Abstract
BackgroundTo protect hospitalized patients, who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally. However, its effectiveness is still being debated. To assess the effectiveness of HCW influenza vaccination, we performed an ecological study to evaluate the association between healthcare worker influenza vaccination and the incidence of nosocomial influenza in a tertiary hospital within Singapore between 2013 and 2018.MethodsNosocomial influenza was defined as influenza among inpatients diagnosed 7 days or more after admission by laboratory testing, while healthcare worker influenza vaccination rate was defined as the proportion of healthcare workers that was vaccinated at the end of each annual seasonal vaccination exercise. A modified Poisson regression was performed to assess the association between the HCW vaccination rates and monthly nosocomial influenza incidence rates.ResultsNosocomial influenza incidence rates followed the trend of non-nosocomial influenza, showing a predominant mid-year peak. Across 2,480,010 patient-days, there were 256 nosocomial influenza cases (1.03 per 10,000 patient-days). Controlling for background influenza activity and the number of influenza tests performed, no statistically significant association was observed between vaccination coverage and nosocomial influenza incidence rate although a protective effect was suggested (IRR 0.89, 95%CI:0.69–1.15, p = 0.37).ConclusionNo significant association was observed between influenza vaccination rates and nosocomial influenza incidence rates, although a protective effect was suggested. Aligning local HCW vaccine timing and formulation to that of the Southern Hemisphere may improve effectiveness. HCW vaccination remains important but demonstrating its effectiveness in preventing nosocomial influenza is challenging.
Highlights
To protect hospitalized patients, who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally
To protect hospitalized patients who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended by many national bodies and has been strongly encouraged if not required in many hospitals internationally [1]
Aim As a large tertiary hospital located in the tropics, we aimed to evaluate the association between HCW influenza vaccination and nosocomial influenza incidence rates
Summary
To protect hospitalized patients, who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally. To protect hospitalized patients who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended by many national bodies and has been strongly encouraged if not required in many hospitals internationally [1]. At an institution-level, there have been few studies that evaluated the effectiveness of institution-wide influenza vaccination on nosocomial influenza incidence rates, most of which are from the northern hemisphere [4, 5]. These commonly report and analyze aggregated annual influenza proportions. Studies in tropical countries, where influenza activity is year-round and show multiple peaks [6], and those that report incidence rates are lacking
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