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Effect of Influenza Vaccination of Nursing Home Staff on Mortality of Residents: A Cluster-Randomized Trial |
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| Authors: | Magali Lemaitre,MPH,,Thierry Meret,MD,,Monique Rothan-Tondeur,PhD,,Joel Belmin,MD,,Jean-Louis Lejonc,MD,,Laurence Luquel,MD,,Franç ois Piette,MD,,Michel Salom,MD,,Marc Verny,MD,PhD,,Jean-Marie Vetel,MD,,Pierre Veyssier,MD,, Fabrice Carrat,MD,PhD |
| Affiliation: | 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 Santéet de la Recherche Médicale, UMR-S 707, Paris, France;;Résidence Saint Rémy, Saint Rémy Les Chevreuses, France;;Observatoire du Risque Infectieux en Gériatrie, Hôpital Charles-Foix, Ivry sur Seine, France;;Geriatric Service, Hôpital Charles-Foix, Assistance Publique Hôpitaux de Paris, Ivry sur Seine, France;;Internal Medicine Service, Hôpital Albert-Chennevier, Assistance Publique Hôpitaux de Paris, Créteil, France;;Geriatric Service, Hôpital de Longjumeau, Longjumeau, France;;Internal Medicine Service, Hôpital Charles-Foix, Assistance Publique Hôpitaux de Paris, Ivry sur Seine, France;;Gerontology Clinic, Fondation L Bellan, Magnanville, France;;Geriatric Medicine Service, Hôpital PitiéSalpétrière, Assistance Publique Hôpitaux de Paris, Paris, France;;Geriatric Service, Centre Hospitalier, Le Mans, France;;Internal Medicine and Infectious Diseases, Centre Hospitalier, Compiègne, France;and;Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris, France. |
| 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. |
| Keywords: | elderly nursing homes residents staff influenza vaccination |