The Occupational Risk of Influenza A (H1N1) Infection among Healthcare Personnel during the 2009 Pandemic: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

IntroductionThe aim of this review was to record systematically and assess the published literature relating to the occupational risk of influenza A (H1N1) infection among healthcare personnel during the 2009 pandemic.MethodsThe literature search was performed in June 2015. An update was carried out in May 2016. It was applied to the electronic databases EMBASE, MEDLINE, PsycINFO, PubMed, CINAHL and Google Scholar. The quality assessment was conducted with a tool using eight criteria. A meta-analysis was carried out to compute pooled effect estimates for influenza A (H1N1) infection.ResultsA total of 26 studies were included in the review, 15 studies met the criteria for the meta-analysis. After a sensitivity analysis the pooled analysis showed a significantly increased odds for influenza A (H1N1) infection for healthcare personnel compared to controls/comparisons (OR = 2.08, 95% CI = 1.73 to 2.51). The pooled prevalence rate for healthcare personnel alone was 6.3%.ConclusionsThis review corroborates the assumption that healthcare personnel were particularly at risk of influenza A (H1N1) infection during the 2009 pandemic. Healthcare facilities should intensify their focus on strategies to prevent infections among healthcare personnel, especially during the first period of pandemics.

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“…HCPs were significantly more likely to develop infection (odds ratio [OR] 2.08, 95% CI 1.73-2.51) with a pooled prevalence of 6.3%. 52 As COVID-19 has disproportionately affected HCPs, emergency physicians must be vigilant about potential exposure risks and adhere to appropriate infection prevention precautions. 53,54 In Italy, anywhere from 8-30%…”

A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence

“…Taken together, these studies highlight that setting [88] , occupation [89] or patient contact level, risk procedure [90] , circulating virus, and existing immunity in the population (i.e. H1N1) can all vary risk [63] . However, respiratory illness has been reported as one of the main causes of sickness absence in HWs [92] , [91] , pandemics and epidemics can be associated with concurrent increased rates of HW absenteeism [12] , [92] , [93] , and HWs do overall appear to be at risk of contracting influenza.…”

“…The review included a higher level systematic review and meta -analysis on the occupational risk of pandemic H1N1 in HWs compared to the general population or across occupations. This meta -analysis [63] evaluated 15 studies (29,358 subjects), including 11 high quality studies of laboratory-confirmed influenza, and showed a significantly increased OR = 2.08 (95% CI, 1.73–2.51) in HWs with a higher risk in physicians {OR = 6.03 (95% CI, 2.11–17.8)}.…”

“…The evidence on whether HWs are at increased risk of influenza infection (symptomatic and asymptomatic) in HWs is mixed. Recent studies suggest a higher risk with pH1N1 [11] , [12] , [13] , [63] , a high attack rate, and variations in risk which are connected to occupational exposure. Other studies find a risk to patients and HWs during an outbreak [16] and following contact with ILI patients [15] .…”

Human Susceptibility to Influenza Infection and Severe Disease

“…Occupational hazards are a good example. Health-care personnel are at increased risk of exposure to IAV as was shown during the 2009 A/H1N1 pandemic (Lietz et al 2016). Individuals who work in close contact with animals, such as birds and swine, may also have an increased risk of zoonotic transmission (Harris et al 2017;Root et al 2017).…”