Paid sick days and stay-at-home behavior for influenza

Paid Sick Leave Among U.S. Healthcare Personnel, April 2022

INTRODUCTION

Healthcare personnel are at risk for acquiring and transmitting respiratory infections in the workplace. Paid sick leave benefits allow workers to stay home and visit a healthcare provider when ill. The objectives of this study were to quantify the percentage of healthcare personnel reporting paid sick leave, identify differences across occupations and settings, and determine the factors associated with having paid sick leave.

METHODS

In a national nonprobability Internet panel survey of healthcare personnel in April 2022, respondents were asked, Does your employer offer paid sick leave? Responses were weighted to the U.S. healthcare personnel population by age, sex, race/ethnicity, work setting, and census region. The weighted percentage of healthcare personnel who reported paid sick leave was calculated by occupation, work setting, and type of employment. Using multivariable logistic regression, the factors associated with having paid sick leave were identified.

RESULTS

In April 2022, 73.2% of 2,555 responding healthcare personnel reported having paid sick leave, similar to 2020 and 2021 estimates. The percentage of healthcare personnel reporting paid sick leave varied by occupation, ranging from 63.9% (assistants/aides) to 81.2% (nonclinical personnel). Female healthcare personnel and those working as licensed independent practitioners, in the Midwest, and in the South were less likely to report paid sick leave.

CONCLUSIONS

Most healthcare personnel from all occupational groups and healthcare settings reported having paid sick leave. However, differences by sex, occupation, type of work arrangement, and Census region exist and highlight disparities. Increasing healthcare personnel's access to paid sick leave may decrease presenteeism and subsequent transmission of infectious diseases in healthcare settings.

Modelling the impact of non-pharmaceutical interventions on workplace transmission of SARS-CoV-2 in the home-delivery sector

OBJECTIVE

We aimed to use mathematical models of SARS-COV-2 to assess the potential efficacy of non-pharmaceutical interventions on transmission in the parcel delivery and logistics sector.

METHODS

We devloped a network-based model of workplace contacts based on data and consultations from companies in the parcel delivery and logistics sectors. We used these in stochastic simulations of disease transmission to predict the probability of workplace outbreaks in this settings. Individuals in the model have different viral load trajectories based on SARS-CoV-2 in-host dynamics, which couple to their infectiousness and test positive probability over time, in order to determine the impact of testing and isolation measures.

RESULTS

The baseline model (without any interventions) showed different workplace infection rates for staff in different job roles. Based on our assumptions of contact patterns in the parcel delivery work setting we found that when a delivery driver was the index case, on average they infect only 0.14 other employees, while for warehouse and office workers this went up to 0.65 and 2.24 respectively. In the LIDD setting this was predicted to be 1.40, 0.98, and 1.34 respectively. Nonetheless, the vast majority of simulations resulted in 0 secondary cases among customers (even without contact-free delivery). Our results showed that a combination of social distancing, office staff working from home, and fixed driver pairings (all interventions carried out by the companies we consulted) reduce the risk of workplace outbreaks by 3-4 times.

CONCLUSION

This work suggests that, without interventions, significant transmission could have occured in these workplaces, but that these posed minimal risk to customers. We found that identifying and isolating regular close-contacts of infectious individuals (i.e. house-share, carpools, or delivery pairs) is an efficient measure for stopping workplace outbreaks. Regular testing can make these isolation measures even more effective but also increases the number of staff isolating at one time. It is therefore more efficient to use these isolation measures in addition to social distancing and contact reduction interventions, rather than instead of, as these reduce both transmission and the number of people needing to isolate at one time.

Is paid sick leave bad for business? A systematic review

Vigorous legislative activity both for and against paid sick leave has occurred over the last decade. Although a compelling body of evidence suggests that paid sick leave supports personal and public health goals, a notable barrier in opposition to paid sick leave is apprehension about the potential short-term and long-term harms to business. This review critically assesses the relationship between paid sick leave and favorable or unfavorable business conditions. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically review six research databases between 2000 and November 2022. Of 2664 studies identified, 123 were considered potentially relevant and 43 were included in the review. In addition to absence from work, paid sick leave was associated with favorable business conditions such as increased job satisfaction; improved retention; and reductions in occupational injury, contagion, presenteeism, and death; as well as some measures of firm performance and labor market conditions. Overall, our review discovered more evidence supporting the relationship between paid sick leave and favorable business conditions as compared with evidence that supported unfavorable business conditions. Although more research is needed, these findings can be used to inform firm-level and public policy decisions about paid sick leave.

The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

Charting current evidence on the health and non-health benefits and equity impacts of pandemic/epidemic individual-level economic relief programmes: a scoping review protocol

INTRODUCTION

The emergence of a regional or global scale infectious disease outbreak often requires the implementation of economic relief programmes in affected jurisdictions to sustain societal welfare and, presumably, population health. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity. Thus, our objective is to map the current state of the literature with respect to the types of individual-level economic relief programmes implemented during infectious disease outbreaks and the impact of these programmes on the effectiveness of public health measures, individual and population health, non-health benefits and equity.

METHODS AND ANALYSIS

Our scoping review is guided by the updated Arksey and O'Malley scoping review framework. Eligible studies will be identified in eight electronic databases and grey literature using text words and subject headings of the different pandemic and epidemic infectious diseases that have occurred, and economic relief programmes. Title and abstract screening and full-text screening will be conducted independently by two trained study reviewers. Data will be extracted using a pretested data extraction form. The charting of the key findings will follow a thematic narrative approach. Our review findings will provide in-depth knowledge on whether and how benefits associated with pandemic/epidemic individual-level economic relief programmes differ across social determinants of health factors.This information is critical for decision-makers as they seek to understand the role of pandemic/epidemic economic mitigation strategies to mitigate the health impact and reduce inequity gap.

ETHICS AND DISSEMINATION

Since the scoping review methodology aims to synthesise evidence from literature, this review does not require ethical approval. Findings of our review will be disseminated to health stakeholders at policy meetings and conferences; published in a peer-review scientific journal; and disseminated on various social media platforms.

Using GPS-enabled mobile phones to evaluate the associations between human mobility changes and the onset of influenza illness

Due to the challenges in data collection, there are few studies examining how individuals' routine mobility patterns change when they experience influenza-like symptoms (ILS). In the present study, we aimed to assess the association between changes in routine mobility and ILS using mobile phone-based GPS traces and self-reported surveys from 1,155 participants over the 2016-2017 influenza season. We used a set of mobility metrics to capture individuals' routine mobility patterns and matched their weekly ILS survey responses. For a statistical analysis, we used a time-stratified case-crossover analysis and conducted a stratified analysis to examine if such associations are moderated by demographic and socioeconomic factors, such as age, gender, occupational status, neighborhood poverty and education levels, and work type. We found that statistically significant associations existed between reduced routine mobility patterns and the experience of ILS. Results also indicated that the association between reduced mobility and ILS was significant only for female and for participants with high socioeconomic status. Our findings offered an improved understanding of ILS-associated mobility changes at the individual level and suggest the potential of individual mobility data for influenza surveillance.

Cash transfer during the COVID-19 pandemic: a multicentre, randomised controlled trial

Objective

To evaluate the effect of a one-time cash transfer of $C1000 in people who are unable to physically distance due to insufficient income.

Design

Open-label, multi-centre, randomised superiority trial.

Setting

Seven primary care sites in Ontario, Canada; six urban sites associated with St. Michael’s Hospital in Toronto and one in Manitoulin Island.

Participants

392 individuals who reported trouble affording basic necessities due to disruptions related to COVID-19.

Intervention

After random allocation, participants either received the cash transfer of $C1000 (n=196) or physical distancing guidelines alone (n=196).

Main outcome measures

The primary outcome was the maximum number of symptoms consistent with COVID-19 over 14 days. Secondary outcomes were meeting clinical criteria for COVID-19, SARS-CoV-2 presence, number of close contacts, general health and ability to afford basic necessities.

Results

The primary outcome of number of symptoms reported by participants did not differ between groups after 2 weeks (cash transfer, mean 1.6 vs 1.9, ratio of means 0.83; 95% CI 0.56 to 1.24). There were no statistically significant effects on secondary outcomes of the meeting COVID-19 clinical criteria (7.9% vs 12.8%; risk difference −0.05; 95% CI −0.11 to 0.01), SARS-CoV-2 presence (0.5% vs 0.6%; risk difference 0.00 95% CI −0.02 to 0.02), mean number of close contacts (3.5 vs 3.7; rate ratio 1.10; 95% CI 0.83 to 1.46), general health very good or excellent (60% vs 63%; risk difference −0.03 95% CI −0.14 to 0.08) and ability to make ends meet (52% vs 51%; risk difference 0.01 95% CI −0.10 to 0.12).

Conclusions

A single cash transfer did not reduce the COVID-19 symptoms or improve the ability to afford necessities. Further studies are needed to determine whether some groups may benefit from financial supports and to determine if a higher level of support is beneficial.

Trial registration number

NCT04359264.

Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review

BACKGROUND

Workplace transmission is a significant contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. Previous studies have found that infectious illness presenteeism could contribute to outbreaks in occupational settings and identified multiple occupational and organisational risk factors. Amid the COVID-19 pandemic, it is imperative to investigate presenteeism particularly in relation to respiratory infectious disease (RID). Hence, this rapid review aims to determine the prevalence of RID-related presenteeism, including COVID-19, and examines the reported reasons and associated risk factors.

METHODS

The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in English and Chinese. Database searches included MEDLINE, EMBASE, Web of Science, China Knowledge Resource Integrated Database (CNKI) and preprint databases MedRxiv and BioRxiv.

RESULTS

The search yielded 54 studies, of which four investigated COVID-19-related presenteeism. Prevalence of work presenteeism ranged from 14.1 to 55% for confirmed RID, and 6.6 to 100% for those working with suspected or subclinical RID. The included studies demonstrated that RID-related presenteeism is associated with occupation, sick pay policy, age, gender, health behaviour and perception, vaccination, peer pressure and organisational factors such as presenteeism culture.

CONCLUSIONS

This review demonstrates that presenteeism or non-adherence to isolation guidance is a real concern and can contribute to workplace transmissions and outbreaks. Policies which would support workers financially and improve productivity, should include a range of effective non-pharmaceutical inventions such as workplace testing, promoting occupational health services, reviewing pay and bonus schemes and clear messaging to encourage workers to stay at home when ill. Future research should focus on the more vulnerable and precarious occupational groups, and their inter-relationships, to develop comprehensive intervention programs to reduce RID-related presenteeism.

Awareness and use of (emergency) sick leave: US employees' unaddressed sick leave needs in a global pandemic

We study US sick leave use and unaddressed sick leave needs in the midst of the global severe acute respiratory syndrome coronavirus type 2 (SARS COV 2) pandemic based on a representative survey. More than half of all US employees are unaware of the new emergency sick leave options provided by the federal Families First Coronavirus Response Act (FFCRA). Awareness and take-up rates are significantly higher among Asian Americans and lower among the foreign-born. About 8 million employees used emergency sick leave in the first 6 to 8 mo. Nevertheless, the share of employees who needed but could not take paid sick leave tripled in the pandemic; unaddressed sick leave needs total 15 million employees per month and are 69% higher among women. Our findings show that access to paid sick leave significantly reduces unaddressed sick leave needs. We conclude that given the fragmented US sick leave landscape, to address the strong increase in unaddressed sick leave needs during the pandemic, federal FFCRA response was not adequate.

Paid Sick Leave and Healthcare Utilization in Adults: A Systematic Review and Meta-analysis

CONTEXT

The U.S. is the only industrialized country in the world with no national policy mandating paid sick leave for workers. This study systematically reviews and quantifies the impact of paid sick leave on the use of healthcare services among employed adults.

EVIDENCE ACQUISITION

Articles published from January 2000 to February 2020 were located in MEDLINE/PubMed, SCOPUS, ScienceDirect, and Embase from March/April 2020. Key search terms included paid sick leave and health care utilization. Articles were assessed for methodologic quality, and qualitative and quantitative data were extracted. From the quantitative data, pooled OR, distribution, and heterogeneity statistics were calculated when possible.

EVIDENCE SYNTHESIS

A total of 12 manuscripts met the criteria for systematic review, and 8 of them had statistics required for meta-analysis. Individuals with paid sick leave had 1.57 (95% CI=1.50, 1.63; p<0.001) odds of having an influenza vaccination, 1.54 (95% CI=1.48, 1.60; p<0.001) odds of having a mammogram, 1.33 (95% CI=1.25, 1.41; p<0.001) odds of seeing a doctor, and 1.29 (95% CI=1.18, 1.39; p<0.001) odds of getting a Pap test compared with individuals without paid sick leave. However, the I² was relatively high with a significant p-value for most of the services, indicating potential heterogeneity.

CONCLUSIONS

Paid sick leave is likely to be an effective way to increase the use of primary and preventive healthcare services in the U.S. Further studies should be carried out to track outcomes over a longer period and to compare the effect of the number of paid sick days in relation to healthcare utilization.

WHO'S IN AND WHO'S OUT UNDER WORKPLACE COVID SYMPTOM SCREENING?

COVID symptom screening, a new workplace practice, is already affecting many millions of American workers. As of this writing, 34 states already require, and federal guidance recommends, frequent screening of at least some employees for fever or other symptoms. This paper provides the first empirical work identifying major features of symptom screening in a broad population and exploring the trade-offs employers face in using daily symptom screening. First, we find that common symptom checkers could screen out up to 7 percent of workers each day, depending on the measure used. Second, we find that the measures used will matter for three reasons: Many respondents report any given symptom, survey design affects responses, and demographic groups report symptoms at different rates, even absent fluctuations in likely COVID exposure. This last pattern can potentially lead to disparate impacts and is important from an equity standpoint.

Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017-2018

We assessed determinants of work attendance during the first 3 days after onset of acute respiratory illness (ARI) among workers 19-64 years of age who had medically attended ARI or influenza during the 2017-2018 influenza season. The total number of days worked included days worked at the usual workplace and days teleworked. Access to paid leave was associated with fewer days worked overall and at the usual workplace during illness. Participants who indicated that employees were discouraged from coming to work with influenza-like symptoms were less likely to attend their usual workplace. Compared with workers without a telework option, those with telework access worked more days during illness overall, but there was no difference in days worked at the usual workplace. Both paid leave benefits and business practices that actively encourage employees to stay home while sick are necessary to reduce the transmission of ARI and influenza in workplaces.

Health inequities in influenza transmission and surveillance

The lower an individual's socioeconomic position, the higher their risk of poor health in low-, middle-, and high-income settings alike. As health inequities grow, it is imperative that we develop an empirically-driven mechanistic understanding of the determinants of health disparities, and capture disease burden in at-risk populations to prevent exacerbation of disparities. Past work has been limited in data or scope and has thus fallen short of generalizable insights. Here, we integrate empirical data from observational studies and large-scale healthcare data with models to characterize the dynamics and spatial heterogeneity of health disparities in an infectious disease case study: influenza. We find that variation in social and healthcare-based determinants exacerbates influenza epidemics, and that low socioeconomic status (SES) individuals disproportionately bear the burden of infection. We also identify geographical hotspots of influenza burden in low SES populations, much of which is overlooked in traditional influenza surveillance, and find that these differences are most predicted by variation in susceptibility and access to sickness absenteeism. Our results highlight that the effect of overlapping factors is synergistic and that reducing this intersectionality can significantly reduce inequities. Additionally, health disparities are expressed geographically, and targeting public health efforts spatially may be an efficient use of resources to abate inequities. The association between health and socioeconomic prosperity has a long history in the epidemiological literature; addressing health inequities in respiratory-transmitted infectious disease burden is an important step towards social justice in public health, and ignoring them promises to pose a serious threat.

Social Determinants of Health and Implementation Research: Lessons from the COVID-19 Pandemic

During the past three decades, the world has experienced many clinical and public health challenges that require implementation of practices and policies informed by an understanding of social determinants of health and health inequities, but perhaps none as global and pervasive as the current COVID-19 pandemic. In the context of this special themed issue on Social Determinants of Health and Implementation Research: Three Decades of Progress and a Need for Convergence, we highlight the application of social determinants of health and implementation research on various aspects of the COVID-19 pandemic.

Economic Burden of Influenza in Thailand: A Systematic Review

Thailand has a high incidence and high mortality rates of influenza. This study summarizes the evidence on economic burden or costs of influenza subsequent to the occurrence of influenza illness in the Thai population by specific characteristics such as population demographics, health conditions, healthcare facilities, and/or cost types from published literature. A systematic search was conducted in six electronic databases. All costs were extracted and adjusted to 2018 US dollar value. Out of 581 records, 11 articles (1 with macroeconomic analysis and 10 with microeconomic analyses) were included. Direct medical costs per episode for outpatients and inpatients ranged from US$4.21 to US$212.17 and from US$163.62 to US$4577.83, respectively, across distinct influenza illnesses. The overall burden of influenza was between US$31.1 and US$83.6 million per year and 50-53% of these estimates referred to lost productivity. Costs of screening for an outbreak of influenza at an 8-bed-intensive-care-unit hospital was US$38242.75 per year. Labor-sensitive sectors such as services were the most affected part of the Thai economy. High economic burden tended to occur among children and older adults with co-morbidities and to be related to complications, non-vaccinated status, and severe influenza illness. Strategies involving prevention, limit of transmission, and treatment focusing on aforementioned patients’ factors, containment of hospitalization expenses and quarantine process, and assistance on labor-sensitive economy sectors are likely to reduce the economic burden of influenza. However, a research gap exists regarding knowledge about the economic burden of influenza in Thailand.

Behavioral strategies for reducing disease transmission in the workplace

The coronavirus pandemic highlighted that workplaces may serve as a hub of disease transmission if proper precautions are not enacted. The Centers for Disease Control recommends several strategies for decreasing the spread of illnesses in the workplace, including a) promoting proper hand hygiene, b) cleaning and sanitizing the work area, c) encouraging sick employees to stay home, d) personal protective equipment, and, e) social distancing. Research suggests that instructions are often not sufficient to change work behaviors, and behavioral interventions may be needed. Thus, the present paper reviews existing research that informs the implementation of behavioral strategies to reduce the spread of disease in the workplace, and makes recommendations for organizations to protect employees, clients, and customers. Intervention components such as training, prompts, the reduction of response effort, clear workplace policies, feedback, and consequences are discussed, and practical recommendations and suggestions for future research are provided.

The development of gendered health-related support dynamics over the course of a marriage

For married adults with chronic illnesses or functional limitations, informal support from a spouse is often essential for their well-being, but support around health issues is not confined to later life. Attention to processes of support throughout the entire intimate relationship can provide insight into support dynamics in later life. Additionally, health-related support from a spouse tends to be gendered with women providing more support. Our analysis of relationship timeline interviews with 23 older adult couples demonstrates that these gendered support dynamics develop and are sustained throughout a marriage. We identify three patterns of support: (1) acknowledged gender inequality in support in which women readily provided support when their husbands had health issues but men provided support less consistently for their wives' health issues throughout the relationship; (2) mutual support in which both spouses provided support for the other whenever there were health needs; and (3) independence, in which men and women provided relatively little support to one another, viewing each other as responsible for their own health and well-being. These support patterns are established early within marriages and continue as health issues intensify. These patterns of spousal support are linked to broader systems of gender inequality and societal messages about gender. Our study moves away from conceptualizations of support provisions around health issues as only being situated in later life. We instead show how dynamics of support are developed and normalized throughout a marriage and suggest that spousal support studies should take into account long-term marital dynamics.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Social Distancing Measures

Influenza virus infections are believed to spread mostly by close contact in the community. Social distancing measures are essential components of the public health response to influenza pandemics. The objective of these mitigation measures is to reduce transmission, thereby delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system. We conducted systematic reviews of the evidence base for effectiveness of multiple mitigation measures: isolating ill persons, contact tracing, quarantining exposed persons, school closures, workplace measures/closures, and avoiding crowding. Evidence supporting the effectiveness of these measures was obtained largely from observational studies and simulation studies. Voluntary isolation at home might be a more feasible social distancing measure, and pandemic plans should consider how to facilitate this measure. More drastic social distancing measures might be reserved for severe pandemics.

Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries

Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.

Reported variability in healthcare facility policies regarding healthcare personnel working while experiencing influenza-like illnesses: An emerging infections network survey

BACKGROUND

Presenteeism, or working while ill, by healthcare personnel (HCP) experiencing influenza-like illness (ILI) puts patients and coworkers at risk. However, hospital policies and practices may not consistently facilitate HCP staying home when ill.

OBJECTIVE AND METHODS

We conducted a mixed-methods survey in March 2018 of Emerging Infections Network infectious diseases physicians, describing institutional experiences with and policies for HCP working with ILI.

RESULTS

Of 715 physicians, 367 (51%) responded. Of 367, 135 (37%) were unaware of institutional policies. Of the remaining 232 respondents, 206 (89%) reported institutional policies regarding work restrictions for HCP with influenza or ILI, but only 145 (63%) said these were communicated at least annually. More than half of respondents (124, 53%) reported that adherence to work restrictions was not monitored or enforced. Work restrictions were most often not perceived to be enforced for physicians-in-training and attending physicians. Nearly all (223, 96%) reported that their facility tracked laboratory-confirmed influenza (LCI) in patients; 85 (37%) reported tracking ILI. For employees, 109 (47%) reported tracking of LCI and 53 (23%) reported tracking ILI. For independent physicians, not employed by the facility, 30 (13%) reported tracking LCI and 11 (5%) ILI.

CONCLUSION

More than one-third of respondents were unaware of whether their institutions had policies to prevent HCP with ILI from working; among those with knowledge of institutional policies, dissemination, monitoring, and enforcement of these policies was highly variable. Improving communication about work-restriction policies, as well as monitoring and enforcement, may help prevent the spread of infections from HCP to patients.

Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006-2015

Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006–2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers’ health.

Child Influenza Vaccination and Adult Work Loss: Reduced Sick Leave Use Only in Adults With Paid Sick Leave

INTRODUCTION

Children are a population of interest for influenza. They are at increased risk for severe influenza, comprise a substantial portion of influenza morbidity, and significantly contribute to its transmission in the household and subsequent parental work loss. The association between influenza vaccination and work loss prevention, however, has rarely been studied, and the sparse existing literature has very limited generalizability to U.S. adults, thus requiring better characterization.

METHODS

Using pooled National Health Interview Survey data (2013-2015, analyses conducted in 2018) nationally representative of working U.S. adults with household children (n=23,014), zero-inflated negative binomial regression examined the association of child influenza vaccination (exposure) with sick days (outcome) stratified by paid sick leave (no: n=10,741, yes: n=12,273).

RESULTS

Child influenza vaccination was associated with significantly lower sick day usage, but only among adults with paid sick leave (prevalence rate ratio=0.79, 95% CI=0.67, 0.93), equating to average annual sick days of 4.07 vs 3.29 in adults with unvaccinated versus vaccinated household children (difference=0.78 fewer days annually).

CONCLUSIONS

Influenza vaccination of children is associated with reduced sick leave in household adults, helping to keep the workforce healthy and reduce influenza's costly annual economic burden. This only occurred among adults with paid sick leave, however, which is distributed inequitably by income, education, gender, occupation, and race/ethnicity. Health in All Policies considers downstream health effects of social and economic policy; the failure of federal policy to ensure paid sick leave likely contributes to propagating influenza and health inequities.

A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers

BACKGROUND

Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW.

METHODS

We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings.

RESULTS

Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness.

DISCUSSION

Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.