Las intervenciones para aumentar la cobertura de la vacuna contra la gripe estacional en trabajadores de la salud: una revisión y meta-análisis de regresión sistemática.

Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI.: 0.08-0.45), followed by "soft" mandates such as declination statements (RRunvacc = 0.64, 95% CI.: 0.45-0.92), increased awareness (RRunvacc = 0.83, 95% CI.: 0.71-0.97) and increased access (RRunvacc = 0.88, 95% CI.: 0.78-1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ(2) = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.