Fight FLU evidence

Vaccinating against influenza

Vaccinating against influenza in 'at-risk' groups'. National Institute of Clinical Studies, Evidence-Practice Gaps Report, Volume 2: pp26-29, 2005.

This report describes why influenza vaccination of 'at risk' groups aged 18-64 is important, summarises the best available evidence and provides data on current practice in Australia. Flu Gaps report (228KB PDF)

Barriers and Facilitators

''Barriers & Facilitators to influenza vaccination among high-risk groups aged less than 65 years'. Zwar N, Hasan I, Harris M, Traynor V. Research Centre for Primary Health Care and Equity, University of New South Wales, February 2006.

This report describes the results of a general practice focus group study to identify the barriers to influenza vaccination, especially in 'at risk' adult groups. NICS_Influenza_Evidence_Report_2_Barriers_and_Facilitators (354KB PDF)

Literature review part two                  

'Influenza vaccination for the 'at risk' Australian adults aged between 18 and 64'. Part 2 Cost-of-Illness study of current practice and cost analysis of extending vaccination to all at risk Australian adults. Colgan S, Tay-Teo K, Shik S, and Carter R. Health Economics Group, the University of Melbourne, February 2006.

This report presents estimates of the current economic burden of influenza vaccination in adults at risk of contracting influenza and developing complications for the Australian population. NICS_Influenza_Evidence_Report_3_(Part 2)_Cost_of_Illness (482KB PDF)

High-risk medical conditions

Influenza has a higher case fatality rate in middle-aged persons with chronic medical conditions than in persons about 65 years of age who are well.

Lowering the age for routine influenza vaccination to 50 years: AAFP leads the nation in influenza vaccination policy. Zimmerman, R.K. (1999) American Family Physician, 60, 2061-6, 2069-70 (free full text).

Asthma

Influenza vaccinations seem unlikely to worsen asthma.

Cates CJ, Jefferson T, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD000364. DOI: 10.1002/14651858.CD000364.pub3.

Renal disease

(Late-stage chronic)

Influenza vaccination demonstrated reduced infection rates and resultant decreased morbidity and mortality.

The value of vaccination in chronic kidney disease. Kausz, A. et al (2004) Seminars in Dialysis, 17, 9-11 (link to abstract).

Chronic obstructive pulmonary disease

Inactivated vaccine reduces exacerbations in COPD patients due to a reduction in exacerbations occurring three or more weeks after vaccination, and due to influenza.

Poole P, Chacko EE, Wood-Baker R, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD002733. DOI: 10.1002/14651858.CD002733.pub2.

Cancer

Influenza vaccination in children being treated with chemotherapy for cancer

This record should be cited as: Goossen GM, Kremer LCM, van de Wetering MD. Influenza vaccination in children being treated with chemotherapy for cancer. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006484. DOI: 10.1002/14651858.CD006484.pub2.

Diabetes

Influenza vaccination reduced hospital admissions by 79 per cent during two epidemics.

Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes. Colquhoun, A. J., et al (1997) Epidemiology & Infection, 119, 335-41.

Cardiovascular disease

Multiple studies show that the influenza vaccine decreases the incidence of cardiovascular events by 20-70 per cent in the settings of primary and secondary prevention.

Influenza and atherosclerosis: vaccination for cardiovascular disease prevention. Madjid, M. et al. (2005) Expert Opin Biol Ther, 5, 91-96.

Pregnancy

(2nd & 3rd trimester)

Influenza vaccination recommended due to the high risk of exposure and disease due to influenza viruses in pregnant women, as well as the impact of influenza virus infection on the foetus and infant. Historical data from the influenza pandemics of 1918 and 1957 illustrate potential risks.

Maternal immunization with inactivated influenza vaccine: rationale and experience. Englund, J.A. (2003) Vaccine, 21, 3460-4.

Health care workers in aged care facilities     

Current Australian guidelines recommend annual vaccination for staff of nursing homes and long term care facilities to protect those at high risk. This pair matched randomised controlled trial found that vaccinating care home staff can prevent deaths, health service use, influenza like illness and hospital admissions in residents during periods of moderate influenza activity.

Effectiveness of an influenza vaccine program for care home staff to prevent death, morbidity, and health service use amongst residents: cluster randomized controlled trial. A.C. Hayward, R. Harling, S. Wetten et al. BMJ 333:1241 (2006) - free full text.

Health care workers

The authors of this systematic review have made the following conclusions. There is no high quality evidence that vaccinating health care workers reduces the incidence of influenza or its complications in the elderly in institutions. There is evidence that vaccinating the elderly has a modest impact on the complications from influenza. There is high quality evid­ence that vaccinating healthy adults under 60, which includes health care workers, reduces cases of influenza.

Thomas RE, Jefferson T, Demicheli V, Rivetti D. Influenza vaccination for health care workers who work with the elderly. Cochrane Database of Systematic Reviews 2006. Issue 3. Art. No.: CD005187. DOI: 10.1002/14651858.CD0055187.pub2.

Vaccination of health care workers has been shown to reduce influenza infection and absenteeism among health care workers.

Wilde JA, McMillan JA, Serwint J et al. Effectiveness of influenza vaccine in health care professional: a randomized trial. JAMA 1999;281:908-13.

In this systematic review 18 out of 493 studies met the criteria for inclusion. The major findings were that vaccination of health care workers (HCWs) protects them and provides indirect protection to high-risk patients; that vaccination is highly effective in HCWs with minimal adverse effects; that promotional campaigns increase the uptake of vaccination in HCWs; and that vaccination of HCWs is cost effective and probably cost saving.

Vaccinating healthcare workers against influenza to protect the vulnerable - Is if a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. A Burls, R Jordan, p Barton et. al. Vaccine 24 (2006) 4212-4221.

A nationwide 2 year awareness campaign which involved distributions of information material to hospitals and engagement of stakeholders such as professional HCW associations, increased vaccination rates in health care workers (HCWs) from 21% to 26%, and found different rates between medical and nursing groups.

Leitmeyer K, Buchholz U, Kramer M et. al. Influenza vaccination in German health care workers: effects and findings after two rounds of a nationwide awareness campaign. Vaccine 24 (2006) 7003-8.

Patient reminder/recall  

Reminding people to have vaccinations increased the number of people vaccinated, whether the people were due or overdue for the vaccine.

Patient Reminder and Patient Recall Systems to Improve Immunization Rates. Cochrane Database of Systematic Reviews, CD003941. Vann JC Jacobson, P Szilagyi (free access for Australian residents through the Australian national Cochrane Library licence).

A combination of interventions

A general practice in Queensland used four strategies to target the 65 and over age group for influenza vaccination and increased the rate from 77% in 2004 to 83% in 2005. The strategies were: a computer search for the target population; telephone recruitment and booking by the receptionist; removal of cost by bulk billing; and using nurse led immunisation.

Burns P, Fulton B, Crawford M. An audit of influenza vaccination rates. Australian Family Physician 35: 7: 551-552. July 2006

There is strong evidence for the effectiveness of a combination of one or more interventions to enhance access to vaccination services (expanded access in health care settings, reduced out-of-pocket costs) with at least one provider- or system-based intervention (standing orders, provider reminder systems, provider assessment and feedback), and /or at least one intervention to increase demand for vaccination (patient reminders, patient education).

Recommendations to Improve Targeted Vaccination Coverage among High-Risk Adults. Task Force on Community Preventative Services. Am J Prev Med 2005:28(5S):231-237.