Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial
Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial
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DOI：
10.1136/bmj.39010.581354.55
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发表时间：
2006-12-16
影响因子：
--
通讯作者：
Watson, John M.
中科院分区：
文献类型：
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作者：
Hayward, Andrew C.;Harling, Richard;Watson, John M.
目的探讨养老院工作人员接种流感疫苗是否能间接保护居民。设计配对群随机对照试验。2003-4年和2004-5年冬季在英国设立大型私人连锁养老院。参与者：来自44个养老院（22个干预之家和22个匹配的对照之家）的养老院工作人员（n = 1703）和居民（n = 2604）。干预措施向干预之家而不是对照之家的工作人员提供疫苗接种。主要结局指标主要结局指标为居民的全因死亡率。次要结局是流感样疾病和居民的卫生服务使用情况。结果2003-4年干预之家全职工作人员疫苗接种率为48.2%(407/884)，对照之家为5.9%（51/859）。2004- 2005年，接种率分别为43.2%（365/844）和3.5%（28/800）。2004- 2005年，全国流感发病率大大低于平均水平。在2003-4年流感活动期间，干预之家居民的死亡率与对照之家相比显著下降（比率差异为每100名居民5.0人，95%可信区间为7.0至2.0人），流感样疾病（P = 0.004）、因流感样疾病向全科医生求诊（P = 0.008）和因流感样疾病住院（P = 0.009）。在2004-5年或2003-4年无流感活动期间没有发现显著差异。结论：在流感中度活动期间，为养老院工作人员接种流感疫苗可预防死亡、卫生服务使用和居民流感样疾病。
Objective To determine whether vaccination of care home staff against influenza indirectly protects residents.Design Pair matched cluster randomised controlled trial.Setting Large private chain of UK care homes during the winters of 2003-4 and 2004-5.Participants Nursing home staff (n = 1703) and residents (n = 2604) in 44 care homes (22 intervention homes and 22 matched control homes).Interventions Vaccination offered to staff in intervention homes but not in control homes.Main outcome measures The primary outcome was all cause mortality of residents. Secondary outcomes were influenza-like illness and health service use in residents.Results In 2003-4 vaccine coverage in full time staff was 48.2% (407/884) in intervention homes and 5.9% (51/859) in control homes. In 2004-5 uptake rates were 43.2% (365/844) and 3.5% (28/800). National influenza rates were substaritially below average in 2004-5. In the 2003-4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes (rate difference - 5.0 per 100 residents, 95% confidence interval - 7.0 to - 2.0) and in influenza-like illness (P = 0.004), consultations with general practitioners for influenza-like illness (P = 0.008), and admissions to hospital with influenza-like illness (P = 0.009). No significant differences were found in 2004-5 or during periods of no influenza activity in 2003-4.Conclusions Vaccinating care home staff against influenza can prevent deaths, health service use, and influenza-like illness in residents during periods of moderate influenza activity.