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Although we strongly support increasing influenza vaccination of health care workers, we believe that guidance supporting this effort should be based on scientifically sound evidence regarding influenza vaccine effectiveness and the subsequent disease reduction in influenza workers and their patients. The editorial by Flegel contains factual errors, and the data cited to support the case for health care worker vaccination are problematic.1
The vaccine efficacy rate of “about 86% when the circulating strain and vaccine strain are well matched” is not an accurate statement, and the reference provided does not support that conclusion.1,2 We recently conducted a comprehensive meta-analysis of influenza vaccine efficacy and effectiveness and found that the trivalent inactivated vaccine provides approximately 59% protection in healthy younger adults and that match did not significantly affect how well the vaccine protected against influenza.3 Additionally, we found that the perception that current influenza vaccines provide such high levels of protection is a major barrier to developing novel-antigen, game-changing vaccines.4
Also, the 4 randomized controlled trials cited in reference 5 do not provide strong evidence to support an impact on patient mortality when increased numbers of health care workers are vaccinated.5 In fact, 2 of the studies do not support this claim,6,7 and the other 2 only weakly support it.8,9
The cost savings report cited10 (reference6 in the editorial) uses the 2006 HICPAC statement as the source for these cost savings, but those numbers are not present in that report.11 Additionally, most cost-effectiveness numbers are based on overestimated vaccine efficacy and need to be revised.4
Last, there is no process for selecting influenza vaccine strains that reduces the risk of Guillain-Barré syndrome (GBS), as the reason influenza vaccine causes GBS is still unclear.