Influenza Vaccination of Healthcare Workers

Influenza vaccination of health care workersTo support his argument in favour of compulsory influenza vaccination of health care workers, Flegel 1 cites a Cochrane review 2 as evidence of the vaccine's benefit.However the following points should be noted: • Flegel fails to convey to readers the Cochrane review's warning: "All findings must be interpreted with caution given the presence of selection bias." 2 • The author has cited the 2006 version of the Cochrane review, 2 rather than the up-to-date version from 2010. 3 • The up-to-date Cochrane review from 2010 largely contradicts Flegel's statements, and suggests the evidence of benefit is poor.The reviewers write: "The three studies in the first publication of this review and the two new studies we identified in this update are all at high risk of bias."They summarize: "We conclude that there is no evidence that only vaccinating healthcare workers prevents laboratoryproven influenza, pneumonia, and death from pneumonia in elderly residents in long-term care facilities."• Flegel also failed to cite another Cochrane review, which suggests alternatives to vaccination: "Implementing barriers to transmission, such as isolation, and hygienic measures (wearing masks, gloves and gowns) can be effective in containing respiratory virus epidemics or in hospital wards." 4 These issues should be clarified and corrected.