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Effectiveness & cost-effectiveness of vaccinating healthcare workers against influenza, and strategies to improve uptake. Dr Rachel Jordan University of Birmingham, UK. Amanda Burls, Beverley Wake, Pelham Barton, Babatunde Olowokure, Esther Albon, Jeremy Hawker. Overview. Background
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Effectiveness & cost-effectiveness of vaccinating healthcare workers against influenza, and strategies to improve uptake Dr Rachel Jordan University of Birmingham, UK Amanda Burls, Beverley Wake, Pelham Barton, Babatunde Olowokure, Esther Albon, Jeremy Hawker
Overview • Background • Effectiveness of influenza vaccine in HCW • Effectiveness in protecting patients • Cost-effectiveness • Barriers • Interventions to improve uptake
Influenza vaccine and HCW • Influenza important public health problem… • Significant mortality & morbidity in elderly & high risk groups • Vaccinate most at risk • Also provide indirect protection eg HCWs, carers • Recommended by WHO (& most of Europe) • Uptake in Europe <25% [UK~13%]
Methodology • Series of systematic review sub-q’s • Cochrane Library, MEDLINE, EMBASE etc to June 2004 • Independent data extraction & quality assessment • Primary studies – series of questions • Updates
Cost-effectiveness • Methods: Simple economic model • HCW Vaccination programme vs no prog • Carman et al 2000 • UK 2003-4 costs • Staff, vaccine, absenteeism • Benefits discounted at 3.5% • Patient mortality, life expectancy • Updated to include Hayward 2006 et al
Large number of surveys Variety of designs, settings and personnel Range of response rates COMMON REASONS FOR REFUSING Fear of side effects Fear vaccine causes flu Dislike of injections Unaware available Unaware useful Forgetting/lack of time Perceived low risk of contracting influenza Barriers to vaccination
How do we improve uptake? • Common themes: Convenience & education • 5 RCTs – range of interventions • Many before/after studies or descriptive evaluations of programmes
Evidence….RCTs • Promotional/education campaigns – little effect?
Evidence….RCTs • Promotion + education + local vaccination
Evidence….before/after • Mobile carts – potential greatest effect?
Evidence…. • Combinations of: • Information/marketing • convenience • Vaccine clinics + mandatory declination report via intranet • eg Bertin 2007, Cleveland Hospital • 55% after vs 38% before • Convenience + individual feedback & follow-up • eg McCullers 2006, Pediatric Cancer Hospital • 80% after vs 45% before
Conclusions • Vaccinating HCW is effective & cost-effective • Uptake is still low • Barriers are known • Still lack of trials demonstrating best methods of improving uptake
Implications • We need good RCTs of methods to improve uptake • Mobile carts combined with other methods promising • Mandatory declination? • Individual feedback/follow-up?
Acknowledgements • Main funders: European Scientific Working Group on Influenza