Routine vs. On-Demand Discharge Planning Strategy in Intermediate-Risk Patients for Complex Discharge: a Cluster-Randomized, Multiple Crossover Trial.

BACKGROUND: Early hospital discharge planning can help to reduce the length of stay and unplanned readmission in high-risk patients. Therefore, it is important to select patients who can benefit from a personalized discharge planning based on validated tools. The modified Blaylock Risk Assessment Screening Score (BRASS) is routinely used in the Molinette Hospital (Turin, Italy) to screen patients at high risk for discharge, but the effectiveness of the discharge planning is uncertain in intermediate-risk patients. OBJECTIVE: To evaluate the best strategy for discharge planning by the Continuity of Care Hospital Unit (CCHU) in intermediate-risk patients according to modified BRASS. DESIGN: Cluster-randomized, multiple crossover trial. PARTICIPANTS: Adult patients admitted in the Medicine and Neurology departments of the Molinette Hospital in Turin, Italy, between June 2018 and May 2019 with a BRASS intermediate risk. INTERVENTIONS: A routine discharge planning strategy (RDP, Routine Discharge Plan), which involved the management of all intermediate-risk patients, was compared to an on-demand discharge planning strategy (DDP, on-Demand Discharge Planning), which involved only selected patients referred to the CCHU by ward staff. MAIN MEASURES: The primary outcome was the 90-day hospital readmission for any cause (HR90). Secondary outcomes included the prolonged length of stay (pLOS). KEY RESULTS: Eight hundred two patients (median age 79 years) were included (414 RDP and 388 DDP). Comparing RDP vs. DDP periods, HR90 was 27.6% and 27.3% (OR 1.01, 90%CI 0.76-1.33, p = 0.485); and pLOS was 47 (11.4%) and 40 (10.3%) (OR 1.24, 95%CI 0.72-2.13, p = 0.447), respectively. CONCLUSIONS: This is one of the largest randomized study conducted to compare the effectiveness of two different hospital discharge planning strategies. In patients with intermediate risk of hospital discharge, a RDP offers no advantage over a DDP and results in an unnecessary increase in staff workload. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03436940.

The humoral and cellular response to mRNA SARS-CoV-2 vaccine is influenced by HLA polymorphisms.

Host genetic variability contributes to susceptibility to SARS-CoV-2 infection and COVID-19 evolution and the role of HLA system has not clearly emerged, suggesting the involvement of other factors. Studying response to vaccination with Spyke protein mRNA represents an ideal model to highlight whether the humoral or cellular responses are influenced by HLA. Four hundred and sixteen workers, vaccinated with Comirnaty beginning 2021, were selected within the Azienda Ospedaliera Universitaria "Città della Salute e della Scienza di Torino." The humoral response was determined with the LIAISON® kit, while the analysis of the cellular response was performed with the Quantiferon SARS-CoV-2 assay, for the S1 (receptor-binding domain; Ag1) and S1 and S2 (Ag2) subunits of the Spyke protein. Six HLA loci were typed by next-generation sequencing. Associations between HLA and vaccine response were performed with univariate and multivariate analyses. An association was found between A*03:01, B*40:02 and DPB1*06:01 and high antibody concentration and between A*24:02, B*08:01 and C*07:01 and low humoral responses. The haplotype HLA-A*01:01 ~ B1*08:01 ~ C*07:01 ~ DRB1*03:01 ~ DQB1*02:01 conferred an increased risk of low humoral response. Considering cellular responses, 50% of the vaccinated subjects responded against Ag1 and 59% against Ag2. Carriers of DRB1*15:01 displayed a higher cellular response both to Ag1 and Ag2 compared to the rest of the cohort. Similarly, DRB1*13:02 predisposed to a robust cellular response to Ag1 and Ag2, while DRB1*11:04 showed an opposite trend. Cellular and humoral responses to Comirnaty are influenced by HLA. Humoral response is mainly associated to class I alleles, with A*03:01, previously associated to protection against severe COVID-19, and response to vaccination, standing out. Cellular response predominantly involves class II alleles, with DRB1*15:01 and DPB1*13:01 prevailing. Affinity analysis for Spyke peptides is generally in line with the association results.

Facilitating discharge planning: the Risk Assessment of Complex Discharge Index.

BACKGROUND: Untimely social interventions prolong hospitalizations, suggesting discharge planning should begin early. This study aimed to create a tool to identify, already in Emergency department, patients at risk of complex discharge for social reasons. METHODS: We developed the Risk Assessment of Complex Discharge Index (RACDI). In Emergency department, we administered RACDI to patients destined to hospitalization. We calculated sensitivity and specificity of RACDI in identifying patients who need a social intervention. RACDI was compared with simplified BRASS. A multivariable logistic regression explored social intervention predictors (P-value < 0.05). RESULTS: RACDI was administered to 296 patients. There were significant associations between classes of risk defined by RACDI or by simplified BRASS and social intervention. The sensitivity of RACDI and simplified BRASS was, respectively, 0.59 and 0.43; the specificity 0.81 and 0.83. Chances of social intervention were higher for patients at high risk with RACDI (adjOR:3.13, 95% CI: 1.23-8.00, P = 0.017). CONCLUSIONS: The reduced items and mostly dichotomous answers made RACDI a tool easy to be used in daily practice. RACDI helps in classifying patients needing discharge planning for social care and is a starting point to standardize the evaluation of social context early in hospitalization. Further work is needed to overcome limitations and assess additional outcomes.

Cellular Immune Response to BNT162b2 mRNA COVID-19 Vaccine in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital.

We describe the results of a T-cell immunity evaluation performed after a median elapsed time of 7 months from second-dose BNT162b2 vaccine administration, in a representative sample of 419 subjects from a large cohort of hospital workers. Overall, the Quantiferon SARS-CoV-2 assay detected a responsive pattern in 49.9%, 59.2% and 68.3% of subjects to three different antigenic stimuli from SARS-CoV-2, respectively, with 72.3% of positivity to at least one antigenic stimulus. Potential predictors of cellular response were explored by multivariable analyses; factors associated with positivity to cellular response (to Ag1 antigenic stimulus) were a previous SARS-CoV-2 infection (OR = 4.24, 95% CI 2.34−7.67, p < 0.001), increasing age (per year: OR = 1.03 95% CI 1.01−1.06, p = 0.019 and currently smoking (compared to never smoking) (OR = 1.93, 95% CI 1.11−3.36, p = 0.010). Increasing time interval between vaccine administration and T-cell test was associated with decreasing cellular response (per week of time: OR = 0.94, 95% CI 0.91−0.98, p = 0.003). A blood group A/AB/B (compared to group O) was associated with higher levels of cellular immunity, especially when measured as Ag2 antigenic stimulus. Levels of cellular immunity tended to be lower among subjects that self-reported an autoimmune disorder or an immunodeficiency and among males. Further studies to assess the protective significance of different serological and cellular responses to the vaccine toward the risk of reinfection and the severity of COVID-19 are needed to better understand these findings.

Risk Assessment and Management for Potential Living Kidney Donors: The Role of "Third-Party" Commission.

Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical "third party", completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital "Città della Salute e della Scienza" of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the "Third-Party" Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.

Factors Influencing Level and Persistence of Anti SARS-CoV-2 IgG after BNT162b2 Vaccine: Evidence from a Large Cohort of Healthcare Workers.

We aimed at evaluating quantitative IgG response to BNT162b2 COVID-19 vaccine among health care workers (HCW), and exploring the role of demographic, clinical, and occupational factors as predictors of IgG levels. On May 2021, among 6687 HCW at the largest tertiary care University-Hospital of Northwestern Italy, at a median of 15 weeks (Interquartile range-IQR 13.6−16.0) after second-dose, serological response was present in 99.8%. Seropositivity was >97% in all the subgroups, except those self-reporting immunodeficiency (94.9%). Overall, the median serological IgG value was 990 BAU/mL (IQR 551−1870), with most of subjects with previous SARS-CoV-2 infection or with shorter time lapse (2−8 weeks) between vaccination and serology with values in the highest quintile (>2080). At multivariable analysis, significant predictors of lower values were increasing age, male, current smoking, immunodeficiency, recent occupational contacts, and increasing time lapse from vaccination; conversely, previous infection and recent household contacts were significantly associated with higher IgG levels. Subjects with previous infection kept a very high level (around 2000 BAU/mL) up to 120 days. These results, besides supporting a high serological response up to 4−5 months, suggest predictive factors of faster decay of IgG levels that could be useful in tailoring vaccination strategies.

The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis.

The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017-2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017-2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.

Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy.

This observational study evaluated SARS-CoV-2 IgG seroprevalence and related clinical, demographic, and occupational factors among workers at the largest tertiary care University-Hospital of Northwestern Italy and the University of Turin after the first pandemic wave of March-April 2020. Overall, about 10,000 individuals were tested; seropositive subjects were retested after 5 months to evaluate antibodies waning. Among 8769 hospital workers, seroprevalence was 7.6%, without significant differences related to job profile; among 1185 University workers, 3.3%. Self-reporting of COVID-19 suspected symptoms was significantly associated with positivity (Odds Ratio (OR) 2.07, 95%CI: 1.76-2.44), although 27% of seropositive subjects reported no previous symptom. At multivariable analysis, contacts at work resulted in an increased risk of 69%, or 24% for working in a COVID ward; contacts in the household evidenced the highest risk, up to more than five-fold (OR 5.31, 95%CI: 4.12-6.85). Compared to never smokers, being active smokers was inversely associated with seroprevalence (OR 0.60, 95%CI: 0.48-0.76). After 5 months, 85% of previously positive subjects still tested positive. The frequency of SARS-COV-2 infection among Health Care Workers was comparable with that observed in surveys performed in Northern Italy and Europe after the first pandemic wave. This study confirms that infection frequently occurred as asymptomatic and underlines the importance of household exposure, seroprevalence (OR 0.60, 95%CI: 0.48-0.76).

Severe and moderate seasonal influenza epidemics among Italian healthcare workers: A comparison of the excess of absenteeism.

BACKGROUND: This study aims to quantify the excess of sickness absenteeism among healthcare workers (HCWs), to estimate the impact of a severe versus moderate influenza season and to determine whether the vaccination rates are associated with reduced sickness absence. METHODS: We investigated the excess absenteeism that occurred in a large Italian hospital, 5300 HCWs, during the severe influenza season of 2017/2018 and compared it with three moderate flu seasons (2010/2013). Data on influenza vaccinations and absenteeism were obtained from the hospital's databases. The data were split into two periods: the epidemic, from 42 to 17 weeks, and non-epidemic, defined as 18 to 41 weeks, which was used as the baseline. We stratified the absenteeism among HCWs in multiple variables. RESULTS: Our study showed an increased absenteeism among HCWs during the epidemic period of severe season in comparison with non-epidemic periods, the absolute increase correlated with a relative increase of 70% (from 4.05 to 6.68 days/person). Vaccinated HCWs had less excess of absenteeism in comparison with non-vaccinated HCWs (1.74 vs 2.71 days/person). The comparison with the moderate seasons showed a stronger impact on HCW sick absenteeism in the severe season (+0.747days/person, P = .03), especially among nurses and HCWs in contact with patients (+1.53 P < .01; +1.19 P < .01). CONCLUSIONS: In conclusion, a severe influenza epidemic has greater impacts on the absenteeism among HCWs than a moderate one. Although at a low rate, a positive effect of vaccination on absenteeism is present, it may support healthcare facilities to recommend vaccinations for their workers.

Impact of COVID-19 lockdown measures on oncological surgical activity: Analysis of the surgical pathology caseload of a tertiary referral hospital in Northwestern Italy.

BACKGROUND AND OBJECTIVES: Italy was severely affected by the severe acute respiratory syndrome coronavirus 2 pandemic. Our Institution, Piedmont's largest tertiary referral center, was designated as a non-COVID-19 hospital and activities were reorganized to prioritize critical services like oncological care. The aim of this study was to investigate the efficacy in preserving the oncological surgical practice at our Institution during the most critical months of the COVID-19 epidemic by analyzing the surgical pathology activity. METHODS: The number of oncological surgical resections submitted to histopathological examination from 9th March 2020 to 8th May 2020 were collected as well staging/grading data and compared with the previous three pre-COVID-19 years (2017-2019). RESULTS: Overall, no decrease was observed for most tumor sites (5/9) while breast resections showed the largest drop (109 vs. 160; -31.9%), although a full recovery was already noticed during the second half of the period. Conversely, the selected control benchmarks showed a sharp decrease (-80.4%). Distribution of pathological TNM stages (or tumor grades for central nervous system tumors) showed no significant differences during the lockdown compared with previous years (p > .05). CONCLUSIONS: The present data suggest the possibility of preserving this cornerstone oncological activity during an evolving public health emergency thanks to a prompt workflow reorganization.

Carrying on with liver transplantation during the COVID-19 emergency: Report from piedmont region.

BACKGROUND: The COVID-19 pandemic is an emergency worldwide. In Italy, liver transplant activity was carried on, but despite all efforts, a 25% reduction of procured organs has already been observed during the first 4 weeks of the outbreak. AIMS: To analyze if our strategy and organization of LT pathway during the first two months of the COVID-19 emergency succeeded in keeping a high level of LT activity, comparing the number of LT in the first two months with the same period of time in 2019. METHODS: We compared the liver transplants performed in our Center between February 24th and April 17th, 2020 with liver transplants performed in the same period in 2019. RESULTS: In 2020, 21 patients underwent liver transplantation from deceased donors, exactly as the year before, without statistically significant difference. All patients survived in both groups, and the rate of early graft dysfunction was 24% in 2020 and 33% in 2019. In 2020 Median MELD was higher (17 vs 13). We were able to perform 3 multiorgan transplants and one acute liver failure. Nobody died on waiting list. The performance of our Center, despite the maxi-emergency situation, was steady and this was the result of a tremendous team working within the hospital and in our region. CONCLUSIONS: Team working allowed our Center to maintain its activity level, taking care of patients before and after liver transplantation. Sharing our experience, we hope to be helpful to other Centers that are facing the pandemic and, if another pandemic comes, to be more prepared to deal with it.

Predicting Length of Stay and Discharge Destination for Surgical Patients: A Cohort Study.

Discharge planning is important to prevent surgical site infections, reduce costs, and improve the hospitalization experience. The identification of early variables that can predict a longer-than-expected length of stay or the need for a discharge with additional needs can improve this process. A cohort study was conducted in the largest hospital of Northern Italy, collecting discharge records from January 2017 to January 2020 and pre-admission visits in the last three months. Socio-demographic and clinical data were collected. Linear and logistic regression models were fitted. The main outcomes were the length of stay (LOS) and discharge destination. The main predictors of a longer LOS were the need for additional care at discharge (+10.76 days), hospitalization from the emergency department (ED) (+5.21 days), and age (+0.04 days per year), accounting for clinical variables (p < 0.001 for all variables). Each year of age and hospitalization from the ED were associated with a higher probability of needing additional care at discharge (OR 1.02 and 1.77, respectively, p < 0.001). No additional findings came from pre-admission forms. Discharge difficulties seem to be related mainly to age and hospitalization procedures: those factors are probably masking underlying social risk factors that do not show up in patients with planned admissions.

[Audit and Feedback approach in the CoViD-19 emergency: adaptation of the EASY-NET project in the AOU Città della Salute e della Scienza of Turin.] / Audit e Feedback nell'emergenza CoViD-19: adattamento del progetto EASY-NET nell'AOU Città della Salute e della Scienza di Torino.

CoViD-19 pandemic heavily impacted most on-going research activities, causing delays and need of re-programming. EASY-NET (NET-2016-02364191) is a network project, started in April 2019, co-funded by the Italian Ministry of Health and the participating regions. Within the general project, centred on the evaluation of Audit and Feedback (A&F) strategies in improving quality and equity in different health care contexts, the Piedmont region is responsible of the work package 3 (WP3) on specific oncology pathways and procedures. After a thorough evaluation of the impact of the CoViD-19 emergency on the WP3 activities, at the beginning of March 2020, the decision was to continue, with some adaptations, the audits already started, and to delay those in the early planning phase. The provisional availability of part of the time-persons involved in EASY-NET on one side, and the urgency of acquiring data on the management of the large number of CoViD-19 patients admitted to the study coordinator hospital on the other side, determined the personnel responsible of the WP3, in accordance with the hospital management, to invest these resources in monitoring the CoViD-19 hospitalized patients with both A&F activity and research objectives. Besides periodic reports, a web site, with restricted access to the involved health care personnel, was developed to allow a direct and timely consultation of graphics describing the flow of the patients, their management, and outcomes. This experience was made possible thanks to a favourable combination of different factors: the presence within the hospital of a group of experienced epidemiologists in A&F, the availability of extra resources, the strong support and collaboration by the hospital management and the readiness for authorisation by the Ethics Committee. We underline the need to provide a certain degree of flexibility in the long-term projects funded by the Ministry of Health, the extraordinary adaptability of the A&F approach also to emergency situations and the possibility of combining audit activities and research objectives in the same project.

Transitional care: A new model of care from young age to adulthood.

INTRODUCTION: Transition of care represents the transfer from child to adult care. An effective transition maintains continuity of care and presents better clinical outcomes. This process has assumed growing relevance, thanks to improved survivorship of chronic paediatric patients. Actually, there is no a one-size model fitting for all transitions, but each Service organizes its own clinical pathway. AIM: The study proposes an organizational model for transition, differentiated according to patient complexity. METHODS: The working group discussed, through regular meetings, the appropriate transitional model for our Hospital. The working group defined a common scheme of transition and elaborated a synthetic document for patients. Then, the common model is adapted, through clinicians' contribution, for different diseases. The complexity assessment includes clinical data, nursing and social information. RESULTS: The working group defined a common model identifying the main information to be included and detailed in each transition report. The team defined two pathways based on patient's complexity. In case of good compensation and autonomous management, the adolescent is addressed towards standard transition process, a smoother transition from paediatric to adult care with direct connection among healthcare professionals. In case of complex clinical and/or social conditions, an Interdisciplinary Transition Group (ITG) is activated. The group preventively evaluates each patient in periodic meetings and provides a personalized planning of care. In order to define the complexity of a patient, clinical and social determinants are considered. Some diseases are considered complex by default, while others require ITG involvement in case of multiple comorbidities, severe clinical situation, concomitant social criticality and/or cognitive impairment. DISCUSSION: Transition of care represents an important phase in chronic diseases management. The proposed model assures a multidisciplinary approach, involving all specialists of both paediatric and adult teams. A key determinant of transition is information transmission. Then, the model proposes a common transition report format. Finally, a further perspective study is already in program, in order to assess clinical effectiveness.

A new strategy to promote flu vaccination among health care workers: Molinette Hospital's experience.

RATIONALE, AIMS, AND OBJECTIVES: Seasonal flu represents a major public health issue, especially for health care workers (HCWs). WHO highlights the need of higher awareness and flu vaccine coverage among HCWs. In Europe the coverage is less than 30-40%. Italy reports some of the lowest rates. The paper aims to illustrate the 2017/2018 flu vaccination campaign within Molinette, the third Italian hospital for dimensions, to provide inputs about strategies for increasing HCWs coverage. The campaign objective was to increase the administered doses at least of 30%. METHODS: The intervention included informational material, direct educational sessions for workers, extension of the access time to Occupational Medicine Service, elimination of the reservation requirement, composition of "moving vaccination units" (MVUs), and organisation of vaccination sessions within departments. RESULTS: In 2017/2018, 593 doses were administered. The doses percentage change between 2017/2018 and 2016/2017 vaccination seasons was +46.06%, while it was +84.74% compared with the previous 5-year period mean. The majority was administered by Occupational Medicine Service, while 6.75% by MVUs. Among the total doses, 72.68% were administered to workers, 13.49% to residents, 6.75% to students, and 7.08% to "other". So, 7.68% of total workforce was vaccinated. Only 0.3% of vaccinated people presented mild adverse reactions. CONCLUSIONS: A combined campaign, that includes actions for education, increase of awareness, improved access to facilities and active offers to workers has potentiality but there is still work to do. The vaccination increase was determined mostly by the re-organization of the occupational medicine, while the MVUs were useful to HCWs of detached offices.

[Qualitative experiential analysis of the BRASS scale.] / Analisi qualitativa esperienziale di revisione della scala BRASS.

BACKGROUND: Hospital discharge can potentially represent an issue. Therefore, it is important to early identify patients at higher risk. A valid tool in this field is the Blaylock Risk Assessment Screening Score (BRASS). AIMS: The study aims to elaborate a simplified score system, throughout the contribution of healthcare professionals considering the single items of the original score. METHODS: The study included a qualitative analysis, conducted in order to draft the synthetic tool. Alongside, a statistical analysis was carried out. The findings of these two works were compared and joined in the realization of the proposed evaluation tool. RESULTS: The synthetic tool, developed by the working team, is composed by 20 items. The qualitative analysis agrees with the statistical approach. Moreover, the qualitative analysis consented to redefine some items, especially considering social support, and to include some additional information e.g. clinical problems. LIMITATIONS: The analysis considered only General Medicine wards, all located in the same Hospital. Therefore, generalisation to other settings or patients should be further tested. CONCLUSIONS: The synthetic tool, realized during the study, aims to improve the individuation of at-risk inpatients. The agreement between statistical and qualitative analysis can be considered a point of strength of our work. Our analysis consented to include some new items, improving overall organization. In conclusion, the working group aims to conduct further study in order to individuate the more appropriate cut-off of the new scoring method.

Cost of Sickness Absenteeism during Seasonal Influenza Outbreaks of Medium Intensity among Health Care Workers.

This study aims to estimate the economic costs of sickness absenteeism of health care workers in a large Italian teaching hospital during the seasonal flu periods. A retrospective observational study was performed. The excess data of hospital's sickness absenteeism during three seasonal influenza periods (2010/2011; 2011/2012; 2012/2013) came from a previous study. The cost of sickness absenteeism was calculated for six job categories: medical doctor, technical executive (i.e., pharmacists); nurses and allied health professionals (i.e., radiographer), other executives (i.e., engineer), non-medical support staff, and administrative staff, and for four age ranges: <39, 40⁻49, 50⁻59, and >59 years. An average of 5401 employees working each year were under study. There were over 11,100 working days/year lost associated with an influenza period in Italy, the costs associated were approximately 1.7 million euros, and the average work loss was valued at € 327/person. The major shares of cost appeared related to nurses and allied health professionals (45% of total costs). The highest costs for working days lost were reported in the 40⁻49 age range, accounting for 37% of total costs. Due to the substantial economic burden of sickness absenteeism, there are clear benefits to be gained from the effective prevention of the influenza.