Thomas R E, Jefferson T O, Demicheli V, Rivetti D
Department of Family Medicine, University of Calgary, Calgary, AB, Canada.
Lancet Infect Dis. 2006 May;6(5):273-9. doi: 10.1016/S1473-3099(06)70462-5.
Our aim was to review the evidence of efficacy and effectiveness of influenza vaccination of health-care workers in reducing cases of influenza-like illness, influenza, complications from influenza, death from influenza, and death from all causes among the elderly people they care for in institutions. We searched 11 electronic databases in any language and identified two cluster-randomised controlled trials with moderate risk of bias and one cohort study at high risk of bias that addressed our questions. Staff vaccination had a significant effect on influenza-like illness (vaccine effectiveness [VE] 86%, 95% CI 40-97%) only when patients were vaccinated too. If patients were not vaccinated, staff immunisation had no effect. Vaccinating health-care workers did not appear efficacious against influenza (RR 0.87, 95% CI 0.46-1.63). There was no significant effect of vaccination on lower respiratory tract infections: (RR 0.70, 95% CI 0.41-1.20). Deaths from pneumonia were significantly reduced (VE 39%, 95% CI 2-62%), as were deaths from all causes (VE 40%, 95% CI 27-50%). These findings must be interpreted in the light of possible selection, performance, attrition, and detection biases.
我们的目的是回顾医护人员接种流感疫苗在减少其所照顾的机构内老年人的流感样疾病、流感、流感并发症、流感死亡以及全因死亡病例方面的有效性和效果证据。我们检索了11个任何语言的电子数据库，确定了两项偏倚风险为中等的整群随机对照试验以及一项偏倚风险为高的队列研究，这些研究涉及了我们的问题。只有当患者也接种疫苗时，工作人员接种疫苗才对流感样疾病有显著效果（疫苗效力[VE]86%，95%CI 40 - 97%）。如果患者未接种疫苗，工作人员免疫则没有效果。接种医护人员疫苗对流感似乎没有效果（RR 0.87，95%CI 0.46 - 1.63）。接种疫苗对下呼吸道感染没有显著效果：（RR 0.70，95%CI 0.41 - 1.20）。肺炎死亡显著减少（VE 39%，95%CI 2 - 62%），全因死亡也显著减少（VE 40%，95%CI 27 - 50%）。这些发现必须结合可能的选择、实施、失访和检测偏倚来解释。
