Worksite: Seasonal Influenza Vaccinations Using Interventions with Actively Promoted, Off-Site Vaccinations non-Healthcare Workers

The CPST finding is based on evidence from a systematic review of 1 study (search period through March 2008). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to worksite health promotion.

Off-site, actively promoted influenza vaccination interventions encourage workers to obtain influenza vaccinations in a location other than that in which they normally work using any of a variety of approaches. These include providing vouchers or leave time, conducting health education sessions, and sending reminders about the vaccination. The intervention must be promoted through formal worksite announcements, such as newsletters, e-mails, paycheck inserts, or posters in the worksite and may include additional components.

One study was included in the review.

• The study examined the effect of providing one group of high-risk workers with a second postcard reminder as compared to a group of high-risk workers who received only one postcard reminder. Workers were encouraged to vaccinate at an off-site benefits provider clinic. The coverage effect estimate for the second postcard was 0.8 percentage points favoring the intervention.

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

The following outlines evidence gaps for these interventions to promote seasonal influenza vaccinations among non-healthcare workers: on-site, reduced cost, actively promoted vaccinations; and actively promoted off-site vaccinations.

The primary questions that remain unanswered from this review relate to cost savings and the overall effectiveness of interventions with additional components like mobile carts or incentives. To address these issues and further the knowledge of the field of worksite influenza vaccination interventions, researchers must conduct rigorous, multi-year studies with concurrent comparison worksites that evaluate on-site, off-site, and other intervention approaches. Additionally, researchers should investigate the following:

• How might the successes in increasing influenza vaccination coverage in the body of evidence for healthcare workers inform efforts in non-healthcare worksites?
• What specific barriers, besides access, should implementers address with their interventions?
• What might be the cost of presenteeism associated with influenza in the worksite, including, for example, the cost of injuries due to reduced alertness, the cost of reduced morale, and the cost of spreading infection to other workers?

The one included study was conducted in the U.S. and targeted people aged 18 to 64 years with high-risk conditions.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table – Effectiveness Review

Economic Review

Summary Evidence Table – Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Ahmed F, Friedman C, Franks A, et al. Effect of the frequency of delivery of reminders and an influenza tool kit on increasing influenza vaccination rates among adults with high-risk conditions. Am J Manage Care 2004;10(10):698-702.

The following outlines the search strategy used for these reviews of interventions to promote seasonal influenza vaccinations among healthcare and non-healthcare workers: on-site, free or reduced cost, actively promoted vaccinations; and actively promoted off-site vaccinations.

With the assistance of a CDC librarian, the team searched for published studies in the following databases: PubMed, PsychInfo, CINAHL, Web of Science, Science Direct, Embase, CSA Illumina (Cambridge Scientific Abstracts), Proquest, Cochrane Library, Google Scholar, Sociological Abstracts, EconLit, and Global Health. The team also searched bibliographic reference lists and accepted suggestions of studies from members of the team.

The team considered studies for inclusion if they:

• Were primary research published in a journal or a technical or government report
• Were published in English
• Met minimum research quality criteria for study design and execution specifically, using designs with before-and-after comparisons in the intervention group or comparisons across two groups receiving different levels of intervention
• Evaluated an intervention designed to increase seasonal influenza vaccination coverage, conducted and promoted among workers in a healthcare worksite
• Evaluated change in seasonal influenza vaccination coverage, morbidity, mortality, or worker productivity associated with the intervention.

The team searched for and accepted for possible inclusion studies published through March 2008.

Database: MEDLINE (OVID) 722 results

exp Influenza, Human/ or (influenza or flu).mp
AND
exp Vaccination/ or exp Immunization Programs/ or exp Immunization/ or exp
Vaccines/ or (immuniz$ or vaccin$ or inoculat$ or jab or jabs).mp
AND
exp Work/ or exp Workplace/ or exp Health Personnel/ or exp Employment/ or
(worksite or workplace or work or employee or worker or employer or working).mp

Database: PSYCINFO (Ovid) 29 results

exp INFLUENZA/ or (influenza or flu).mp
AND
exp Immunization/ or (immuniz$ or vaccin$ or inoculat$ or jab or jabs).mp
AND
exp Personnel/ or exp Employment Status/ or exp Employee Attitudes/ or exp EMPLOYER ATTITUDES/ or exp Management Personnel/ or exp Employee Benefits/ or exp Personnel/ or exp Health Personnel/ or exp Nurses/ or exp Medical Personnel/ or (worksite or workplace or work or employee or worker or employer or working).mp

Database: CINAHL (Ovid) 538 results

exp INFLUENZA A VIRUS/ or exp INFLUENZA, AVIAN/ or exp INFLUENZA/ or exp
INFLUENZA A VIRUS, H5N1 SUBTYPE/ or (influenza or flu).mp
AND
exp Vaccines/ or exp INFLUENZA VACCINE/ or exp Immunization/ or (immuniz$ or vaccin$ or inoculat$ or jab or jabs).mp
AND
exp “MEDICAL SOCIAL WORKER SERVICE (SABA CCC)”/ or exp work/ or exp RESCUE WORK/ or exp WORK ENVIRONMENT/ or exp “QUALITY OF WORKING LIFE”/ or exp
MOTHERS, WORKING/ or exp WOMEN, WORKING/ or exp EMPLOYEE INCENTIVE PROGRAMS/ or exp EMPLOYEE ATTITUDES/ or exp EMPLOYEE ASSISTANCE PROGRAMS/ or exp EMPLOYEE ORIENTATION/ or exp EMPLOYMENT/ or exp HEALTH PERSONNEL AS PATIENTS/ or exp PERSONNEL, HEALTH FACILITY/ or exp HEALTH PERSONNEL, INFECTED/ or exp ALLIED HEALTH PERSONNEL/ or exp HEALTH PERSONNEL, UNLICENSED/ or exp HEALTH PERSONNEL/ or exp HEALTH PERSONNEL, MINORITY/ or exp LABORATORY PERSONNEL/ or exp NURSING HOME PERSONNEL/ or (worksite or workplace or work or employee or worker or employer or working).mp

Database: Web of Science 496 results

TS=(influenza or flu) or TI=(influenza or flu)
AND
TS=(immuniz* OR vaccin* OR inoculat* OR jab OR jabs) or TI=(immuniz* OR vaccin* OR inoculat* OR jab OR jabs)
AND
TS=(worksite or workplace or work or employee or worker or employer or working)
or TI=(worksite or workplace or work or employee or worker or employer or working)
(DocType=All document types; Language=English; Databases=SCI-EXPANDED, SSCI; Timespan=1980-2007 )

Database: Science Direct 224 results

TITLE-ABSTR-KEY((worksite or workplace or work or employee or worker or employer or working) AND (immuniz* OR vaccin* OR inoculat* OR jab OR jabs) AND (influenza or flu))

Database: Embase 1409 results

‘influenza’/exp OR ‘Influenza virus’/exp OR ‘influenza vaccine’/exp or influenza or flu
AND
‘immunization’/exp OR ‘preventive health service’/exp OR ‘influenza vaccination’/exp
OR ‘virus vaccine’/exp OR ‘vaccination’/exp OR ‘vaccine’/exp OR ‘influenza
vaccine’/exp OR ‘inoculation’/exp or immuniz* OR vaccin* OR inoculat* OR jab OR jabs
AND
‘workplace’/exp OR ‘work’/exp OR ‘worker’/exp OR ‘aged worker’/exp OR ‘health care personnel’/exp OR ’employee’/exp OR ’employer’/exp OR ’employment’/exp or worksite or workplace or work or employee or worker or employer or working

Database: CSA 33 results

influenza or flu
and
immuniz* OR vaccin* OR inoculat* OR jab OR jabs
and
worksite or workplace or work or employee or worker or employer or working

Database: Proquest 152 results

influenza or flu
and
immuniz* OR vaccin* OR inoculat* OR jab OR jabs
and
worksite or workplace or work or employee or worker or employer or working

Database: Cochrane 168 results

same as Medline

Database: EconLit 7 results

(worksite or workplace or work or employee or worker or employer or working) AND
(immuniz* OR vaccin* OR inoculat* OR jab OR jabs) AND (

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.