Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis

Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs). We searched OVID MEDLINE (1950 to 2010), EMBA...

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Published inPloS one Vol. 6; no. 10; p. e26239
Main Authors Kuster, Stefan P., Shah, Prakesh S., Coleman, Brenda L., Lam, Po-Po, Tong, Agnes, Wormsbecker, Anne, McGeer, Allison
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 18.10.2011
Public Library of Science (PLoS)
Subjects
Adult
Adults
Analysis
Antibodies
Biology
Confidence intervals
Health
Health aspects
Health care
Health Personnel - statistics & numerical data
Humans
Immunization
Incidence
Infections
Influenza
Influenza, Human - epidemiology
Lists
Medical personnel
Medical research
Medicine
Meta-analysis
Observational studies
Older people
Polymerase chain reaction
Risk factors
Seasons
Studies
Vaccination
Vaccines
Workers
Online AccessGet full text

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Abstract Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs). We searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs. Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
AbstractList Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs).BACKGROUNDWorking in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs).We searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs.METHODS AND FINDINGSWe searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs.Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.CONCLUSIONSCompared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs). We searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
Background Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs). Methods and Findings We searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs. Conclusions Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs). We searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs. Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
Background Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs). Methods and Findings We searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs. Conclusions Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
BackgroundWorking in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs).Methods and findingsWe searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction. From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs.ConclusionsCompared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.
Audience Academic
Author Lam, Po-Po
Shah, Prakesh S.
McGeer, Allison
Coleman, Brenda L.
Tong, Agnes
Wormsbecker, Anne
Kuster, Stefan P.
AuthorAffiliation 4 Hospital for Sick Children, Toronto Ontario, Canada
2 University of Toronto, Toronto Ontario, Canada
3 Ontario Agency for Health Protection and Promotion, Toronto Ontario, Canada
Centers for Disease Control and Prevention, United States of America
1 Mount Sinai Hospital, Toronto Ontario, Canada
AuthorAffiliation_xml – name: 2 University of Toronto, Toronto Ontario, Canada
– name: 1 Mount Sinai Hospital, Toronto Ontario, Canada
– name: Centers for Disease Control and Prevention, United States of America
– name: 4 Hospital for Sick Children, Toronto Ontario, Canada
– name: 3 Ontario Agency for Health Protection and Promotion, Toronto Ontario, Canada
Author_xml – sequence: 1
  givenname: Stefan P.
  surname: Kuster
  fullname: Kuster, Stefan P.
– sequence: 2
  givenname: Prakesh S.
  surname: Shah
  fullname: Shah, Prakesh S.
– sequence: 3
  givenname: Brenda L.
  surname: Coleman
  fullname: Coleman, Brenda L.
– sequence: 4
  givenname: Po-Po
  surname: Lam
  fullname: Lam, Po-Po
– sequence: 5
  givenname: Agnes
  surname: Tong
  fullname: Tong, Agnes
– sequence: 6
  givenname: Anne
  surname: Wormsbecker
  fullname: Wormsbecker, Anne
– sequence: 7
  givenname: Allison
  surname: McGeer
  fullname: McGeer, Allison
BackLink https://www.ncbi.nlm.nih.gov/pubmed/22028840$$D View this record in MEDLINE/PubMed
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Snippet Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence...
Background Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review...
BackgroundWorking in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review...
Background Working in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review...
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SubjectTerms Adult
Adults
Analysis
Antibodies
Biology
Confidence intervals
Health
Health aspects
Health care
Health Personnel - statistics & numerical data
Humans
Immunization
Incidence
Infections
Influenza
Influenza, Human - epidemiology
Lists
Medical personnel
Medical research
Medicine
Meta-analysis
Observational studies
Older people
Polymerase chain reaction
Risk factors
Seasons
Studies
Vaccination
Vaccines
Workers
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Title Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis
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http://dx.doi.org/10.1371/journal.pone.0026239
Volume 6
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