Influenza vaccine among care home staff in England: a service evaluation with implications for the COVID-19 era

BACKGROUND. Influenza vaccination is key to protecting social care workers and preventing outbreaks in care homes, and studies suggest it may also reduce COVID-19 burden. However, influenza vaccination of care home staff has not historically been routinely monitored or published in England. Here we report rare data from care home service evaluations of vaccination policies and practices, so as to contextualize new data being collected nationally by government from the 2021-22 season onwards, and inform interventions to maximize protection of residents and staff. METHODS. In 2014 and again in 2015 managers of all 850 care homes in Surrey and Sussex registered with the Care Quality Commission were sent questionnaires by post or email inquiring about: type of care; ownership; employment and influenza policies; vaccine uptake.RESULTS. In 2014 186 homes responded (21.9%), in 2015 122 (14.4%). In both years, c.55% provided only residential care, and around 80% were privately owned. Most lacked staff vaccination policies (2014, 57%; 2015, 61.5%), just over half had occupational health policies. In both years >74% had not paid for staff influenza vaccination, despite government policy that it was part of occupational health responsibilities. Evidence of vaccination of permanent staff was not checked by >84% of homes, >69% were unaware of agency staff vaccination status. Reported vaccine uptake for residents in 2014 was 87.2% (86.2–88.1), for staff 40.7% (38.4–43.0). In 2015, 84.5% (82.6–86.2) and 20.1% (18.1–22.2).CONCLUSIONS. Most homes did not have a staff vaccination policy, pay for staff influenza vaccination, or check evidence of vaccination status. In both years covered by this service evaluation care homes reported less than half of their staff were vaccinated against influenza. Cautious comparison with current data suggests rates have probably not markedly improved. Resurgence of influenza is expected as pandemic related social distancing measures phase out. Very recent introduction of routine collection of care home self-reports on influenza vaccination will hopefully enhance compliance. However, in anticipation of the 2022-23 winter influenza season urgent action is needed to tackle what is obviously a long-standing problem. Achieving greater staff vaccination coverage would not only help protect staff from contracting influenza at work, but also reduce risks of influenza outbreaks and may also lessen COVID-19 burden, both of which would otherwise cause avoidable morbidity and mortality in vulnerable residents, and increase social care and NHS workloads.