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A further example of the potential effect of such bias is the apparently counterintuitive effectiveness of the vaccines in elderly individuals living in the community.

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In this population, the vaccines are apparently ineffective in the prevention of influenza, influenza-like illness, pneumonia, hospital admissions, or deaths from any respiratory disease, but are effective in the prevention of hospital admission for influenza and pneumonia and in the prevention of deaths from all causes.

That such differences are the result of a baseline imbalance in health status and other systematic differences in the two groups of participants cannot be discounted.

  • A Phase III trial of the vaccine is scheduled to start in.
  • Evidence from randomised controlled trials, in which bias is reduced to a minimum, is scant and badly reported. Unfortunately, because of the global recommendations on influenza vaccination, placebo-controlled trials, which could clarify the effects of influenza vaccines in individuals, are no longer possible on ethical grounds.

    Whatever the causes of observed variability, we believe that the decision to vaccinate against influenza cannot be made on the basis of the results from single studies, reporting observations from a few seasons, but that it should be taken on the basis of all available evidence.


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    Influenza control based on call vaccination of schoolchildren was missed in Japan in the 1960 s and was observed with a decrease in the overall mortality killing.

    The conclusions drawn from studies done in individuals who live in long-term care facilities are different to those drawn from studies in individuals who live in the community.

    Despite a remaining heterogeneity and an overestimation of the effects as a result of study design, it is possible to detect a gradient of effectiveness, in which vaccines have little effect on cases of influenza-like illness, but have greater effect on its complications.

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  • This finding suggests that control through vaccination is a possibility. The effectiveness of vaccines in the community, however, is modest, irrespective of adjustment for systematic differences between vaccine recipients and non-recipients.

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    The difficulties of achieving good coverage in those who most need it, or the diluting effect on vaccines for influenza of other agents circulating in the community causing influenza-like illness, clinically indistinguishable from influenza, might be to blame.

    Researchers noted empirical proof of both, with differential vaccine uptake among the same population linked to age, sex, and health status, and a low effect on influenza-like illness throughout our datasets, even in periods of supposedly high influenza viral circulation when the proportion of cases of influenza-like illness caused by influenza and the possible benefits of vaccination are highest.

    On the basis of these observations, we believe efforts should be concentrated on achieving high vaccination coverage in long-term care facilities coupled with a systematic assessment of the effect of such a policy.

    One possible way to improve this strategy might involve the vaccination of carers in an effort to reduce transmission Thomas R, Jefferson T, Demicheli V. Influenza vaccine for patients with chronic obstructive pulmonary disease.

    Rechercher

    Vaccines for preventing influenza in people with asthma. Vaccines for preventing influenza in people with cystic fibrosis.

    Finally, investment in the development of better vaccines than available at present should be linked to better knowledge of the causes and patterns of influenza-like illnesses in different communities.


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    This partnership could lead to the inception of a more comprehensive and perhaps more effective strategy for the control of acute respiratory infections, relying on several preventive interventions that take into account the multi-agent nature of influenza-like illness and its context such as personal hygiene ref, and provision of electricity and adequate food, water, and sanitation ref.

    In elderly individuals living in the community, vaccines were not significantly effective against influenza RR 0. In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part.

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