human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nosocomial influenza is a large burden in hospitals . Despite recommendations from the World Health Organization to vaccinate healthcare workers against influenza , vaccine uptake remains low in most European countries . We performed a pragmatic cluster r and omised controlled trial in order to assess the effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital healthcare workers ( HCWs ) and on  in-patient morbidity . We included hospital HCWs of three intervention and three control University Medical Centers ( UMCs ) , and 3,367 patients . An implementation programme was offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and patient morbidity . In 2009/10 , the coverage of seasonal , the first and second dose of p and emic influenza vaccine  as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs ( all p<0.05 ) . At the internal medicine departments of the intervention group with higher vaccine coverage compared to the control group , nosocomial influenza and /or pneumonia was recorded in 3.9 % and 9.7 % of patients of intervention and control UMCs , respectively ( p=0.015 ) . Though potential bias could not be completely ruled out , an increase in vaccine coverage was associated with decreased patient in-hospital morbidity from influenza and /or pneumonia OBJECTIVES Report of epidemiological , clinical and virological data collected from the prospect i ve surveillance of febrile episodes observed in aged residents of a long-stay care unit of 33 beds , at the University Hospital of Saint-Etienne , during the 1997 - 1998 winter season . METHODS Systematic collection of clinical and biological data from febrile patients ( > or = 38 degrees C ) on a form , including virological findings obtained from a nasal swab and paired serum specimens . RESULTS From 38 patients ( 37 of them having been vaccinated against influenza in October 1997 ) , 18 febrile episodes were recorded in 16 subjects , including 3 respiratory syncytial virus infections and a late-occurring outbreak ( March 1998 ) of influenza due to a A/H3N2 strain ( 15 cases , 14 of them virologically confirmed ) . No death was noted after the influenza outbreak . In 8 of the 9 tested patients with influenza , " protective " titres of antibodies directed towards the hemagglutinin of the vaccinal strain were present by radial hemolysis test three months before the beginning of the outbreak . During the influenza outbreak , the attack rate of symptomatic infection was 45.5 % in elderly and 47.5 % in healthcare workers ( mainly unvaccinated ) . The occurrence of the first cases in the latter suggests their possible role in the transmission of the virus to the aged . CONCLUSION This study underlines the epidemic circulation of multiple respiratory viruses during the same winter season in long-stay care facilities , the occurrence of clinical influenza infections in vaccinated patients exhibiting protective antibody titres and the role of unvaccinated healthcare workers in the propagation of influenza in institutionalised aged The authors report the results of a 3-year ( August 1984-May 1987 ) prospect i ve study of intensive surveillance for nursing home-associated infections in 666 patients in a 300-bed nursing home in San Diego , California . Ninety-three percent ( 666 of 714 ) of the eligible subjects enrolled ; 75 % were women . The mean age of the subjects was 81.6 years .  Lengths of stay ranged from 1 day to 1,025 days , with a mean of 166 days ; the cumulative length of stay for all subjects was 110,746 days ( 303 years ) . Operational definitions that were heavily dependent on evaluation of clinical signs and symptoms were used by nurse practitioners in weekly or biweekly assessment s of all patients to identify infections . The overall incidence of nursing home-associated infection was 7.1 infections/1,000 patient-days . Many of the infections would not have been recognized by persons less skilled than nurse practitioners . Among the 788 nursing home-associated infections identified , 362 ( 47 % ) were in the respiratory tract ( 286 lower respiratory and 76 upper respiratory ) ; 200 ( 25 % ) were associated with skin and subcutaneous and mucous membranes ; 140 ( 18 % ) were symptomatic urinary tract infections ; 13 ( 2 % ) were bacteremia ; and 73 ( 9 % ) were other infections Background In acute-care hospitals , no evidence of a protective effect of healthcare worker ( HCW ) vaccination on hospital-acquired influenza ( HAI ) in patients has been documented . Our study objective was to ascertain the effectiveness of  influenza vaccination of HCW on HAI among patients . Methods A nested case-control investigation was implemented in a prospect i ve surveillance study of influenza-like illness ( ILI ) in a tertiary acute-care university hospital . Cases were patients with virologically-confirmed influenza occurring ≥ 72 h after admission , and controls were patients with ILI presenting during hospitalisation with negative influenza results after nasal swab testing . Four controls per case , matched per influenza season ( 2004 - 05 , 2005 - 06 and 2006 - 07 ) , were r and omly selected . Univariate and multivariate conditional logistic regression models were fitted to assess factors associated with HAI among patients . Results In total , among 55 patients analysed , 11 ( 20 % ) had laboratory-confirmed HAI . The median HCW vaccination rate in the units was 36 % . The median proportion of vaccinated HCW in these units was 11.5 % for cases vs. 36.1 % for the controls ( P = 0.11 ) ; 2 ( 20 % ) cases and 21 ( 48 % ) controls were vaccinated against influenza in the current season ( P = 0.16 ) . The proportion of ≥ 35 % vaccinated HCW in short-stay units appeared to protect against HAI among patients ( odds ratio = 0.07 ; 95 % confidence interval 0.005 - 0.98 ) , independently of patient age , influenza season and potential influenza source in the units . Conclusions Our observational study indicates a shielding effect of more than 35 % of vaccinated HCW on HAI among patients in acute-care units . Investigations , such as controlled clinical trials , are needed to vali date the benefits of HCW vaccination on HAI incidence in patients BACKGROUND Annual influenza vaccination is recommended for health care workers in both the United States and Canada . Estimations of vaccine coverage are commonly used to evaluate these vaccination programs . PURPOSE We identify , discuss , and illustrate challenges including definitions of health care worker ( HCW ) , selection of indicators , and data sources in the estimation of staff influenza  vaccination coverage rates . METHODS To illustrate the impact of the factors we discuss , we created a data base of a simulated pool of HCWs that included varying proportions of permanent , casual , and contract staff under differing scenarios of staff turnover and differing probabilities of individuals being vaccinated . The Excel 97 r and om number generator ( Microsoft ) was used to r and omly allocate the HCW to different strata under differing staff turnover rates and to design ate individuals as being vaccinated . RESULTS The nature of the staff targeted in the program policy has a large impact on the estimations of vaccine coverage . Different indicators provide data that might be useful for different purpose s. The counts in the numerator and denominator of a period prevalence may be useful for estimation of the total workload required of the vaccination program . An incidence density might be useful as an indicator of the efficiency of the program in " capturing " staff for vaccination . The indicator that may be easiest is the point prevalence . CONCLUSION Program evaluators must think carefully when planning to estimate staff vaccination coverage to avoid invalid comparisons of estimates over time and place . State or province-wide targets for health care worker ( HCW ) vaccination may be meaningless unless appropriate criteria for the calculation of influenza vaccination rates are developed and specified OBJECTIVES To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents . DESIGN Pair-matched cluster-r and omized trial . SETTING Forty nursing homes matched for size , staff vaccination coverage during the previous season , and resident disability index . PARTICIPANTS All persons aged 60 and older residing in the nursing homes . INTERVENTION Influenza vaccine was administered to volunteer staff after a face-to-face interview . No intervention took place in control nursing homes . MEASUREMENTS The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community . Secondary endpoints were rates of hospitalization and influenza-like illness ( ILI ) in residents and sick leave from work in staff . RESULTS Staff influenza vaccination rates were 69.9 % in the vaccination arm versus 31.8 % in the control arm . Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm ( odds ratio=0.86 , P=.08 ) , although multivariate-adjusted analysis showed 20 % lower mortality ( P=.02 ) , and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents ( correlation coefficient=-0.42 , P=.007 ) . In the vaccination arm , significantly lower resident hospitalization rates were not observed , but ILI in residents was 31 % lower ( P=.007 ) , and sick leave from work in staff was 42 % lower ( P=.03 ) . CONCLUSION These results support influenza vaccination of staff caring for institutionalized elderly people Objective To determine whether vaccination of care home staff  against influenza indirectly protects residents . Design Pair matched cluster r and omised controlled trial . Setting Large private chain of UK care homes during the winters of 2003 - 4 and 2004 - 5 . Participants Nursing home staff ( n=1703 ) and residents ( n=2604 ) in 44 care homes ( 22 intervention homes and 22 matched control homes ) . Interventions Vaccination offered to staff in intervention homes but not in control homes . Main outcome measures The primary outcome was all cause mortality of residents . Secondary outcomes were influenza-like illness and health service use in residents . Results In 2003 - 4 vaccine coverage in full time staff was 48.2 % ( 407/884 ) in intervention homes and 5.9 % ( 51/859 ) in control homes . In 2004 - 5 uptake rates were 43.2 % ( 365/844 ) and 3.5 % ( 28/800 ) . National influenza rates were substantially below average in 2004 - 5 . In the 2003 - 4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes ( rate difference −5.0 per 100 residents , 95 % confidence interval −7.0 to −2.0 ) and in influenza-like illness ( P=0.004 ) , consultations with general practitioners for influenza-like illness ( P=0.008 ) , and admissions to hospital with influenza-like illness ( P=0.009 ) . No significant differences were found in 2004 - 5 or during periods of no influenza activity in 2003 - 4 . Conclusions Vaccinating care home staff against influenza can prevent deaths , health service use , and influenza-like illness in residents during periods of moderate influenza activity . Trial registration National Research Register N0530147256 BACKGROUND Although influenza is the leading infections cause of death in the United States , only 40 % of health care workers ( HCW ) comply with Centers for Disease Control and Prevention recommendation for routine influenza vaccination . METHODS This study investigated a novel approach for improving influenza vaccination rates among HCW . Eight hundred employees we selected , 200 each from the following 4 categories : professional staff , resident physicians , registered nurses , and licensed practical nurses . Subjects were r and omly assigned to receive ( 1 ) no intervention , ( 2 ) a letter explaining the importance of influenza vaccine for HCW , ( 3 ) a ticket activated with influenza vaccine administration for a raffle of a free Caribbean vacation for 2 , or ( 4 ) both the educational letter and the raffle ticket . We compared the proportion of employees receiving vaccination and participating in the raffle across groups . RESULTS The influenza vaccination rate for all study subjects was 41 % . The number of subjects receiving vaccine did not differ by occupation ( P = .87 ) or intervention group ( P = .66 ) . CONCLUSIONS This study provides no evidence to support the use of mailed educational letters or a single large raffle prize incentive as a means to boost hospital employee influenza vaccination rates Background Because of a lack of efficacy of influenza vaccination in elderly population , there are still numerous outbreaks in geriatric health care setting s. The health care workers ( HCW ) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care setting s. However , the rates of vaccinated HCWs are still low in France . The French Geriatric Infection Risk Institute ( ORIG ) performed 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nosocomial influenza is a large burden in hospitals . Despite recommendations from the World Health Organization to vaccinate healthcare workers against influenza , vaccine uptake remains low in most European countries . We performed a pragmatic cluster r and omised controlled trial in order to assess the effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital healthcare workers ( HCWs ) and on  in-patient morbidity . We included hospital HCWs of three intervention and three control University Medical Centers ( UMCs ) , and 3,367 patients . An implementation programme was offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and patient morbidity . In 2009/10 , the coverage of seasonal , the first and second dose of p and emic influenza vaccine  as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs ( all p<0.05 ) . At the internal medicine departments of the intervention group with higher vaccine coverage compared to the control group , nosocomial influenza and /or pneumonia was recorded in 3.9 % and 9.7 % of patients of intervention and control UMCs , respectively ( p=0.015 ) . Though potential bias could not be completely ruled out , an increase in vaccine coverage was associated with decreased patient in-hospital morbidity from influenza and /or pneumonia OBJECTIVES Report of epidemiological , clinical and virological data collected from the prospect i ve surveillance of febrile episodes observed in aged residents of a long-stay care unit of 33 beds , at the University Hospital of Saint-Etienne , during the 1997 - 1998 winter season . METHODS Systematic collection of clinical and biological data from febrile patients ( > or = 38 degrees C ) on a form , including virological findings obtained from a nasal swab and paired serum specimens . RESULTS From 38 patients ( 37 of them having been vaccinated against influenza in October 1997 ) , 18 febrile episodes were recorded in 16 subjects , including 3 respiratory syncytial virus infections and a late-occurring outbreak ( March 1998 ) of influenza due to a A/H3N2 strain ( 15 cases , 14 of them virologically confirmed ) . No death was noted after the influenza outbreak . In 8 of the 9 tested patients with influenza , " protective " titres of antibodies directed towards the hemagglutinin of the vaccinal strain were present by radial hemolysis test three months before the beginning of the outbreak . During the influenza outbreak , the attack rate of symptomatic infection was 45.5 % in elderly and 47.5 % in healthcare workers ( mainly unvaccinated ) . The occurrence of the first cases in the latter suggests their possible role in the transmission of the virus to the aged . CONCLUSION This study underlines the epidemic circulation of multiple respiratory viruses during the same winter season in long-stay care facilities , the occurrence of clinical influenza infections in vaccinated patients exhibiting protective antibody titres and the role of unvaccinated healthcare workers in the propagation of influenza in institutionalised aged The authors report the results of a 3-year ( August 1984-May 1987 ) prospect i ve study of intensive surveillance for nursing home-associated infections in 666 patients in a 300-bed nursing home in San Diego , California . Ninety-three percent ( 666 of 714 ) of the eligible subjects enrolled ; 75 % were women . The mean age of the subjects was 81.6 years .  Lengths of stay ranged from 1 day to 1,025 days , with a mean of 166 days ; the cumulative length of stay for all subjects was 110,746 days ( 303 years ) . Operational definitions that were heavily dependent on evaluation of clinical signs and symptoms were used by nurse practitioners in weekly or biweekly assessment s of all patients to identify infections . The overall incidence of nursing home-associated infection was 7.1 infections/1,000 patient-days . Many of the infections would not have been recognized by persons less skilled than nurse practitioners . Among the 788 nursing home-associated infections identified , 362 ( 47 % ) were in the respiratory tract ( 286 lower respiratory and 76 upper respiratory ) ; 200 ( 25 % ) were associated with skin and subcutaneous and mucous membranes ; 140 ( 18 % ) were symptomatic urinary tract infections ; 13 ( 2 % ) were bacteremia ; and 73 ( 9 % ) were other infections Background In acute-care hospitals , no evidence of a protective effect of healthcare worker ( HCW ) vaccination on hospital-acquired influenza ( HAI ) in patients has been documented . Our study objective was to ascertain the effectiveness of  influenza vaccination of HCW on HAI among patients . Methods A nested case-control investigation was implemented in a prospect i ve surveillance study of influenza-like illness ( ILI ) in a tertiary acute-care university hospital . Cases were patients with virologically-confirmed influenza occurring ≥ 72 h after admission , and controls were patients with ILI presenting during hospitalisation with negative influenza results after nasal swab testing . Four controls per case , matched per influenza season ( 2004 - 05 , 2005 - 06 and 2006 - 07 ) , were r and omly selected . Univariate and multivariate conditional logistic regression models were fitted to assess factors associated with HAI among patients . Results In total , among 55 patients analysed , 11 ( 20 % ) had laboratory-confirmed HAI . The median HCW vaccination rate in the units was 36 % . The median proportion of vaccinated HCW in these units was 11.5 % for cases vs. 36.1 % for the controls ( P = 0.11 ) ; 2 ( 20 % ) cases and 21 ( 48 % ) controls were vaccinated against influenza in the current season ( P = 0.16 ) . The proportion of ≥ 35 % vaccinated HCW in short-stay units appeared to protect against HAI among patients ( odds ratio = 0.07 ; 95 % confidence interval 0.005 - 0.98 ) , independently of patient age , influenza season and potential influenza source in the units . Conclusions Our observational study indicates a shielding effect of more than 35 % of vaccinated HCW on HAI among patients in acute-care units . Investigations , such as controlled clinical trials , are needed to vali date the benefits of HCW vaccination on HAI incidence in patients BACKGROUND Annual influenza vaccination is recommended for health care workers in both the United States and Canada . Estimations of vaccine coverage are commonly used to evaluate these vaccination programs . PURPOSE We identify , discuss , and illustrate challenges including definitions of health care worker ( HCW ) , selection of indicators , and data sources in the estimation of staff influenza  vaccination coverage rates . METHODS To illustrate the impact of the factors we discuss , we created a data base of a simulated pool of HCWs that included varying proportions of permanent , casual , and contract staff under differing scenarios of staff turnover and differing probabilities of individuals being vaccinated . The Excel 97 r and om number generator ( Microsoft ) was used to r and omly allocate the HCW to different strata under differing staff turnover rates and to design ate individuals as being vaccinated . RESULTS The nature of the staff targeted in the program policy has a large impact on the estimations of vaccine coverage . Different indicators provide data that might be useful for different purpose s. The counts in the numerator and denominator of a period prevalence may be useful for estimation of the total workload required of the vaccination program . An incidence density might be useful as an indicator of the efficiency of the program in " capturing " staff for vaccination . The indicator that may be easiest is the point prevalence . CONCLUSION Program evaluators must think carefully when planning to estimate staff vaccination coverage to avoid invalid comparisons of estimates over time and place . State or province-wide targets for health care worker ( HCW ) vaccination may be meaningless unless appropriate criteria for the calculation of influenza vaccination rates are developed and specified OBJECTIVES To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents . DESIGN Pair-matched cluster-r and omized trial . SETTING Forty nursing homes matched for size , staff vaccination coverage during the previous season , and resident disability index . PARTICIPANTS All persons aged 60 and older residing in the nursing homes . INTERVENTION Influenza vaccine was administered to volunteer staff after a face-to-face interview . No intervention took place in control nursing homes . MEASUREMENTS The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community . Secondary endpoints were rates of hospitalization and influenza-like illness ( ILI ) in residents and sick leave from work in staff . RESULTS Staff influenza vaccination rates were 69.9 % in the vaccination arm versus 31.8 % in the control arm . Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm ( odds ratio=0.86 , P=.08 ) , although multivariate-adjusted analysis showed 20 % lower mortality ( P=.02 ) , and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents ( correlation coefficient=-0.42 , P=.007 ) . In the vaccination arm , significantly lower resident hospitalization rates were not observed , but ILI in residents was 31 % lower ( P=.007 ) , and sick leave from work in staff was 42 % lower ( P=.03 ) . CONCLUSION These results support influenza vaccination of staff caring for institutionalized elderly people Objective To determine whether vaccination of care home staff  against influenza indirectly protects residents . Design Pair matched cluster r and omised controlled trial . Setting Large private chain of UK care homes during the winters of 2003 - 4 and 2004 - 5 . Participants Nursing home staff ( n=1703 ) and residents ( n=2604 ) in 44 care homes ( 22 intervention homes and 22 matched control homes ) . Interventions Vaccination offered to staff in intervention homes but not in control homes . Main outcome measures The primary outcome was all cause mortality of residents . Secondary outcomes were influenza-like illness and health service use in residents . Results In 2003 - 4 vaccine coverage in full time staff was 48.2 % ( 407/884 ) in intervention homes and 5.9 % ( 51/859 ) in control homes . In 2004 - 5 uptake rates were 43.2 % ( 365/844 ) and 3.5 % ( 28/800 ) . National influenza rates were substantially below average in 2004 - 5 . In the 2003 - 4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes ( rate difference −5.0 per 100 residents , 95 % confidence interval −7.0 to −2.0 ) and in influenza-like illness ( P=0.004 ) , consultations with general practitioners for influenza-like illness ( P=0.008 ) , and admissions to hospital with influenza-like illness ( P=0.009 ) . No significant differences were found in 2004 - 5 or during periods of no influenza activity in 2003 - 4 . Conclusions Vaccinating care home staff against influenza can prevent deaths , health service use , and influenza-like illness in residents during periods of moderate influenza activity . Trial registration National Research Register N0530147256 BACKGROUND Although influenza is the leading infections cause of death in the United States , only 40 % of health care workers ( HCW ) comply with Centers for Disease Control and Prevention recommendation for routine influenza vaccination . METHODS This study investigated a novel approach for improving influenza vaccination rates among HCW . Eight hundred employees we selected , 200 each from the following 4 categories : professional staff , resident physicians , registered nurses , and licensed practical nurses . Subjects were r and omly assigned to receive ( 1 ) no intervention , ( 2 ) a letter explaining the importance of influenza vaccine for HCW , ( 3 ) a ticket activated with influenza vaccine administration for a raffle of a free Caribbean vacation for 2 , or ( 4 ) both the educational letter and the raffle ticket . We compared the proportion of employees receiving vaccination and participating in the raffle across groups . RESULTS The influenza vaccination rate for all study subjects was 41 % . The number of subjects receiving vaccine did not differ by occupation ( P = .87 ) or intervention group ( P = .66 ) . CONCLUSIONS This study provides no evidence to support the use of mailed educational letters or a single large raffle prize incentive as a means to boost hospital employee influenza vaccination rates Background Because of a lack of efficacy of influenza vaccination in elderly population , there are still numerous outbreaks in geriatric health care setting s. The health care workers ( HCW ) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care setting s. However , the rates of vaccinated HCWs are still low in France . The French Geriatric Infection Risk Institute ( ORIG ) performed 
    Output:
    