Economic evaluations of seasonal influenza vaccination for the elderly

The Council of the European Union (EU) has recommended that action should be taken to increase influenza vaccination in the elderly population | BMJ Open

Image source: Joe The Goat Farmer – Flickr // CC BY 2.0

Objectives: The aims were to systematically review and critically appraise economic evaluations for influenza vaccination in the elderly population in the EU.

Results: Of the 326 search results, screening identified eight relevant studies. Results varied widely, with the incremental cost-effectiveness ratio ranging from being both more effective and cheaper than no intervention to costing €4 59 350 per life-year gained. Cost-effectiveness was most sensitive to variations in influenza strain, vaccination type and strategy, population and modelling characteristics.

Conclusions: Most studies suggest that vaccination is cost-effective (seven of eight studies identified at least one cost-effective scenario). All but one study used economic models to synthesise data from different sources. The results are uncertain due to the methods used and the relevance and robustness of the data used. Sensitivity analysis to explore these aspects was limited. Integrated, controlled prospective clinical and economic evaluations and surveillance data are needed to improve the evidence base. This would allow more advanced modelling techniques to characterise the epidemiology of influenza more accurately and improve the robustness of cost-effectiveness estimates.

Full reference: Shields. G.E. et al. (2017) Systematic review of economic evaluations of seasonal influenza vaccination for the elderly population in the European Union. BMJ Open. 7:e014847



Practice Transformation Program Increases Adult Influenza Vaccination

Infection Control Today | Published online: 3 November 2016


An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study by Lin, et al. (2016) was to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine.

Twenty-five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions.

A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were Hispanic. After one year, both intervention and control arms significantly (P < 0.001) increased influenza vaccination, with average increases of 2.7 to 6.5 percentage points. In regression analyses, likelihood of influenza vaccination was significantly higher in sites with lower percentages of patients with missed opportunities (P < 0.001) and, after adjusting for missed opportunities, the intervention further improved vaccination rates in Houston (lower baseline rates) but not Pittsburgh (higher baseline rates). In the follow-up intervention, the likelihood of vaccination increased for both intervention sites and those that reduced missed opportunities (P < 0.005).

The researchers say that reducing missed opportunities across the practice increases likelihood of influenza vaccination of adults. The 4 Pillars™ Practice Transformation Program provides strategies for reducing missed opportunities to vaccinate adults.

Read the full overview here

Read the original article here

Flu vaccine: best practice guide for GPs

Public Health England. Published online: 28 June 2016

Leaflet for GPs and practice staff to support the nasal spray flu vaccination programme for children in 2016 to 2017.

phe flu
Image source: PHE

This leaflet is intended for GPs and practice staff. It provides best practice guidance on how to:

  • prepare to deliver the programme
  • improve uptake of the vaccine
  • identify eligible children
  • promote the programme

It is not intended for children, parents or guardians. They will receive their own dedicated information at the appropriate time.

Read the full guidance here

UK stands by nasal flu vaccine for children as US doctors are told to stop using it

Hawkes, N. BMJ. 2016. 353:i3546
Image source: Sanofi Pasteur // CC BY-NC-ND 2.0

Image shows an influenza virus (orthomyxovirus) seen through an electronic microscope.

The £100m (€130m; $150m) a year childhood flu vaccination campaign in the United Kingdom will continue despite evidence from the United States that the inhaled vaccine is ineffective.

Public Health England (PHE) said that its data contradict those of the US Advisory Committee on Immunization Practices, which recently advised the Centers for Disease Control and Prevention (CDC) to stop vaccinating children because, for the past three flu seasons, the vaccine seemed to have little effect.

All children in the UK aged 2 have been offered vaccination against flu since September 2013, and the programme was extended last year to include infant school children. It is gradually being rolled out to include all children aged 2 to 17.

PHE published provisional figures for the UK that showed that the inhaled vaccine taken by 2 to 17 year olds achieved similar protection against laboratory confirmed flu as did adult vaccines in older age groups. The vaccine prevented flu in more than half of the children given it, with an effectiveness of 57.6% (95% confidence interval 25.1% to 76%). Similar results had been reported by the Finnish National Institute for Health and Welfare, which found an effectiveness of 46%.

Richard Pebody, head of flu surveillance for PHE, said, “These findings are encouraging and in line with what we also typically see for the adult flu vaccine. There is no reason to change current recommendations regarding use of the children’s nasal spray vaccine in the UK.

Read the full article here

View the PHE figures here

NIH Study Finds Factors That May Influence Influenza Vaccine Effectiveness

Infection Control Today. Published online: 19 April 2016.
Image source: R. Dourmashkin, Wellcome Images // CC BY-NC-ND 4.0

Image shows Influenza B (Li) virus particles.

The long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited, new research suggests. Currently, seasonal flu vaccines are designed to induce high levels of protective antibodies against hemagglutinin (HA), a protein found on the surface of the influenza virus that enables the virus to enter a human cell and initiate infection. New research conducted by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, found that higher levels of antibody against a different flu surface protein–neuraminidase (NA)–were the better predictor of protection against flu infection and its unpleasant side effects. Neuraminidase, which is not currently the main target antigen in traditional flu vaccines, enables newly formed flu viruses to exit the host cell and cause further viral replication in the body.

The findings, from a clinical trial in which healthy volunteers were willingly exposed to naturally occurring 2009 H1N1 influenza type A virus, appear online today in the open-access journal mBio.

Read the full commentary here