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[Universal immunisation against influenza in paediatrics, yes or no?]
J González de Dios1, C Rodrigo Gonzalo de Liria, P A Piedra
1Servicio de Pediatría, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, España.
Insights
Pediatric flu vaccination offers a favorable cost-benefit-risk balance. While efficacy is good, effectiveness varies, especially in children under two, highlighting the need for more research in this age group.
Area of Science:
- Pediatrics
- Vaccinology
- Public Health
Context:
- Influenza vaccination recommendations differ significantly between the United States and Europe.
- Evidence-based medicine principles were applied to evaluate flu vaccine data.
Purpose:
- To determine the efficacy, effectiveness, and safety of current influenza vaccines (trivalent inactivated and live attenuated influenza vaccine [LAIV]) in healthy children.
- To assess the evidence supporting universal pediatric influenza immunization.
Summary:
- Nine systematic reviews (2005-2012) analyzing randomized controlled trials, cohort studies, and case studies were included.
- Flu vaccine efficacy ranged from 58%-65%, and effectiveness from 28%-61%, generally increasing with age.
- Limited evidence exists for children under two years, indicating a need for more research in this demographic.
Impact:
- The study supports a positive cost-benefit-risk profile for childhood influenza vaccination.
- Further research is recommended for infants aged 6-23 months, including studies on adjuvants, higher doses, and LAIV.
- Improving the prediction of circulating influenza strains is crucial for vaccine development.
Introduction:
The recommendations on influenza vaccination are not homogeneous between countries, with striking differences between the current recommendations in United States and Europe.
Objective:
The objective of the study is to determine the efficacy, effectiveness and safety of the current flu vaccine (trivalent inactivated vaccine and adapted to the cold [LAIV] live virus vaccine) in healthy children, and to try and answer the following question: universal immunization against influenza in Paediatrics, yes or no?
Material And Methods:
A scheme of work based on the five standard steps of evidence or science-based medicine was used: 1) question, 2) search, 3) valuation, 4) applicability and 5) adequacy.
Results:
Nine systematic reviews, published between 2005 and 2012, were selected that answered our clinical question, and which included the best available information (randomised clinical trials, cohort studies and case studies).
Conclusions:
The flu vaccine in childhood has the right cost - benefit - risk relationship. In all systematic reviews the efficacy of the flu vaccine varied between 58%-65%, and effectiveness between 28%-61%. Both efficacy and effectiveness increase with age, and there are limited studies showing sufficient evidence in children < 2 years. There are further areas to develop: more and better clinical trials on influenza vaccines in infants from 6 to 23 months; further research to achieve better influenza vaccines (addition of adjuvants, higher doses in children between 6 and 23 months, and study the LAIV vaccine in children between 6 and 23 months); and improvement in the prediction of vaccine strains responsible for the outbreak.
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