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Clin Infect Dis. 2016 Feb 15;62(4):448-455. doi: 10.1093/cid/civ952. Epub 2015 Nov 12.

Illness Severity and Work Productivity Loss Among Working Adults With Medically Attended Acute Respiratory Illnesses: US Influenza Vaccine Effectiveness Network 2012-2013.

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Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
University of Pittsburgh Schools of the Health Sciences and University of Pittsburgh Medical Center, Pennsylvania.
Scott and White Health, Texas A&M University Health Science Center College of Medicine, Temple.
Group Health Research Institute, Seattle, Washington.



Influenza causes significant morbidity and mortality, with considerable economic costs, including lost work productivity. Influenza vaccines may reduce the economic burden through primary prevention of influenza and reduction in illness severity.


We examined illness severity and work productivity loss among working adults with medically attended acute respiratory illnesses and compared outcomes for subjects with and without laboratory-confirmed influenza and by influenza vaccination status among subjects with influenza during the 2012-2013 influenza season.


Illnesses laboratory-confirmed as influenza (ie, cases) were subjectively assessed as more severe than illnesses not caused by influenza (ie, noncases) based on multiple measures, including current health status at study enrollment (≤7 days from illness onset) and current activity and sleep quality status relative to usual. Influenza cases reported missing 45% more work hours (20.5 vs 15.0; P < .001) than noncases and subjectively assessed their work productivity as impeded to a greater degree (6.0 vs 5.4; P < .001). Current health status and current activity relative to usual were subjectively assessed as modestly but significantly better for vaccinated cases compared with unvaccinated cases; however, no significant modifications of sleep quality, missed work hours, or work productivity loss were noted for vaccinated subjects.


Influenza illnesses were more severe and resulted in more missed work hours and productivity loss than illnesses not confirmed as influenza. Modest reductions in illness severity for vaccinated cases were observed. These findings highlight the burden of influenza illnesses and illustrate the importance of laboratory confirmation of influenza outcomes in evaluations of vaccine effectiveness.


illness severity; medically attended acute respiratory illness; medically attended influenza; vaccine effectiveness; work productivity

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