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Sick Leave Policies and Influenza-like Illness | CDC EID - Volume 17, Number 8–August 2011

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Volume 17, Number 8–August 2011
Cost-effectiveness of Sick Leave Policies for Health Care Workers with Influenza-like Illness, Brazil, 2009
Nancy Val y Val P. Mota, Renata D. Lobo, Cristiana M. Toscano, Antonio C. Pedroso de Lima, M. Beatriz Souza Dias, Helio Komagata, and Anna S. Levin
Comments to Author
Author affiliations: Hospital das Clínicas, São Paulo, Brazil (N.V.V.P. Mota, R.D. Lobo, M.B. Souza Dias, H. Komagata, A.S. Levin); Federal University of Goiás, Goiânia, Brazil (C.M. Toscano); and University of São Paulo, São Paulo (A.C. Pedroso de Lima, A.S. Levin)

Suggested citation for this article

We describe the effect of influenza-like illness (ILI) during the outbreak of pandemic (H1N1) 2009 on health care worker (HCW) absenteeism and compare the effectiveness and cost of 2 sick leave policies for HCWs with suspected influenza. We assessed initial 2-day sick leaves plus reassessment until the HCW was asymptomatic (2-day + reassessment policy), and initial 7-day sick leaves (7-day policy). Sick leaves peaked in August 2009: 3% of the workforce received leave for ILI. Costs during May–October reached R$798,051.87 (≈US $443,362). The 7-day policy led to a higher monthly rate of sick leave days per 100 HCWs than did the 2-day + reassessment policy (8.72 vs. 3.47 days/100 HCWs; p<0.0001) and resulted in higher costs (US $609 vs. US $1,128 per HCW on leave). ILI affected HCW absenteeism. The 7-day policy was more costly and not more effective in preventing transmission to patients than the 2-day + reassessment policy

During mid-April 2009, Mexico reported 1,918 cases of influenza-like illness (ILI) and 84 deaths. In July 2009, the World Health Organization (WHO) declared an influenza pandemic on the basis of widespread pandemic influenza A (H1N1) 2009 observed globally (1). On July 16, the Brazilian Ministry of Health notified transmission within the country and declared the epidemic to be widespread (2). During the 2009–10 season, pandemic (H1N1) 2009 was the main contributor to influenza infections.

In 2009, WHO reported 12,799 deaths from pandemic (H1N1) 2009. South America was affected during the winter season (June–September). Brazil reported 48,978 confirmed cases of pandemic (H1N1) 2009, with 2,051 deaths (3). In São Paulo, the most populated state in the country (≈40 million inhabitants), the reported incidence was higher than anywhere else in the country (15.17 cases/100,000 inhabitants); 479 persons died (4).

Hospital das Clínicas (HC), the largest hospital in Brazil, was assigned by the State Health Department as 1 of the reference hospitals for persons with severe pandemic (H1N1) 2009 in the city of São Paulo. During the pandemic, specific sick leave policies were instituted at HC for health care workers (HCWs) who had influenza.

Considerable concern exists among HCWs about the risks of working during an influenza epidemic. Although they feel responsible to care for patients, they also are concerned about their own and their families' health (5,6). Transmission of influenza from HCWs to patients under their care is also a concern (7). Isolation precautions needed to prevent transmission of pandemic (H1N1) 2009 virus were heavily debated, and recommendations from the US Centers for Disease Control and Prevention (Atlanta, GA, USA) and WHO conflicted (8). Guidance on appropriate sick leave policies to avoid transmission from HCWs varies and is not well established (9).

Interim guidelines for protecting HCWs from pandemic (H1N1) 2009 (9) suggest that HCWs in whom fever and respiratory symptoms develop should be excluded from work for at least 24 hours after defervescence. HCWs caring for severely immunocompromised patients should be reassigned or excluded from work for 7 days after symptom onset or until resolution of symptoms, whichever is longer.

Workforces at large tertiary care hospitals functioning as reference hospitals for persons with influenza may be substantially affected during pandemics, particularly in regard to absenteeism and associated costs. Effectiveness and costs of sick leave policies should be evaluated to guide hospital managers and public health officials, particularly during epidemics and pandemics.

The objectives of this study were to describe the effects of ILI during the pandemic (H1N1) 2009 outbreak on HCW absenteeism and the associated costs. Furthermore, we aimed to compare effectiveness and cost of 2 policies for HCW sick leave during the first wave of pandemic (H1N1) 2009 in a large urban tertiary care hospital.

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Suggested Citation for this Article

Mota NVVP, Lobo RD, Toscano CM, Pedroso de Lima AC, Souza Dias BM, Komagata H, et al. Cost-effectiveness of sick leave policies for health care workers with influenza-like illness, Brazil, 2009. Emerg Infect Dis [serial on the Internet]. 2011 Aug [date cited].

DOI: 10.3201/eid1708.101546

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Anna S. Levin, Rua Banibas 618, São Paulo, SP 05460-010, Brazil, email:

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