Response
We thank the authors for their interest in our paper.1 We analysed data from 223 healthcare trusts covered ∼800,000 staff in each of four influenza seasons from 2011. Higher influenza vaccination rates were associated with reduced total sickness absence rates (β = –0.425 [95% CI –0.658, –0.192], p<0.001). From this, an increase of 10% in influenza vaccine uptake, such as the one observed between the 2012–13 and 2013–14 influenza seasons, would be associated with a decrease in approximately 0.43 percentage points in the absolute sickness absence rate. Considering the average sickness absence rate was 4.5% across the four influenza seasons. This reduction of 0.43 percentage points translates into a 10% relative decrease in the sickness rate, which suggests that increasing vaccine uptake can have a significant practical impact.
The most likely explanation for this is a direct effect of vaccination. A causal effect of vaccination is supported by the observation that the association between vaccination and sickness absence was only present during the flu season. In addition, the association was independent of staff satisfaction, so the explanation that a ‘happy’ workplace might lead independently both to higher vaccination rates and lower sickness absence cannot explain it.
Around 40% of NHS staff sickness absence is related to respiratory illness2 and rates of healthcare worker (HCW) influenza infection are higher3 than the range modelled in a general population.4 Median duration of HCW sickness absence with flu is 4 days.3 A significant proportion of HCWs have subclinical, but potentially transmissible, illness. The latter point means that the effect of vaccination will extend considerably beyond the individuals vaccinated, being multiplied by the reduction in transmission rates within the hospital environment and at home – vaccinated healthcare staff are therefore protecting their fellow workers as well as their patients,5–9 their families and themselves.
Our data support the view that healthcare vaccination against influenza is a useful intervention and that steps to reduce unwarranted variation in vaccination rates will be worthwhile.
- © Royal College of Physicians 2018. All rights reserved.
References
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- Pereira M
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- Ritchie KA
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- Elder AG
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- Hayward AC
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