Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Langley, J. M. Articles by Faughnan, M. E. Search for Related Content PubMed PubMed Citation Articles by Langley, J. M. Articles by Faughnan, M. E. Related Collections Influenza Related Article

Prevention of influenza in the general population

From the Departments of Pediatrics and of Community Health and Epidemiology, Dalhousie University and IWK Health Centre, Halifax, NS (Langley), and the Department of Medicine, Division of Respirology, St. Micheal's Hospital and University of Toronto, Toronto, Ont. (Faughnan)

Abstract

Background: Although all jurisdictions in Canada offer annual influenza immunization to people at high risk of complications, only Ontario has provided universal annual immunization of healthy adults and children. Use of chemotherapy (amantidine, neuraminidase inhibitors) to prevent influenza varies among provinces. We sought to systematically review the evidence for the prevention of influenza infection in the general population.

Methods: The interventions reviewed were influenza vaccination and prophylactic use of neuraminidase inhibitors. The health outcomes of interest were rates of laboratory-confirmed influenza infection, clinical definitions of influenza-like illness and work absenteeism. MEDLINE and Cochrane databases were searched for relevant articles published between 1966 and March 2003. Only randomized controlled trials (RCTs) were selected. Evidence was appraised using the methodology of the Canadian Task Force on Preventive Health Care.

Results: Eighteen trials involving more than 33 000 healthy adults were identified that met the inclusion criteria; of these, 15 showed that influenza vaccination with either live-attenuated and inactivated vaccines was efficacious. Eleven trials were considered to be of "good" quality, and 7 were considered to be of "fair" quality. The relative risk reduction (RRR) associated with influenza immunization in adults ranged from 0% to 91%. Fifteen RCTs involving more than 45 000 healthy children aged 6 months to 19 years were identified, of which 9 were considered to contain "good" evidence and 6 "fair" evidence. Results from 12 of these trials showed protection against influenza. The RRR ranged from 0% to 93%. There were 6 RCTs of "good" quality showing that neuraminidase inhibitors are effective in preventing influenza infection. Side effects from both influenza vaccination and neuraminidase inhibitor administration were mild.

Interpretation: There are numerous RCTs of good quality in large populations that have consistently shown that influenza vaccination, using inactivated or live-attenuated vaccines, is moderately effective in preventing influenza in the general population (healthy adults and children over 6 months of age). There is good evidence that neuraminidase inhibitor prophylaxis in contacts given within 36 to 48 hours of symptom onset of the household index case is effective; appropriate use of this prevention method requires access to rapid diagnostic methods. Decisions about introduction of routine immunization programs must take into account the cost and cost-effectiveness of a universal program and the burden of illness associated with influenza in each jurisdiction.

This article has been cited by other articles:

				M. Loeb, M. L. Russell, L. Moss, K. Fonseca, J. Fox, D. J. D. Earn, F. Aoki, G. Horsman, P. Van Caeseele, K. Chokani, et al. Effect of Influenza Vaccination of Children on Infection Rates in Hutterite Communities: A Randomized Trial JAMA, March 10, 2010; 303(10): 943 - 950. [Abstract] [Full Text] [PDF]

				M. Loeb, N. Dafoe, J. Mahony, M. John, A. Sarabia, V. Glavin, R. Webby, M. Smieja, D. J. D. Earn, S. Chong, et al. Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers: A Randomized Trial JAMA, November 4, 2009; 302(17): 1865 - 1871. [Abstract] [Full Text] [PDF]

				K. Iglar, S. Katyal, R. Matthew, and V. Dubey Complete health checkup for adults: Update on the Preventive Care Checklist Form(C) Can Fam Physician, January 1, 2008; 54(1): 84 - 88. [Full Text] [PDF]

				D. Baxter Specific immunization issues in the occupational health setting Occup. Med., December 1, 2007; 57(8): 557 - 563. [Abstract] [Full Text] [PDF]

				J. M. Langley Highlights of the National Advisory Committee on Immunization statement on influenza for the 2006-2007 season. Can. Med. Assoc. J., September 26, 2006; 175(7): 742 - 742. [Full Text] [PDF]

				A. Granados, C. Goodman, and L. Eklund Pandemic influenza: using evidence on vaccines and antivirals for clinical decisions and policy making. Eur. Respir. J., April 1, 2006; 27(4): 661 - 663. [Full Text] [PDF]

				A. Moscona Neuraminidase inhibitors for influenza. N. Engl. J. Med., September 29, 2005; 353(13): 1363 - 1373. [Full Text] [PDF]

				J. M. Langley and J. Feightner Influenza vaccine for all? Can. Med. Assoc. J., April 26, 2005; 172(9): 1162 - 1163. [Full Text] [PDF]

				R. Upshur Influenza vaccine for all? Can. Med. Assoc. J., April 26, 2005; 172(9): 1161 - 1162. [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2004, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.