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Dr Rachel Jordan University of Birmingham, UK

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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Dr Rachel Jordan University of Birmingham, UK

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  1. 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

  2. Overview • Background • Effectiveness of influenza vaccine in HCW • Effectiveness in protecting patients • Cost-effectiveness • Barriers • Interventions to improve uptake

  3. 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%]

  4. 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

  5. Effectiveness in HCW

  6. Protection for patients

  7. 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

  8. Results

  9. 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

  10. How do we improve uptake? • Common themes: Convenience & education • 5 RCTs – range of interventions • Many before/after studies or descriptive evaluations of programmes

  11. Evidence….RCTs • Promotional/education campaigns – little effect?

  12. Evidence….RCTs • Promotion + education + local vaccination

  13. Evidence….before/after • Mobile carts – potential greatest effect?

  14. 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

  15. Conclusions • Vaccinating HCW is effective & cost-effective • Uptake is still low • Barriers are known • Still lack of trials demonstrating best methods of improving uptake

  16. Implications • We need good RCTs of methods to improve uptake • Mobile carts combined with other methods promising • Mandatory declination? • Individual feedback/follow-up?

  17. Acknowledgements • Main funders: European Scientific Working Group on Influenza

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