Volume 57, Issue 9 p. 1580-1586

Effect of Influenza Vaccination of Nursing Home Staff on Mortality of Residents: A Cluster-Randomized Trial

Magali Lemaitre MPH

Magali Lemaitre MPH

From the Department of Epidemiology, Information Systems, and Modeling, University Pierre and Marie Curie Paris 6, UMR-S 707, Paris, France

Institut National de la Santé et de la Recherche Médicale, UMR-S 707, Paris, France

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Thierry Meret MD

Thierry Meret MD

Résidence Saint Rémy, Saint Rémy Les Chevreuses, France

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Monique Rothan-Tondeur PhD

Monique Rothan-Tondeur PhD

Observatoire du Risque Infectieux en Gériatrie, Hôpital Charles-Foix, Ivry sur Seine, France

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Joel Belmin MD

Joel Belmin MD

Geriatric Service, Hôpital Charles-Foix, Assistance Publique Hôpitaux de Paris, Ivry sur Seine, France

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Jean-Louis Lejonc MD

Jean-Louis Lejonc MD

Internal Medicine Service, Hôpital Albert-Chennevier, Assistance Publique Hôpitaux de Paris, Créteil, France

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Laurence Luquel MD

Laurence Luquel MD

Geriatric Service, Hôpital de Longjumeau, Longjumeau, France

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François Piette MD

François Piette MD

Internal Medicine Service, Hôpital Charles-Foix, Assistance Publique Hôpitaux de Paris, Ivry sur Seine, France

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Michel Salom MD

Michel Salom MD

Gerontology Clinic, Fondation L Bellan, Magnanville, France

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Marc Verny MD, PhD

Marc Verny MD, PhD

Geriatric Medicine Service, Hôpital Pitié Salpétrière, Assistance Publique Hôpitaux de Paris, Paris, France

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Jean-Marie Vetel MD

Jean-Marie Vetel MD

Geriatric Service, Centre Hospitalier, Le Mans, France

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Pierre Veyssier MD

Pierre Veyssier MD

Internal Medicine and Infectious Diseases, Centre Hospitalier, Compiègne, France; and

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Fabrice Carrat MD, PhD

Fabrice Carrat MD, PhD

From the Department of Epidemiology, Information Systems, and Modeling, University Pierre and Marie Curie Paris 6, UMR-S 707, Paris, France

Institut National de la Santé et de la Recherche Médicale, UMR-S 707, Paris, France

Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris, France.

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First published: 28 August 2009
Citations: 179
Address correspondence to Fabrice Carrat, Epidémiologie, systèmes d'information, modélisation, UMR-S 707, Faculté de médecine Saint Antoine, 27, rue Chaligny, 75571 Paris cedex 12, France.E-mail: [email protected]

Abstract

OBJECTIVES: To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents.

DESIGN: Pair-matched cluster-randomized trial.

SETTING: Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index.

PARTICIPANTS: All persons aged 60 and older residing in the nursing homes.

INTERVENTION: Influenza vaccine was administered to volunteer staff after a face-to-face interview. No intervention took place in control nursing homes.

MEASUREMENTS: The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community. Secondary endpoints were rates of hospitalization and influenza-like illness (ILI) in residents and sick leave from work in staff.

RESULTS: Staff influenza vaccination rates were 69.9% in the vaccination arm versus 31.8% in the control arm. Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P=.08), although multivariate-adjusted analysis showed 20% lower mortality (P=.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=−0.42, P=.007). In the vaccination arm, significantly lower resident hospitalization rates were not observed, but ILI in residents was 31% lower (P=.007), and sick leave from work in staff was 42% lower (P=.03).

CONCLUSION: These results support influenza vaccination of staff caring for institutionalized elderly people.