Thomas Roger E, Jefferson Tom, Lasserson Toby J
Department of Medicine, University of Calgary, UCMC, #1707-1632 14th Avenue, Calgary, Alberta, Canada, T2M 1N7.
Cochrane Database Syst Rev. 2010 Feb 17(2):CD005187. doi: 10.1002/14651858.CD005187.pub3.
Healthcare workers' (HCWs) influenza rates are unknown, but may be similar to the general public and they may transmit influenza to patients.
To identify studies of vaccinating HCWs and the incidence of influenza, its complications and influenza-like illness (ILI) in individuals >/= 60 in long-term care facilities (LTCFs).
We searched CENTRAL (The Cochrane Library 2009, issue 3), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2009), EMBASE (1974 to 2009) and Biological Abstracts and Science Citation Index-Expanded.
Randomised controlled trials (RCTs) and non-RCTs of influenza vaccination of HCWs caring for individuals >/= 60 in LTCFs and the incidence of laboratory-proven influenza, its complications or ILI.
Two authors independently extracted data and assessed risk of bias.
We identified four cluster-RCTs (C-RCTs) (n = 7558) and one cohort (n = 12742) of influenza vaccination for HCWs caring for individuals >/= 60 in LTCFs. Pooled data from three C-RCTs showed no effect on specific outcomes: laboratory-proven influenza, pneumonia or deaths from pneumonia. For non-specific outcomes pooled data from three C-RCTs showed HCW vaccination reduced ILI; data from one C-RCT that HCW vaccination reduced GP consultations for ILI; and pooled data from three C-RCTs showed reduced all-cause mortality in individuals >/= 60.
AUTHORS' CONCLUSIONS: No effect was shown for specific outcomes: laboratory-proven influenza, pneumonia and death from pneumonia. An effect was shown for the non-specific outcomes of ILI, GP consultations for ILI and all-cause mortality in individuals >/= 60. These non-specific outcomes are difficult to interpret because ILI includes many pathogens, and winter influenza contributes < 10% to all-cause mortality in individuals >/= 60. The key interest is preventing laboratory-proven influenza in individuals >/= 60, pneumonia and deaths from pneumonia, and we cannot draw such conclusions.The identified studies are at high risk of bias.Some HCWs remain unvaccinated because they do not perceive risk, doubt vaccine efficacy and are concerned about side effects. This review did not find information on co-interventions with HCW vaccination: hand washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, anti-virals, and asking HCWs with ILI not to work. We conclude there is no evidence that vaccinating HCWs prevents influenza in elderly residents in LTCFs. High quality RCTs are required to avoid risks of bias in methodology and conduct, and to test these interventions in combination.
医护人员的流感感染率尚不清楚，但可能与普通大众相似，并且他们可能将流感传播给患者。
确定针对长期护理机构（LTCF）中60岁及以上人群的医护人员接种流感疫苗的研究，以及流感及其并发症和流感样疾病（ILI）的发病率。
我们检索了CENTRAL（《考克兰图书馆》2009年第3期），其中包含考克兰急性呼吸道感染小组的专业注册库、MEDLINE（1966年至2009年）、EMBASE（1974年至2009年）以及生物学文摘和科学引文索引扩展版。
针对长期护理机构中照顾60岁及以上人群的医护人员进行流感疫苗接种的随机对照试验（RCT）和非随机对照试验，以及实验室确诊的流感、其并发症或ILI的发病率。
两位作者独立提取数据并评估偏倚风险。
我们确定了四项针对长期护理机构中照顾60岁及以上人群的医护人员进行流感疫苗接种的整群随机对照试验（C-RCT）（n = 7558）和一项队列研究（n = 12742）。三项C-RCT的汇总数据显示对特定结局无影响：实验室确诊的流感、肺炎或肺炎死亡。对于非特定结局，三项C-RCT的汇总数据显示医护人员接种疫苗可降低ILI；一项C-RCT的数据显示医护人员接种疫苗可减少因ILI进行的全科医生会诊；三项C-RCT的汇总数据显示60岁及以上人群的全因死亡率降低。
对于特定结局未显示出效果：实验室确诊的流感、肺炎和肺炎死亡。对于60岁及以上人群的ILI、因ILI进行的全科医生会诊和全因死亡率等非特定结局显示出效果。这些非特定结局难以解释，因为ILI包括多种病原体，并且冬季流感在60岁及以上人群的全因死亡率中所占比例不到10%。关键关注点是预防60岁及以上人群的实验室确诊流感、肺炎和肺炎死亡，而我们无法得出这样的结论。所纳入的研究存在较高的偏倚风险。一些医护人员未接种疫苗，因为他们未意识到风险、怀疑疫苗效力且担心副作用。本综述未找到关于与医护人员接种疫苗联合干预措施的信息：洗手、戴口罩、早期发现实验室确诊的流感、隔离、避免入院、使用抗病毒药物以及要求患有ILI的医护人员不工作。我们得出结论，没有证据表明医护人员接种疫苗可预防长期护理机构中老年居民感染流感。需要高质量的RCT来避免方法学和实施过程中的偏倚风险，并对这些联合干预措施进行测试。
