Giuseppe
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PLoS Medicine - Health Benefits of Universal Influenza Vaccination Strategy
Health Benefits of Universal Influenza Vaccination Strategy
C?cile Viboud*, Mark Miller
Funding: The authors received no specific funding for this article.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Viboud C, Miller M (2008) Health Benefits of Universal Influenza Vaccination Strategy. PLoS Med 5(10): e216 doi:10.1371/journal.pmed.0050216
Published: October 28, 2008
This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
C?cile Viboud and Mark Miller are at the Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America.
* To whom correspondence should be addressed. E-mail:viboudc@mail.nih.gov
Provenance: Commissioned; not externally peer reviewed
Most countries in Europe and North America target influenza immunization to persons at highest risk for complications, including seniors 65 years and older, those with certain chronic illnesses, and young children. Despite increases in vaccination rates in these high-risk groups over the last few decades, morbidity and mortality from influenza remain high.
Disappointing Results of Targeted Influenza Vaccination Strategies
Seniors suffer about 90% of the influenza seasonal mortality burden, and rates of hospitalization and death are increasing as the population ages [1]. Studies of national trends in the United States and Italy showed that even after adjusting for population aging and pathogenicity of circulating influenza viruses, vaccine uptake in seniors was not associated with a decline in influenza-related mortality ([2,3]; Figure 1).
These disappointing experiences can be explained by the phenomenon of immune senescence, whereby immune response to vaccines declines in the last decades of life [4].
These results?along with a growing understanding that the expected effectiveness of vaccination had been greatly overestimated in seniors [5,6]?have fueled debate over the best strategy to protect high-risk populations [1,7].
In response, the US public health authorities have gradually broadened the recommended target group for vaccination, which now includes all children aged six months to 18 years of age [8].
This new strategy is likely to reduce severe pediatric influenza outcomes, and it could also protect seniors by reducing influenza transmission from high-transmitter populations, although the exact benefits have yet to be evaluated.
Linked Research Article
This Perspective discusses the following new studies published in PLoS Medicine:
Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur REG, et al. (2008) The effect of universal influenza immunization on mortality and health care use. PLoS Med 5(10): e211. doi:10.1371/journal.pmed.0050211
Comparing influenza-related mortality and health care use between Ontario and other Canadian provinces, Jeffrey Kwong and colleagues find evidence that Ontario's universal vaccination program has reduced the burden of influenza.
van den Dool C, Bonten MJM, Hak E, Heijne JCM, Wallinga J (2008) The effects of influenza vaccination of health care workers in nursing homes: Insights from a mathematical model. PLoS Med 5(10): e200. doi:10.1371/journal.pmed.0050200 Using a mathematical model to simulate influenza transmission in nursing homes, Carline van den Dool and colleagues find that each additional staff member vaccinated further reduces the risk to patients.
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<cite cite="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050216">PLoS Medicine - Health Benefits of Universal Influenza Vaccination Strategy</cite>C?cile Viboud*, Mark Miller
Funding: The authors received no specific funding for this article.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Viboud C, Miller M (2008) Health Benefits of Universal Influenza Vaccination Strategy. PLoS Med 5(10): e216 doi:10.1371/journal.pmed.0050216
Published: October 28, 2008
This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
C?cile Viboud and Mark Miller are at the Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America.
* To whom correspondence should be addressed. E-mail:viboudc@mail.nih.gov
Provenance: Commissioned; not externally peer reviewed
Most countries in Europe and North America target influenza immunization to persons at highest risk for complications, including seniors 65 years and older, those with certain chronic illnesses, and young children. Despite increases in vaccination rates in these high-risk groups over the last few decades, morbidity and mortality from influenza remain high.
Disappointing Results of Targeted Influenza Vaccination Strategies
Seniors suffer about 90% of the influenza seasonal mortality burden, and rates of hospitalization and death are increasing as the population ages [1]. Studies of national trends in the United States and Italy showed that even after adjusting for population aging and pathogenicity of circulating influenza viruses, vaccine uptake in seniors was not associated with a decline in influenza-related mortality ([2,3]; Figure 1).
These disappointing experiences can be explained by the phenomenon of immune senescence, whereby immune response to vaccines declines in the last decades of life [4].
These results?along with a growing understanding that the expected effectiveness of vaccination had been greatly overestimated in seniors [5,6]?have fueled debate over the best strategy to protect high-risk populations [1,7].
In response, the US public health authorities have gradually broadened the recommended target group for vaccination, which now includes all children aged six months to 18 years of age [8].
This new strategy is likely to reduce severe pediatric influenza outcomes, and it could also protect seniors by reducing influenza transmission from high-transmitter populations, although the exact benefits have yet to be evaluated.
Linked Research Article
This Perspective discusses the following new studies published in PLoS Medicine:
Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur REG, et al. (2008) The effect of universal influenza immunization on mortality and health care use. PLoS Med 5(10): e211. doi:10.1371/journal.pmed.0050211
Comparing influenza-related mortality and health care use between Ontario and other Canadian provinces, Jeffrey Kwong and colleagues find evidence that Ontario's universal vaccination program has reduced the burden of influenza.
van den Dool C, Bonten MJM, Hak E, Heijne JCM, Wallinga J (2008) The effects of influenza vaccination of health care workers in nursing homes: Insights from a mathematical model. PLoS Med 5(10): e200. doi:10.1371/journal.pmed.0050200 Using a mathematical model to simulate influenza transmission in nursing homes, Carline van den Dool and colleagues find that each additional staff member vaccinated further reduces the risk to patients.
-