Lemaitre Magali, Meret Thierry, Rothan-Tondeur Monique, Belmin Joel, Lejonc Jean-Louis, Luquel Laurence, Piette François, Salom Michel, Verny Marc, Vetel Jean-Marie, Veyssier Pierre, Carrat Fabrice
Department of Epidemiology, Information Systems, and Modeling, University Pierre and Marie Curie Paris 6, UMR-S 707, Paris, France.
J Am Geriatr Soc. 2009 Sep;57(9):1580-6. doi: 10.1111/j.1532-5415.2009.02402.x. Epub 2009 Aug 4.
To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents.
Pair-matched cluster-randomized trial.
Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index.
All persons aged 60 and older residing in the nursing homes.
Influenza vaccine was administered to volunteer staff after a face-to-face interview. No intervention took place in control nursing homes.
The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community. Secondary endpoints were rates of hospitalization and influenza-like illness (ILI) in residents and sick leave from work in staff.
Staff influenza vaccination rates were 69.9% in the vaccination arm versus 31.8% in the control arm. Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P=.08), although multivariate-adjusted analysis showed 20% lower mortality (P=.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=-0.42, P=.007). In the vaccination arm, significantly lower resident hospitalization rates were not observed, but ILI in residents was 31% lower (P=.007), and sick leave from work in staff was 42% lower (P=.03).
These results support influenza vaccination of staff caring for institutionalized elderly people.
评估工作人员接种流感疫苗对养老院居民全因死亡率的影响。
配对匹配整群随机试验。
40家养老院，根据规模、上一季工作人员疫苗接种覆盖率和居民残疾指数进行匹配。
居住在养老院的所有60岁及以上的人。
在面对面访谈后，为志愿者工作人员接种流感疫苗。对照养老院未采取干预措施。
主要终点是社区流感流行前2周到流行后2周居民的总死亡率。次要终点是居民的住院率和流感样疾病（ILI）发生率以及工作人员的病假率。
接种组工作人员的流感疫苗接种率为69.9%，对照组为31.8%。未调整的初步分析未显示接种组居民的死亡率显著降低（优势比=0.86，P=0.08），尽管多变量调整分析显示死亡率降低了20%（P=0.02），并且观察到工作人员疫苗接种覆盖率与居民全因死亡率之间存在很强的相关性（相关系数=-0.42，P=0.007）。在接种组中，未观察到居民住院率显著降低，但居民的流感样疾病发生率降低了31%（P=0.007），工作人员的病假率降低了42%（P=0.03）。
这些结果支持为照顾机构养老老年人的工作人员接种流感疫苗。
