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Objective To determine whether vaccination of care home staff against influenza indirectly protects residents.

Design Pair matched cluster randomised controlled trial.

Setting Large private chain of UK care homes during the winters of 2003-4 and 2004-5.

Participants Nursing home staff (n=1703) and residents (n=2604) in 44 care homes (22 intervention homes and 22 matched control homes).

Interventions Vaccination offered to staff in intervention homes but not in control homes.

Main outcome measures The primary outcome was all cause mortality of residents. Secondary outcomes were influenza-like illness and health service use in residents.

Results In 2003-4 vaccine coverage in full time staff was 48.2 …