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Flu-related absence, a small proportion of all-cause sickness absence

Frank O'Reilly and Peter Noone
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DOI: https://doi.org/10.7861/clinmedicine.18-3-268
Clin Med June 2018
Frank O'Reilly
An Post, GPO, Dublin, Ireland
Roles: Consultant in Occupational Medicine
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Peter Noone
HSE, Dublin, Ireland
Roles: Consultant in Occupational Medicine
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Editor – The recent paper by Pereira et al on potential for improved sickness absence following influenza vaccination in healthcare workers is interesting.1 We wonder whether the authors conclusions are valid based on the data in their study.

Annual population influenza infection rates are reported at between 5–20%.2 On average each flu case takes 3 days absence.2 Not all of influenza cases result in absence from work.3 In an average influenza season the expected contribution from influenza on total sickness absence may be 0.1–0.3%.

The vaccine is ineffective against other influenza-like illness (ILI) that are not caused by influenza. Generally the vaccine does not exactly match circulating seasonal flu strains, and other factors affect vaccine response,4 which is at best about 60% effective.5 Therefore, the impact of the vaccine on improvement of sickness absence can only be between 0.05 to 0.15% (­average 0.1%).

The data analysis in this paper does correspond with the effect modelling outlined above. The authors' conclusion that ‘A 10% increase in vaccination would be associated with a 10% fall in sickness absence rate’ seems misleading based on the proportion of total sickness absence that is due to flu. In an average flu season the total proportion of influenza-related sickness absence rate is likely to be of the order of only a proportion (0.1%) of the all-cause absence rate of 4.5%. It may be that the authors intended to say that a 10% increase in vaccination would lead to a 10% fall in sickness absence in relation to influenza, but not total absence.

It may be time to review the efficacy of healthcare worker influenza vaccination against the desired objectives of public health policy. To aim to vaccinate 100% of a mostly healthy population, of whom at most about 20% may become infected, with an imperfect vaccine to improve sickness absence by 0.1% in the average flu season, seems of marginal benefit.

  • © Royal College of Physicians 2018. All rights reserved.

References

  1. ↵
    1. Pereira M
    , Williams S, Restrick, Cullinan P, Hopkinson NS, et al. Healthcare worker influenza vaccination and sickness absence – an ecological study. Clin Med 2017;17:484–9.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Schanzer DL
    , Zheng H, Gilmore J. Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey. BMC Infect Dis 2011;11:90.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Elder AG
    , O'Donnell B, McCruden EA, Symington IS, Carman WF. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993–4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:1241–2.
    OpenUrlFREE Full Text
  4. ↵
    1. Osterholm MT
    , Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and ­meta-analysis. Lancet Infect Dis 2012;12:36–44.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Centers for Disease Control and Prevention (CDC)
    . Seasonal influenza vaccine effectiveness, 2005–2018. www.cdc.gov/flu/professionals/­vaccination/effectiveness [Accessed 14 March 2018]
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Flu-related absence, a small proportion of all-cause sickness absence
Frank O'Reilly, Peter Noone
Clinical Medicine Jun 2018, 18 (3) 268; DOI: 10.7861/clinmedicine.18-3-268

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Flu-related absence, a small proportion of all-cause sickness absence
Frank O'Reilly, Peter Noone
Clinical Medicine Jun 2018, 18 (3) 268; DOI: 10.7861/clinmedicine.18-3-268
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