Influenza vaccination for healthcare workers in the UK: appraisal of systematic reviews and policy options.
Influenza vaccination for healthcare workers in the UK: appraisal of systematic reviews and policy options.
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DOI：
10.1136/bmjopen-2016-012149
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发表时间：
2016-09-13
期刊：
影响因子：
2.9
通讯作者：
Garner P
中科院分区：
文献类型：
--
作者：
Kliner M;Keenan A;Sinclair D;Ghebrehewet S;Garner P
英国卫生部建议医护人员每年接种流感疫苗，但接种率仍然很低。对于工作人员来说，接种疫苗的理由和支持这项建议的证据还不确定。从职业健康、雇主和病人安全的角度阐明医护人员接种流感疫苗的理据和证据基础。对已发表的系统评价进行系统评价。纳入的11篇综述的质量各不相同;有些包含完全相同的试验，但提出了相互矛盾的建议。3项综述评估了疫苗对医护人员的影响，发现1项试验报告疫苗有效性（VE）为88%。6篇综述评估了健康成人中的疫苗效应，VE与中位数62%一致（95%CI 56至67）。2篇综述评估了对医护人员工作日损失的影响（3项试验），3篇报告了对健康成人的影响（4项试验）。最近的综述所提出的荟萃分析没有达到统计学显著性的标准水平，但可能具有误导性，因为个别试验表明获益的效果大小存在很大差异。2013年的科克伦综述报告了实验室确诊的流感和患者住院的绝对效应接近0，但排除了临床疑似流感和全因死亡率的数据，这些数据在以前的版本中显示了潜在的重要影响。最近的一项系统性综述报告了这些效应，临床疑似流感减少42%（95% CI 27 - 54），全因死亡率减少29%（95% CI 15 - 41）。流感疫苗接种对雇主和患者安全益处的证据并不简单，不同的系统综述作者对此有不同的解释。由代表所有相关利益相关者的小组制定的完全透明的指南过程可能会使医疗保健工作者未来接受流感疫苗接种受益，该指南明确传达了基本原理，证据基础和判断。
The UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale for vaccination and evidence underpinning the recommendation. To clarify the rationale, and evidence base, for influenza vaccination of healthcare workers from the occupational health, employer and patient safety perspectives. Systematic appraisal of published systematic reviews. The quality of the 11 included reviews was variable; some included exactly the same trials but made conflicting recommendations. 3 reviews assessed vaccine effects in healthcare workers and found 1 trial reporting a vaccine efficacy (VE) of 88%. 6 reviews assessed vaccine effects in healthy adults, and VE was consistent with a median of 62% (95% CI 56 to 67). 2 reviews assessed effects on working days lost in healthcare workers (3 trials), and 3 reported effects in healthy adults (4 trials). The meta-analyses presented by the most recent reviews do not reach standard levels of statistical significance, but may be misleading as individual trials suggest benefit with wide variation in size of effect. The 2013 Cochrane review reported absolute effects close to 0 for laboratory-confirmed influenza, and hospitalisation for patients, but excluded data on clinically suspected influenza and all-cause mortality, which had shown potentially important effects in previous editions. A more recent systematic review reports these effects as a 42% reduction in clinically suspected influenza (95% CI 27 to 54) and a 29% reduction in all-cause mortality (95% CI 15 to 41). The evidence for employer and patient safety benefits of influenza vaccination is not straightforward and has been interpreted differently by different systematic review authors. Future uptake of influenza vaccination among healthcare workers may benefit from a fully transparent guideline process by a panel representing all relevant stakeholders, which clearly communicates the underlying rationale, evidence base and judgements made.