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For: Sato M, Saito R, Tanabe N, Nishikawa M, Sasaki A, Gejyo F, Suzuki H. Antibody Response to Influenza Vaccination in Nursing Home Residents and Healthcare Workers During Four Successive Seasons in Niigata, Japan. Infect Control Hosp Epidemiol 2016;26:859-66. [PMID: 16323321 DOI: 10.1086/502509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]

For:	Sato M, Saito R, Tanabe N, Nishikawa M, Sasaki A, Gejyo F, Suzuki H. Antibody Response to Influenza Vaccination in Nursing Home Residents and Healthcare Workers During Four Successive Seasons in Niigata, Japan. Infect Control Hosp Epidemiol 2016;26:859-66. [PMID: 16323321 DOI: 10.1086/502509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]

Number

Cited by Other Article(s)

Rivasi G, Bulgaresi M, Mossello E, Buscemi P, Lorini C, Balzi D, Barucci R, Del Lungo I, Gangemi S, Giardini S, Piga C, Barghini E, Boni S, Bulli G, Carrai P, Crociani A, Faraone A, Lo Forte A, Martella L, Pupo S, Fortini G, Marozzi I, Bandini G, Cosma C, Stacchini L, Vaccaro G, Baggiani L, Landini G, Bonaccorsi G, Ungar A, Benvenuti E. Course and Lethality of SARS-CoV-2 Epidemic in Nursing Homes after Vaccination in Florence, Italy. Vaccines (Basel) 2021;9:1174. [PMID: 34696282 PMCID: PMC8537408 DOI: 10.3390/vaccines9101174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open

Affiliation(s)

Giulia Rivasi Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
Matteo Bulgaresi Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Enrico Mossello Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
Primo Buscemi Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
Chiara Lorini Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
Daniela Balzi Epidemiology Unit, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy;
Riccardo Barucci Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Ilaria Del Lungo Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Salvatore Gangemi Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Sante Giardini Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Cecilia Piga Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Eleonora Barghini Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Serena Boni Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Giulia Bulli Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Paolo Carrai Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
Andrea Crociani Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
Antonio Faraone Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
Aldo Lo Forte Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
Letizia Martella Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Simone Pupo Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Giacomo Fortini Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
Irene Marozzi Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
Giulia Bandini Division of Internal Medicine, Careggi Hospital, 50134 Florence, Tuscany, Italy;
Claudia Cosma Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
Lorenzo Stacchini Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
Gabriele Vaccaro Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
Lorenzo Baggiani Department of Territorial Health Network, 50134 Florence, Tuscany, Italy;
Giancarlo Landini Department of Internal Medicine, Santa Maria Nuova Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy;
Guglielmo Bonaccorsi Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
Andrea Ungar Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
Enrico Benvenuti Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)

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Matsushita M, Takeuchi S, Kumagai N, Morio M, Matsushita C, Arise K, Awatani T. Booster influenza vaccination confers additional immune responses in an elderly, rural community-dwelling population. Am J Infect Control 2018;46:462-463. [PMID: 29150194 DOI: 10.1016/j.ajic.2017.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]

Verschoor CP, Lelic A, Parsons R, Evelegh C, Bramson JL, Johnstone J, Loeb MB, Bowdish DME. Serum C-Reactive Protein and Congestive Heart Failure as Significant Predictors of Herpes Zoster Vaccine Response in Elderly Nursing Home Residents. J Infect Dis 2017;216:191-197. [PMID: 28838148 DOI: 10.1093/infdis/jix257] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022] Open

Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2016;2016:CD005187. [PMID: 27251461 PMCID: PMC8504984 DOI: 10.1002/14651858.cd005187.pub5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]

Abstract

BACKGROUND

A systematic review found that 3% of working adults who had received influenza vaccine and 5% of those who were unvaccinated had laboratory-proven influenza per season; in healthcare workers (HCWs) these percentages were 5% and 8% respectively. Healthcare workers may transmit influenza to patients.

OBJECTIVES

To identify all randomised controlled trials (RCTs) and non-RCTs assessing the effects of vaccinating healthcare workers on the incidence of laboratory-proven influenza, pneumonia, death from pneumonia and admission to hospital for respiratory illness in those aged 60 years or older resident in long-term care institutions (LTCIs).

SEARCH METHODS

We searched CENTRAL (2015, Issue 9), MEDLINE (1966 to October week 3, 2015), EMBASE (1974 to October 2015) and Web of Science (2006 to October 2015), but Biological Abstracts only from 1969 to March 2013 and Science Citation Index-Expanded from 1974 to March 2013 due to lack of institutional access in 2015.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and non-RCTs of influenza vaccination of healthcare workers caring for individuals aged 60 years or older in LTCIs and the incidence of laboratory-proven influenza and its complications (lower respiratory tract infection, or hospitalisation or death due to lower respiratory tract infection) in individuals aged 60 years or older in LTCIs.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias. Effects on dichotomous outcomes were measured as risk differences (RDs) with 95% confidence intervals (CIs). We assessed the quality of evidence with GRADE.

MAIN RESULTS

We identified four cluster-RCTs and one cohort study (n = 12,742) of influenza vaccination for HCWs caring for individuals ≥ 60 years in LTCIs. Four cluster RCTs (5896 residents) provided outcome data that addressed the objectives of our review. The studies were comparable in their study populations, intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition, lack of blinding, contamination in the control groups and low rates of vaccination coverage in the intervention arms, leading us to downgrade the quality of evidence for all outcomes due to serious risk of bias.Offering influenza vaccination to HCWs based in long term care homes may have little or no effect on the number of residents who develop laboratory-proven influenza compared with those living in care homes where no vaccination is offered (RD 0 (95% CI -0.03 to 0.03), two studies with samples taken from 752 participants; low quality evidence). HCW vaccination probably leads to a reduction in lower respiratory tract infection in residents from 6% to 4% (RD -0.02 (95% CI -0.04 to 0.01), one study of 3400 people; moderate quality evidence). HCW vaccination programmes may have little or no effect on the number of residents admitted to hospital for respiratory illness (RD 0 (95% CI -0.02 to 0.02, one study of 1059 people; low quality evidence). We decided not to combine data on deaths from lower respiratory tract infection (two studies of 4459 people) or all cause deaths (four studies of 8468 people). The direction and size of difference in risk varied between the studies. We are uncertain as to the effect of vaccination on these outcomes due to the very low quality of evidence. Adjusted analyses, which took into account the cluster design, did not differ substantively from the pooled analysis with unadjusted data.

AUTHORS' CONCLUSIONS

Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions. This review did not find information on co-interventions with healthcare worker vaccination: hand-washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, antivirals and asking healthcare workers with influenza or influenza-like illness (ILI) not to work. This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs. High quality RCTs are required to avoid the risks of bias in methodology and conduct identified by this review and to test further these interventions in combination.

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Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2013:CD005187. [PMID: 23881655 DOI: 10.1002/14651858.cd005187.pub4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Abstract

BACKGROUND

Healthcare workers' influenza rates are unknown but may be similar to those of the general public. Healthcare workers may transmit influenza to patients.

OBJECTIVES

SEARCH METHODS

We searched CENTRAL 2013, Issue 2, MEDLINE (1966 to March week 3, 2013), EMBASE (1974 to March 2013), Biological Abstracts (1969 to March 2013), Science Citation Index-Expanded (1974 to March 2013) and Web of Science (2006 to March 2013).

SELECTION CRITERIA

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias.

MAIN RESULTS

We identified four cluster-RCTs (C-RCTs) (n = 7558) and one cohort study (n = 12,742) of influenza vaccination for HCWs caring for individuals ≥ 60 years in LTCFs. Three RCTs (5896 participants) provided outcome data that met our criteria. These three studies were comparable in study populations, intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition and blinding. The pooled risk difference (RD) from the three cluster-RCTs for laboratory-proven influenza was 0 (95% confidence interval (CI) -0.03 to 0.03) and for hospitalisation was RD 0 (95% CI -0.02 to 0.02). The estimated risk of death due to lower respiratory tract infection was also imprecise (RD -0.02, 95% CI -0.06 to 0.02) in individuals aged 60 years or older in LTCIs. Adjusted analyses which took into account the cluster design did not differ substantively from the pooled analysis with unadjusted data.

AUTHORS' CONCLUSIONS

The results for specific outcomes: laboratory-proven influenza or its complications (lower respiratory tract infection, or hospitalisation or death due to lower respiratory tract illness) did not identify a benefit of healthcare worker vaccination on these key outcomes. This review did not find information on co-interventions with healthcare worker vaccination: hand-washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, antivirals and asking healthcare workers with influenza or influenza-like-illness (ILI) not to work. This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs. High-quality RCTs are required to avoid the risks of bias in methodology and conduct identified by this review and to test further these interventions in combination.

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Njuguna H, Ahmed J, Oria PA, Arunga G, Williamson J, Kosgey A, Muthoka P, Mott JA, Breiman RF, Katz MA. Uptake and effectiveness of monovalent influenza A (H1N1) pandemic 2009 vaccine among healthcare personnel in Kenya, 2010. Vaccine 2013;31:4662-7. [PMID: 23859843 DOI: 10.1016/j.vaccine.2013.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/07/2013] [Accepted: 07/02/2013] [Indexed: 01/17/2023]

Abstract

INTRODUCTION

During April-June 2010, the Kenya Ministry of Public Health and Sanitation distributed free monovalent influenza A(H1N1)pdm09 vaccines to health care personnel (HCP) and other vulnerable groups. We conducted a prospective, cohort study among HCP to characterize influenza A(H1N1)pdm09 vaccine uptake, and to assess influenza A(H1N1)pdm09 vaccine effectiveness.

METHODS

We enrolled HCP from 5 hospitals and followed them for 6 months. At enrollment, we asked HCP if they had received the influenza A(H1N1)pdm09 vaccine and their reasons for their decision. We administered weekly questionnaires to participants about respiratory symptoms suffered during the previous week. Participants who had acute respiratory illness were asked to contact our surveillance clinician, and nasopharyngeal and oropharyngeal specimens were collected and later tested for influenza by real-time reverse-transcriptase polymerase-chain-reaction. Vaccine effectiveness was estimated by comparing the incidence of acute respiratory illness, absenteeism from work due to respiratory illness and laboratory-confirmed influenza among vaccinated and unvaccinated HCP.

RESULTS

We enrolled 3803 HCP from the five hospitals; 64% received influenza vaccine. Vaccinated HCP were more likely to develop acute respiratory illness (ARI) and more likely to report missed days of work due to respiratory illness compared to non-vaccinated HCP (adjusted incidence rate ratio (aIRR) 1.50, 95% confidence intervals (CI): 1.33-1.70) and (aIRR 2.02, 95% CI: 1.41-2.88), respectively. Of 531 samples collected from vaccinated and non-vaccinated HCP, 30 were influenza A and 3 were influenza B. Two influenza A(H1N1)pdm09 subtypes were isolated; one from vaccinated and the other from non-vaccinated HCP.

DISCUSSION AND CONCLUSIONS

A majority of Kenyan HCP surveyed reported receiving the influenza A(H1N1)pdm09 vaccine. Because of low circulation of influenza A(H1N1)pdm09 virus during the study period, vaccine effectiveness could not be determined. The findings of increased ARI events and missed days of work among vaccinated HCP were likely confounded by vaccine-seeking behavioral factors.

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Matsushita M, Takeuchi S, Kumagai N, Uehara Y, Matsushita C, Arise K, Seo H, Awatani T. Prevaccination antibody titers can estimate the immune response to influenza vaccine in a rural community-dwelling elderly population. Vaccine 2012;30:1101-7. [DOI: 10.1016/j.vaccine.2011.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/02/2011] [Accepted: 12/03/2011] [Indexed: 11/27/2022]

Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database Syst Rev 2010:CD005187. [PMID: 20166073 DOI: 10.1002/14651858.cd005187.pub3] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Abstract

BACKGROUND

Healthcare workers' (HCWs) influenza rates are unknown, but may be similar to the general public and they may transmit influenza to patients.

OBJECTIVES

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).

SEARCH STRATEGY

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.

SELECTION CRITERIA

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.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias.

MAIN RESULTS

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.

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Summer influenza outbreak in a home for the elderly: application of preventive measures. J Hosp Infect 2009;70:272-7. [PMID: 18799243 DOI: 10.1016/j.jhin.2008.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 07/15/2008] [Indexed: 11/24/2022]

Fiore AE, Bridges CB, Cox NJ. Seasonal Influenza Vaccines. Curr Top Microbiol Immunol 2009;333:43-82. [DOI: 10.1007/978-3-540-92165-3_3] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]

Ong CWM, Tambyah PA. Update on antivirals and vaccines for seasonal and potential pandemic use. Expert Rev Respir Med 2008;2:391-402. [DOI: 10.1586/17476348.2.3.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Skowronski DM, Tweed SA, De Serres G. Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant? J Infect Dis 2008;197:490-502. [PMID: 18275271 DOI: 10.1086/524146] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open

Abstract

Advisory committees have cautioned that influenza vaccine-induced antibody declines more rapidly in the elderly, falling below seroprotective levels within 4 months. We conducted a literature review to assess this assertion. The articles that were included in this review reported antibody levels > or =4 months after influenza immunization in persons > or =60 years old, interpretable in the context of annual influenza vaccine-approval criteria (seroprotection/seroconversion) specified by the Committee for Proprietary Medicinal Products (CPMP) for the elderly. The final review included 14 studies; 8 of which reported seroprotection rates. Seroprotection exceeding CPMP criteria was maintained > or =4 months after influenza immunization in all 8 of the studies reporting this for the H3N2 component and in 5 of the 7 studies reporting this for the H1N1 and B components. In determining whether CPMP criteria were met at season's end, primary antibody response appeared to be more relevant than secondary antibody decline. Both studies reporting seroprotection rates that failed CPMP criteria > or =4 months after influenza immunization for each of the H1N1 and B components had also reported failed seroprotection at 1 month after immunization. If initially achieved after immunization, seroprotection rates of 70%-100% were maintained not just at 4 months (2 studies) but also at 5 months (2 studies) and even at >6 months (4 studies), for the H3N2 and H1N1 vaccine components. Seroprotection rates appeared less consistent for the B vaccine component, throughout the postimmunization period. Seroconversion appears to vary substantially and inversely with preimmunization titers but not with age. In 2 of 6 studies reporting seroconversion alone, CPMP criteria were still met at 4 months. In the other 4 studies, the main reason for failure at 4 months was primary failure at 1 month. A total of 6 studies compared antibody persistence by age, and no consistent differences were found on that basis. The historic concern that the influenza vaccine-induced antibody response in the elderly declines more rapidly and below seroprotective levels within 4 months of immunization should be reconsidered.

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