Background: Seasonal influenza is a significant cause of mortality and morbidity worldwide. Despite annual recommendations, influenza vaccination uptake rates are disproportionately lower among nurses compared to other health care professionals, especially when compared to physicians. Nurses have an additional risk of exposure to influenza infection due to the nature of their work. Aim: To determine the effectiveness of interventions in increasing seasonal influenza vaccination uptake among nurses. Methods: Evidence on the effectiveness of interventions to improve seasonal influenza vaccination uptake among nurses was systematically reviewed. A comprehensive search of six electronic databases and grey literature was undertaken. A minimum of two reviewers completed study selection, data extraction and risk of bias assessment independently. Results: One hundred and thirty-four studies were identified of which one cluster randomised trial met the inclusion criteria. The results of the included study found the implementation of an intervention with multiple components increased nurses' seasonal influenza vaccination rates during a single influenza season in geriatric healthcare settings in France. As the evidence in this review was very limited, it was not possible to make recommendations regarding which interventions were effective at increasing the seasonal influenza vaccination rate for nurses. Conclusion: This systematic review highlights a lack of high-quality studies that assessed interventions to improve the seasonal influenza vaccination of nurses. In view of the likelihood of influenza and the coronavirus (COVID-19) pandemic occurring together, it is imperative to have evidence on effective interventions for the nursing workforce and for policy decision makers.

Influenza is a major public health problem worldwide. Mutations and resistance development make the use of antiviral therapy challenging. Chinese patent medicines are often used to treat influenza in China and well tolerable. However, the misuse of Chinese patent medicines is common. We therefore aimed to develop an evidence-based guideline on treating influenza with Chinese patent medicines in adults to guide clinical practice. We formed a steering committee, a consensus panel, a consultants' group and an evidence synthesis team to guide the development of the guideline. We formulated the clinical questions through two rounds of survey, and finally selected five questions. We then systematically searched the related evidence and conducted meta -analyses, evidence summaries and GRADE decision tables to draft the recommendations, which the consensus panel then voted on using the Delphi method. Finally, we formulated six recommendations based on the evidence synthesis and experts' consensus. For treating mild influenza, we suggest either Lianhua Qingwen capsule, Jinhua Qinggan granule, Banlangen granule, Shufeng Jiedu capsule, or Jinfang Baidu pill, depending on the manifestations. For severe influenza, or mild influenza in patients at high risk of developing severe influenza, we suggest Lianhua Qingwen capsule in combination with antiviral medications and supportive therapy. The strength of all recommendations was weak. Traditional Chinese medicine has great potential to help in the fight against influenza worldwide, but more high-quality studies are still needed to strengthen the evidence.

Background: Given the economic burden of seasonal influenza for the healthcare system, we performed a systematic review aiming to update available evidence on the cost-effectiveness of vaccination of seasonal influenza in different age groups, including children. Methods: A systematic review of the literature on economic evaluations of seasonal influenza vaccination programs in children and adults was carried out. The following databases were searched (January 2013 - April 2018): Medline and PREMEDLINE, EMBASE, EconLit and databases of the Centre for Reviews and Dissemination (DARE, HTA, NHS EED). Results: A total of 11 economic evaluations were included. Methodological quality of included studies was acceptable. Scientific evidence shows that seasonal influenza vaccination programs in school-age children can be a cost-effective alternative from national health system perspective and can be cost-saving from societal perspective in European countries. However, available evidence does not allow us to conclude that influenza vaccination programs in healthy adults under 65 years of age were a cost-effective alternative in our context, due to the high uncertainty and the lack of studies carried out in Spanish context. Conclusions: Vaccination programs for the prevention of seasonal influenza in school-age children (3-16 years) can be a cost-effective strategy.

Background: Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies. Methods: We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes. Results: We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8-19%) of cases, pneumococcus for 10% (95% CI, 6-15%), and meningococcus for 1% (95% CI, 0-2%). These meta-analyses had substantial between-study heterogeneity (I2 > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan. Conclusions: South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.

INTRODUCTION: Vaccination in pregnancy is an effective method to protect against disease for the pregnant woman, foetus and new born infant. In England, it is recommended that pregnant women are vaccinated against pertussis and influenza. Improvement in the uptake of both pertussis and influenza vaccination among pregnant women is needed to prevent morbidity and mortality for both the pregnant women and unborn child. AIM: To identify effective strategies in increasing the uptake of vaccination in pregnancy in high-income countries and to make recommendations for England. METHODS: A systematic review of peer reviewed literature was conducted using a keyword search strategy applied across six databases (Medline, Embase, PsychInfo, PubMed, CINAHL and Web of Science). Articles were screened against an inclusion and exclusion criteria and papers included within the review were quality assessed. RESULTS AND CONCLUSIONS: Twenty-two articles were included in the review. The majority of the papers included were conducted in the USA and looked at strategies to increase influenza vaccination in pregnancy. There is limited high quality evidence for strategies in high-income countries to increase coverage of pertussis and influenza vaccination in pregnancy. A number of strategies have been found to be effective; reminders about vaccination on antenatal healthcare records, midwives providing vaccination, and education and information provision for healthcare staff and patients. Future interventions to increase vaccination in pregnancy should be evaluated to ensure efficacy and to contribute to the evidence base.

BACKGROUND: In Canada, vaccination coverage for seasonal influenza among health care personnel remains below 50%. The objective of this review was to determine which seasonal influenza vaccination campaign or campaign components in health care settings were significantly associated with increases in influenza vaccination among staff. METHODS: We identified articles in eight electronic databases and included randomized controlled trials, controlled before-and-after studies and studies with interrupted time series designs in our review. Two reviewers independently abstracted the data and assessed the risk of biases. We calculated risk ratios and 95% confidence intervals for randomized controlled trials and controlled before-and-after studies and described interrupted time series studies. RESULTS: We identified 99 studies evaluating influenza vaccination campaigns for health care workers, but only 12 of the studies were eligible for review. In nonhospital health care settings, including long-term care facilities, campaigns with a greater variety of components (including education or promotion, better access to vaccines, legislation or regulation and/or role models) were associated with higher risk ratios (i.e, favouring the intervention group). Within hospital settings, the results reported for various types of campaigns were mixed. Many of the criteria for assessing risk of bias were not reported. INTERPRETATION: Campaigns involving only education or promotion resulted in minimal changes in vaccination rates. Further studies are needed to determine the appropriate components and combinations of components in influenza vaccination campaigns for health care personnel.

Objectives: To conduct a literature review of influenza vaccination policy, describing roles and interactions between stakeholders and the factors influencing policy-making. Methods: Major databases were searched using keywords related to influenza vaccination, decision-making and health policy. Titles and abstracts were screened according to defined criteria using independent reviewers. Selected articles were analysed and compared against a checklist. Results: 342 papers were identified, but only 111 included. A wide range of countries was represented in articles published in 1994-2012. We identified numerous stakeholders at the national and international level and found a variety of interactions between them. Using these data, we suggest a scheme for the most important stakeholders and their interactions. Determinants of policy-making were mainly related to the vaccine/disease, political-economic context, and stakeholders communication. The most relevant evidence was clinical/epidemiological studies. After the 2009 pandemic: the importance of mathematical modelling and ethical issues was greater; and the need for better communication between stakeholders was emphasised. Conclusions: The relevance of evidence and factors influencing policy-making varied between countries, according to complex interactions between the stakeholders involved at different levels of decision-making process. These interactions remain unclear, especially at national level, where the most important influenza policy decisions are made. To better define and understand the exact interactions and use of evidence, we recommend undertaking future qualitative studies at national level using small number of countries.

Objectives: To systematically evaluate the effect of extracorporeal membrane oxygenation on survival in adults with acute respiratory failure and to help inform institutional decisions about implementing an extracorporeal membrane oxygenation program or transferring patients to experienced extracorporeal membrane oxygenation centers during the H1N1 influenza pandemic. Data Sources: National Guideline Clearinghouse, MEDLINE, EMBASE, Agency for Healthcare Research and Quality Evidence-based Practice reports, National Institute for Health and Clinical Excellence, Cochrane Library, International Network of Agencies for Health Technology Assessment, and citation review. Study Selection: Studies of extracorporeal membrane oxygenation in adult acute respiratory failure, reporting mortality rates for at least 10 patients in extracorporeal membrane oxygenation and nonextracorporeal membrane oxygenation groups. Data Extraction: Mortality rates were abstracted for all patients and for patients with influenza. Risk ratios were meta-analyzed using random-effects methods and assessed for heterogeneity. Data Synthesis: There are no evidence-based clinical guidelines on the use of extracorporeal membrane oxygenation in patients with influenza. Three randomized controlled trials and three cohort studies evaluated extracorporeal membrane oxygenation in patients with acute respiratory failure; none reported specifically on patients with influenza. Meta-analysis of the randomized controlled trials revealed significant heterogeneity in risk of mortality. The summary risk ratio found by the meta-analysis was 0.93 (95% confidence interval, 0.71 to 1.22). The most recent trial found a reduction in mortality and severe disability at 6 months among patients in whom extracorporeal membrane oxygenation was considered. Observational studies suggest that extracorporeal membrane oxygenation for acute respiratory failure resulting from viral pneumonia is associated with improved mortality compared with other etiologies of acute respiratory failure. Conclusions: The best evidence to guide decisions regarding the use of extracorporeal membrane oxygenation for patients with influenza stems from trials of extracorporeal membrane oxygenation for acute respiratory failure of all etiologies, among which significant heterogeneity exists, and from case series describing outcomes of extracorporeal membrane oxygenation in patients with influenza. Thus, there is insufficient evidence to provide a recommendation for extracorporeal membrane oxygenation use among patients with respiratory failure resulting from influenza. However, clinicians should consider extracorporeal membrane oxygenation within the context of other salvage therapies for acute respiratory failure. (Crit Care Med 2010; 38: 1398-1404)

Objective We review published economic evaluations of influenza vaccination for children, including direct individual benefits and indirect societal benefits, to determine whether more studies are needed to fully understand the expected benefits of such strategies. Methods We searched MEDLINE and EMBASE databases to May 2006 and in-press articles to October 2006 for studies including economic analyses of influenza vaccination in children. Abstracts of all potentially relevant articles were screened. Results Fifteen relevant articles from 1983 were retained. Most were based on modelling, using previously published data and considered the societal perspective. Three were a part of prospective clinical trials. Various paediatric vaccination scenarios and parameters were considered. Vaccinating children against influenza was cost saving or cost effective in 10/15 studies, cost saving or effective only under certain conditions in three studies, and not cost saving or effective in two studies whatever the outcome or perspective considered. Conclusions Most published evidence points to an economic interest for society of vaccinating children against influenza. However, differences in study design hinder the comparison of the various vaccination strategies considered. Comparable and complete data on the burden and cost of disease, and the cost of vaccination are needed, especially outside of North America.