified 4 cluster randomized trials and 4 observational studies conducted in long-term care or hospital settings. Pooled risk ratios across trials for all-cause mortality and influenza-like illness were 0.71 (95% confidence interval [CI], .59–.85) and 0.58 (95% CI, .46–.73), respectively; pooled estimates for all-cause hospitalization and laboratory-confirmed influenza were not statistically significant. The cohort and case-control studies indicated significant protective associations for influenza-like illness and laboratory-confirmed influenza. No studies reported harms to patients. Using GRADE, the quality of the evidence for the effect of HCP vaccination on mortality and influenza cases in patients was moderate and low, respectively. The evidence quality for the effect of HCP vaccination on patient hospitalization was low. The overall evidence quality was moderate.


The quality of evidence is higher for mortality than for other outcomes. HCP influenza vaccination can enhance patient safety.




Editorial Commentary

Influenza Vaccination of Healthcare Workers: Making the Grade for Action

Marie R. Griffin

Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee

Correspondence: Marie R. Griffin, MD, MPH, Department of Preventive Medicine, Vanderbilt University Medical Center, 1500 21st Ave S, Nashville, TN 37212 (marie.griffin@vanderbilt.edu)

It is reasonable to ask what type of evidence is needed to recommend or require annual influenza vaccination of healthcare workers to help prevent transmission of influenza to vulnerable hospitalized patients and to residents of long-term care facilities. To make such a recommendation, one would want to know the risks and consequences of influenza in such patients, the safety of the vaccine and its efficacy in preventing influenza in healthcare workers, and the likelihood that vaccinating such workers could prevent the spread of influenza within these facilities in addition to costs and feasibility….



Entry filed under: Inmunizaciones, REVIEWS.

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