Increasing rates of flu vaccination in primary care staff
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* Zvi Howard Abramson
* Ian Nigel Miskin

We recently reported on a randomized trial of a program to increase staff influenza vaccination in primary care clinics. 1 

As mentioned in the review by Lam and colleagues, 2 previous studies were in hospital and long-term care settings, and only one study had an arm in primary care (with an unsuccessful campaign). The difference between inpatient settings (hospitals and institutions) and outpatient settings (primary care clinics) is obvious but often ignored in the literature. The authors should have been more careful about generalizing analysis of data from staff in nursing homes to “nonhospital settings,” which erroneously suggests that the conclusions also refer to primary care.

Our study showed that a promotional and educational intervention program can be highly effective in increasing the rates of influenza vaccination among staff. The campaign included local vaccination “champions,” whose effectiveness was recently demonstrated in a hospital setting. 3 

Although we performed an intervention to increase rates of vaccination among staff, we think that the evidence about the benefits of such an intervention is weak. Lam and colleagues base the recommendation that all health care personnel should be vaccinated on a 2006 Cochrane review. 4 However, the Cochrane review concluded that there was no credible evidence of the benefit to elderly patients of vaccinating nursing home personnel.

## Footnotes

*   **For the full letter, go to:** [www.cmaj.ca/cgi/eletters/cmaj.091304v1#593856](http://www.cmaj.ca/cgi/eletters/cmaj.091304v1#593856)

## REFERENCES

1.  1. Abramson ZH, Avni O, Levi O, et al. Randomized trial of a program to increase staff influenza vaccination in primary care clinics. *Ann Fam Physician* 2010.8:293–8.
    
    

2.  2. Lam P-P, Chambers LW, Pierrynowski Mac-Dougall DM, et al. Seasonal influenza vaccination campaigns for health care personnel: systematic review. *CMAJ* 2010 July 19. [Epub ahead of print].
    
    

3.  3. Slaunwhite JM, Smith SM, Fleming MT, et al. Increasing vaccination rates among health care works using unit “champions” as a motivator. Can J Infect Control 2009;24:159–64.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=19891169&link_type=MED&atom=%2Fcmaj%2F182%2F12%2F1331.2.atom) 

4.  4. Thomas RE, Jefferson T, Demicheli V, et al. Influenza vaccination for healthcare workers who work with the elderly [review]. *Cochrane Database Syst Rev* 2006;(3):CD005187.