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Meta-Analysis
. 2018 Feb 1;2(2):CD004876.
doi: 10.1002/14651858.CD004876.pub4.

Vaccines for preventing influenza in the elderly

Vittorio Demicheli  1 , Tom Jefferson, Carlo Di Pietrantonj, Eliana Ferroni, Sarah Thorning, Roger E Thomas, Alessandro Rivetti
Affiliations
Meta-Analysis

Vaccines for preventing influenza in the elderly

Vittorio Demicheli et al. Cochrane Database Syst Rev. .

Abstract

Background: The consequences of influenza in the elderly (those age 65 years or older) are complications, hospitalisations, and death. The primary goal of influenza vaccination in the elderly is to reduce the risk of death among people who are most vulnerable. This is an update of a review published in 2010. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions.

Objectives: To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in the elderly.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 11), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1966 to 31 December 2016); Embase (1974 to 31 December 2016); Web of Science (1974 to 31 December 2016); CINAHL (1981 to 31 December 2016); LILACS (1982 to 31 December 2016); WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017); and ClinicalTrials.gov (1 July 2017).

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs assessing efficacy against influenza (laboratory-confirmed cases) or effectiveness against influenza-like illness (ILI) or safety. We considered any influenza vaccine given independently, in any dose, preparation, or time schedule, compared with placebo or with no intervention. Previous versions of this review included 67 cohort and case-control studies. The searches for these trial designs are no longer updated.

Data collection and analysis: Review authors independently assessed risk of bias and extracted data. We rated the certainty of evidence with GRADE for the key outcomes of influenza, ILI, complications (hospitalisation, pneumonia), and adverse events. We have presented aggregate control group risks to illustrate the effect in absolute terms. We used them as the basis for calculating the number needed to vaccinate to prevent one case of each event for influenza and ILI outcomes.

Main results: We identified eight RCTs (over 5000 participants), of which four assessed harms. The studies were conducted in community and residential care settings in Europe and the USA between 1965 and 2000. Risk of bias reduced our certainty in the findings for influenza and ILI, but not for other outcomes.Older adults receiving the influenza vaccine may experience less influenza over a single season compared with placebo, from 6% to 2.4% (risk ratio (RR) 0.42, 95% confidence interval (CI) 0.27 to 0.66; low-certainty evidence). We rated the evidence as low certainty due to uncertainty over how influenza was diagnosed. Older adults probably experience less ILI compared with those who do not receive a vaccination over the course of a single influenza season (3.5% versus 6%; RR 0.59, 95% CI 0.47 to 0.73; moderate-certainty evidence). These results indicate that 30 people would need to be vaccinated to prevent one person experiencing influenza, and 42 would need to be vaccinated to prevent one person having an ILI.The study providing data for mortality and pneumonia was underpowered to detect differences in these outcomes. There were 3 deaths from 522 participants in the vaccination arm and 1 death from 177 participants in the placebo arm, providing very low-certainty evidence for the effect on mortality (RR 1.02, 95% CI 0.11 to 9.72). No cases of pneumonia occurred in one study that reported this outcome (very low-certainty evidence). No data on hospitalisations were reported. Confidence intervaIs around the effect of vaccines on fever and nausea were wide, and we do not have enough information about these harms in older people (fever: 1.6% with placebo compared with 2.5% after vaccination (RR 1.57, 0.92 to 2.71; moderate-certainty evidence)); nausea (2.4% with placebo compared with 4.2% after vaccination (RR 1.75, 95% CI 0.74 to 4.12; low-certainty evidence)).

Authors' conclusions: Older adults receiving the influenza vaccine may have a lower risk of influenza (from 6% to 2.4%), and probably have a lower risk of ILI compared with those who do not receive a vaccination over the course of a single influenza season (from 6% to 3.5%). We are uncertain how big a difference these vaccines will make across different seasons. Very few deaths occurred, and no data on hospitalisation were reported. No cases of pneumonia occurred in one study that reported this outcome. We do not have enough information to assess harms relating to fever and nausea in this population.The evidence for a lower risk of influenza and ILI with vaccination is limited by biases in the design or conduct of the studies. Lack of detail regarding the methods used to confirm the diagnosis of influenza limits the applicability of this result. The available evidence relating to complications is of poor quality, insufficient, or old and provides no clear guidance for public health regarding the safety, efficacy, or effectiveness of influenza vaccines for people aged 65 years or older. Society should invest in research on a new generation of influenza vaccines for the elderly.

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Conflict of interest statement

Vittorio Demicheli: none known.

Tom Jefferson (TJ) was a recipient of a UK National Institute for Health Research grant for a Cochrane Review of neuraminidase inhibitors for influenza. In addition, TJ receives royalties from his books published by Il Pensiero Scientifico Editore, Rome and Blackwells. TJ is occasionally interviewed by market research companies about phase I or II pharmaceutical products (remunerated). In 2011‐13, TJ acted as an expert witness in litigation related to the antiviral oseltamivir, in two litigation cases on potential vaccine‐related damage, and in a labour case on influenza vaccines in healthcare workers in Canada (remunerated). He has acted as a consultant for Roche (1997‐99), GSK (2001‐2), Sanofi‐Synthelabo (2003), and IMS Health (2013) (remunerated). In 2014 he was retained as a scientific adviser to a legal team acting on oseltamivir (remunerated). TJ has a potential financial conflict of interest in the drug oseltamivir. In 2014‐16, TJ was a member of three advisory boards for Boerhinger Ingelheim (remunerated). TJ is holder of a Cochrane Methods Innovations Fund grant to develop guidance on the use of regulatory data in Cochrane Reviews. TJ was a member of an independent data monitoring committee for a Sanofi Pasteur clinical trial on an influenza vaccine (remunerated). Between 1994 and 2013, TJ was the co‐ordinator of the Cochrane Vaccines Field. TJ is a cosignatory of the Nordic Cochrane Centre Complaint to the European Medicines Agency (EMA) over maladministration at the EMA in relation to the investigation of alleged harms of human papillomavirus vaccines and consequent complaints to the European Ombudsman. TJ is coholder of a John and Laura Arnold Foundation grant for development of a RIAT support centre (2017‐20) and Jean Monnet Network Grant, 2017‐20 for The Jean Monnet Health Law and Policy Network.

Carlo Di Pietrantonj: none known.

Eliana Ferroni: none known.

Sarah Thorning: none known.

Roger E Thomas: none known.

Alessandro Rivetti: none known.

Figures

1
1
Study flow. We identified no new randomised controlled trials for the 2016 update and stabilisation.
2
2
Relationship between vaccination rate and attack rate
1.1
1.1. Analysis
Comparison 1: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine, Outcome 1: Influenza
1.2
1.2. Analysis
Comparison 1: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine, Outcome 2: Influenza‐like illness
1.3
1.3. Analysis
Comparison 1: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine, Outcome 3: Pneumonia
1.4
1.4. Analysis
Comparison 1: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine, Outcome 4: All deaths
2.1
2.1. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 1: General malaise
2.2
2.2. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 2: Nausea
2.3
2.3. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 3: Upper respiratory tract symptoms
2.4
2.4. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 4: Headache
2.5
2.5. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 5: Fever
2.6
2.6. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 6: Local tenderness/sore arm
2.7
2.7. Analysis
Comparison 2: Influenza vaccines versus placebo: randomised controlled trials ‐ parenteral vaccine ‐ adverse events, Outcome 7: Swelling ‐ erythema ‐ induration
3.1
3.1. Analysis
Comparison 3: Influenza vaccines versus placebo: randomised controlled trials ‐ inactivated aerosol vaccine, Outcome 1: Influenza
3.2
3.2. Analysis
Comparison 3: Influenza vaccines versus placebo: randomised controlled trials ‐ inactivated aerosol vaccine, Outcome 2: Influenza‐like illness
4.1
4.1. Analysis
Comparison 4: Influenza vaccines versus placebo: randomised controlled trials ‐ live aerosol vaccine, Outcome 1: Influenza
5.1
5.1. Analysis
Comparison 5: Influenza vaccines versus placebo: randomised controlled trials ‐ live aerosol vaccine ‐ adverse events, Outcome 1: General malaise
5.2
5.2. Analysis
Comparison 5: Influenza vaccines versus placebo: randomised controlled trials ‐ live aerosol vaccine ‐ adverse events, Outcome 2: Fever
5.3
5.3. Analysis
Comparison 5: Influenza vaccines versus placebo: randomised controlled trials ‐ live aerosol vaccine ‐ adverse events, Outcome 3: Upper respiratory tract symptoms
5.4
5.4. Analysis
Comparison 5: Influenza vaccines versus placebo: randomised controlled trials ‐ live aerosol vaccine ‐ adverse events, Outcome 4: Lower respiratory tract symptoms
6.1
6.1. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 1: Influenza
6.2
6.2. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 2: Influenza‐like illness
6.3
6.3. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 3: Pneumonia
6.4
6.4. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 4: Hospitalisation for influenza‐like illness or pneumonia
6.5
6.5. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 5: Deaths from flu or pneumonia
6.6
6.6. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 6: All deaths
6.7
6.7. Analysis
Comparison 6: Influenza vaccines versus no vaccination: cohort studies in nursing homes, Outcome 7: Influenza cases (clinically defined without clear definition)
7.1
7.1. Analysis
Comparison 7: Influenza and pneumococcal vaccines versus no vaccination: case‐control studies in nursing homes, Outcome 1: Influenza‐like illness
8.1
8.1. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 1: Influenza
8.2
8.2. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 2: Influenza‐like illness
8.3
8.3. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 3: Pneumonia
8.4
8.4. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 4: Hospitalisation for flu or pneumonia
8.5
8.5. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 5: Hospitalisation for any respiratory disease
8.6
8.6. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 6: Deaths from flu or pneumonia
8.7
8.7. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 7: Deaths from respiratory disease
8.8
8.8. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 8: All deaths
8.9
8.9. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 9: Hospitalisation for heart disease
8.10
8.10. Analysis
Comparison 8: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 10: Combined outcome: all deaths or severe respiratory illness
9.1
9.1. Analysis
Comparison 9: Influenza vaccines versus no vaccination: cohort studies in community ‐ adjusted rates, Outcome 1: Hospitalisation for influenza or pneumonia
9.2
9.2. Analysis
Comparison 9: Influenza vaccines versus no vaccination: cohort studies in community ‐ adjusted rates, Outcome 2: Hospitalisation for any respiratory disease
9.3
9.3. Analysis
Comparison 9: Influenza vaccines versus no vaccination: cohort studies in community ‐ adjusted rates, Outcome 3: Hospitalisation for heart disease
9.4
9.4. Analysis
Comparison 9: Influenza vaccines versus no vaccination: cohort studies in community ‐ adjusted rates, Outcome 4: All deaths
9.5
9.5. Analysis
Comparison 9: Influenza vaccines versus no vaccination: cohort studies in community ‐ adjusted rates, Outcome 5: Combined outcome: all deaths or severe respiratory illness
10.1
10.1. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 1: Influenza
10.2
10.2. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 2: Pneumonia
10.3
10.3. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 3: Hospitalisation for influenza or pneumonia
10.4
10.4. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 4: Hospitalisation for any respiratory disease
10.5
10.5. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 5: Deaths from respiratory disease
10.6
10.6. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 6: All deaths
10.7
10.7. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 7: Hospitalisation for heart disease
10.8
10.8. Analysis
Comparison 10: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ risk groups, Outcome 8: Combined outcome: all deaths or severe respiratory illness
11.1
11.1. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 1: Influenza
11.2
11.2. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 2: Pneumonia
11.3
11.3. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 3: Hospitalisation for influenza or pneumonia
11.4
11.4. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 4: Hospitalisation for any respiratory disease
11.5
11.5. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 5: Deaths from respiratory disease
11.6
11.6. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 6: All deaths
11.7
11.7. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 7: Hospitalisation for heart disease
11.8
11.8. Analysis
Comparison 11: Influenza vaccines versus no vaccination: cohort studies in community‐dwellers ‐ no risk groups, Outcome 8: Combined outcome: all deaths or severe respiratory illness
12.1
12.1. Analysis
Comparison 12: Influenza and pneumococcal vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 1: Influenza‐like illness
12.2
12.2. Analysis
Comparison 12: Influenza and pneumococcal vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 2: Hospitalisation for influenza or pneumonia or respiratory disease
12.3
12.3. Analysis
Comparison 12: Influenza and pneumococcal vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 3: Deaths from influenza or pneumonia
12.4
12.4. Analysis
Comparison 12: Influenza and pneumococcal vaccines versus no vaccination: cohort studies in community‐dwellers, Outcome 4: All deaths
13.1
13.1. Analysis
Comparison 13: Influenza vaccines with adjuvant versus no vaccination: cohort studies in community‐dwellers, Outcome 1: Influenza‐like illness
13.2
13.2. Analysis
Comparison 13: Influenza vaccines with adjuvant versus no vaccination: cohort studies in community‐dwellers, Outcome 2: Hospitalisation for influenza or pneumonia or respiratory disease
13.3
13.3. Analysis
Comparison 13: Influenza vaccines with adjuvant versus no vaccination: cohort studies in community‐dwellers, Outcome 3: All deaths
14.1
14.1. Analysis
Comparison 14: Influenza vaccines versus no vaccination: case‐control studies in community, Outcome 1: Hospitalisations for influenza or pneumonia
14.2
14.2. Analysis
Comparison 14: Influenza vaccines versus no vaccination: case‐control studies in community, Outcome 2: Hospitalisations for any respiratory disease
14.3
14.3. Analysis
Comparison 14: Influenza vaccines versus no vaccination: case‐control studies in community, Outcome 3: Deaths from influenza or pneumonia
14.4
14.4. Analysis
Comparison 14: Influenza vaccines versus no vaccination: case‐control studies in community, Outcome 4: Pneumonia (no better defined)
15.1
15.1. Analysis
Comparison 15: Influenza vaccines versus no vaccination: case‐control studies in community ‐ adjusted rates, Outcome 1: Hospitalisations for influenza or pneumonia
15.2
15.2. Analysis
Comparison 15: Influenza vaccines versus no vaccination: case‐control studies in community ‐ adjusted rates, Outcome 2: Hospitalisations for any respiratory disease
15.3
15.3. Analysis
Comparison 15: Influenza vaccines versus no vaccination: case‐control studies in community ‐ adjusted rates, Outcome 3: Deaths from pneumonia or influenza
16.1
16.1. Analysis
Comparison 16: Influenza and pneumococcal vaccines versus no vaccination: case‐control studies in community, Outcome 1: Hospitalisations for influenza or pneumonia
17.1
17.1. Analysis
Comparison 17: Influenza and pneumococcal vaccines versus no vaccination: case‐control studies in community ‐ adjusted rates, Outcome 1: Hospitalisations for influenza or pneumonia
18.1
18.1. Analysis
Comparison 18: Sensitivity analysis: comparison 01: subgroup analysis by study quality, Outcome 1: Influenza‐like illness
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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    1. Hak E, Nordin J, Wei F, Mullooly J, Poblete S, Strikas R, et al. Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations. Clinical Infectious Diseases 2002;35(4):370-7. - PubMed
Hak 2002b {published data only}
    1. Hak E, Nordin J, Wei F, Mullooly J, Poblete S, Strikas R, et al. Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations. Clinical Infectious Diseases 2002;35(4):370-7. - PubMed
Hara 2006 {published data only}
    1. Hara M, Sakamoto T, Tanaka K. Effectiveness of influenza vaccination in preventing influenza-like illness among community-dwelling elderly: population-based cohort study in Japan. Vaccine 2006;24(27-8):5546-51. - PubMed
Horman 1986 {published data only}
    1. Horman JT, Stetler HC, Israel E, Sorley D, Schipper MT, Joseph JM. An outbreak of influenza A in a nursing home. American Journal of Public Health 1986;76(5):501-4. - PMC - PubMed
Howarth 1987a {published data only}
    1. Howarth DM, Chaston TM, Lickiss K, Weekes JR, O'Doherty C, Foster RE, et al. Age-related responses to influenza vaccination in the Newcastle region during 1983 and 1984. Medical Journal of Australia 1987;146(10):514-7. - PubMed
Howarth 1987b {published data only}
    1. Howarth DM, Chaston TM, Lickiss K, Weekes JR, O'Doherty C, Foster RE, et al. Age-related responses to influenza vaccination in the Newcastle region during 1983 and 1984. Medical Journal of Australia 1987;146(10):514-7. - PubMed
Howells 1975a {published data only}
    1. Howells CH, Vesselinova-Jenkins CK, Evans AD, James J. Influenza vaccination and mortality from bronchopneumonia in the elderly. Lancet 1975;1(7903):381-3. - PubMed
Howells 1975b {published data only}
    1. Howells CH, Vesselinova-Jenkins CK, Evans AD, James J. Influenza vaccination and mortality from bronchopneumonia in the elderly. Lancet 1975;1(7903):381-3. - PubMed
Howells 1975c {published data only}
    1. Howells CH, Vesselinova-Jenkins CK, Evans AD, James J. Influenza vaccination and mortality from bronchopneumonia in the elderly. Lancet 1975;1(7903):381-3. - PubMed
Isaacs 1997 {published data only}
    1. Isaacs S, Dickinson C, Brimmer G. Outbreak of influenza A in an Ontario nursing home - January 1997. Canada Communicable Disease Report 1997;23(14):105-8. - PubMed
Jordan 2007 {published data only}
    1. Jordan RE, Hawker JI, Ayres JG, Tunnicliffe W, Adab P, Olowokure B, et al. A case-control study of elderly patients with acute respiratory illness: effect of influenza vaccination on admission to hospital in winter 2003-2004. Vaccine 2007;25(46):7909-13. - PubMed
Kaplan 1982 {published data only}
    1. Kaplan JE, Katona P, Hurwitz ES, Schonberger LB. Guillain-Barre syndrome in the United States, 1979-1980 and 1980-1981. Lack of an association with influenza vaccination. JAMA 1982;248(6):698-700. - PubMed
Kawai 2003 {published data only}
    1. Kawai N, Ikematsu H, Iwaki N, Satoh I, Kawashima T, Tsuchimoto T, et al. A prospective, internet-based study of the effectiveness and safety of influenza vaccination in the 2001-2002 influenza season. Vaccine 2003;21(31):4507-13. - PubMed
Keitel 1996 {published data only}
    1. Keitel WA, Cate TR, Atmar RL, Turner CS, Nino D, Dukes CM, et al. Increasing doses of purified influenza virus hemagglutinin and subvirion vaccines enhance antibody responses in the elderly. Clinical and Diagnostic Laboratory Immunology 1996;3(5):507-10. - PMC - PubMed
Lasky 1998 {published data only}
    1. Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash D, et al. The Guillain-Barre syndrome and the 1992-1993 and 1993-1994 influenza vaccines. New England Journal of Medicine 1998;339(25):1797-802. - PubMed
Leung 2007 {published data only}
    1. Leung JCK. Effectiveness of influenza vaccination among elderly home residents in Hong Kong: a retrospective cohort study. Hong Kong Practitioner 2007;29(4):123-33.
Lopez Hernandez 1994 {published data only}
    1. Lopez Hernandez B, Vazquez J, Fernandez E, Martinez B, Romero J, Arribas L. Effectiveness of anti-flu vaccine in the elderly. Atencion Primaria 1994;14(1):532-6. - PubMed
Mangtani 2004a {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004b {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004c {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004d {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004e {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004f {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004g {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004h {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004i {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Mangtani 2004j {published data only}
    1. Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ. A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. Journal of Infectious Diseases 2004;190(1):1-10. - PubMed
Margolis 1990a {published data only}
    1. Margolis KL, Nichol KL, Poland GA, Pluhar RE. Frequency of adverse reactions to influenza vaccine in the elderly. A randomized, placebo-controlled trial. JAMA 1990;264(9):1139-41. - PubMed
Meiklejohn 1987 {published data only}
    1. Meiklejohn G, Hall H. Unusual outbreak of influenza A in a Wyoming nursing home. Journal of the American Geriatric Society 1987;35(8):742-6. - PubMed
Monto 2001 {published data only}
    1. Monto AS, Hornbuckle K, Ohmit SE. Influenza vaccine effectiveness among elderly nursing home residents: a cohort study. American Journal of Epidemiology 2001;154(2):155-60. - PubMed
Morens 1995 {published data only}
    1. Morens DM, Rash VM. Lessons from a nursing home outbreak of influenza A. Infection Control and Hospital Epidemiology 1995;16(5):275-80. - PubMed
Mukerjee 1994 {published data only}
    1. Mukerjee A. Spread of influenza: a study of risk factors in homes for the elderly in Wales. Journal of Epidemiology and Community Health 1994;48(6):602-3. - PMC - PubMed
Mullooly 1994 {published data only}
    1. Mullooly JP, Bennett MD, Hornbrook MC, Barker WH, Williams WW, Patriarca PA, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Annals of Internal Medicine 1994;121(12):947-52. - PubMed
Murayama 1999 {published data only}
    1. Murayama N, Suzuki H, Arakawa M, Nerome K, Mizuta K, Kameyama K. Two outbreaks of influenza A (H3N2) in a Japanese nursing home in the winter of 1996-1997, with differing vaccine efficacy. Tohoku Journal of Experimental Medicine 1999;188(4):289-98. - PubMed
Nichol 1994a {published data only}
    1. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. New England Journal of Medicine 1994;331(12):778-84. - PubMed
Nichol 1994b {published data only}
    1. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. New England Journal of Medicine 1994;331(12):778-84. - PubMed
Nichol 1994c {published data only}
    1. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. New England Journal of Medicine 1994;331(12):778-84. - PubMed
Nichol 1998a {published data only}
    1. Nichol KL, Wuorenma J, Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Archives of Internal Medicine 1998;158(16):1769-76. - PubMed
Nichol 1998b {published data only}
    1. Nichol KL, Wuorenma J, Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Archives of Internal Medicine 1998;158(16):1769-76. - PubMed
Nichol 2003a {published data only}
    1. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. New England Journal of Medicine 2003;348(14):1322-32. - PubMed
Nichol 2003b {published data only}
    1. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. New England Journal of Medicine 2003;348(14):1322-32. - PubMed
Nicholson 1999 {published data only}
    1. Nicholson KG, Kent J, Hammersley V. Influenza A among community-dwelling elderly persons in Leicestershire during winter 1993-4; cigarette smoking as a risk factor and the efficacy of influenza vaccination. Epidemiology and Infection 1999;123(1):103-8. - PMC - PubMed
Nordin 2001a {published data only}
    1. Nordin J, Mullooly J, Poblete S, Strikas R, Petrucci R, Wei F, et al. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. Journal of Infectious Diseases 2001;184(6):665-70. - PubMed
Nordin 2001b {published data only}
    1. Nordin J, Mullooly J, Poblete S, Strikas R, Petrucci R, Wei F, et al. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. Journal of Infectious Diseases 2001;184(6):665-70. - PubMed
Ohmit 1995a {published data only}
    1. Ohmit SE, Monto AS. Influenza vaccine effectiveness in preventing hospitalization among the elderly during influenza type A and type B seasons. International Journal of Epidemiology 1995;24(6):1240-8. - PubMed
Ohmit 1995b {published data only}
    1. Ohmit SE, Monto AS. Influenza vaccine effectiveness in preventing hospitalization among the elderly during influenza type A and type B seasons. International Journal of Epidemiology 1995;24(6):1240-8. - PubMed
Ohmit 1999 {published data only}
    1. Ohmit SE, Arden NH, Monto AS. Effectiveness of inactivated influenza vaccine among nursing home residents during an influenza type A (H3N2) epidemic. Journal of the American Geriatric Society 1999;47(2):165-71. - PubMed
Patriarca 1985a {published data only}
    1. Patriarca PA, Weber JA, Parker RA, Hall WN, Kendal AP, Bregman DJ, et al. Efficacy of influenza vaccine in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985;253(8):1136-9. - PubMed
Patriarca 1985b {published data only}
    1. Patriarca PA, Weber JA, Parker RA, Hall WN, Kendal AP, Bregman DJ, et al. Efficacy of influenza vaccine in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985;253(8):1136-9. - PubMed
Pregliasco 2002 {published data only}
    1. Pregliasco F, Giardini G, Sandrini MC, Perucchini E, Vergani C. Protective efficacy of Inflexal V in the elderly pazinte [Efficacia protettiva di Inflexal V nel pazinte anziano]. Vaccine at a Glance 2002;1(1):2-5.
Puig‐Barberà 1997 {published data only}
    1. Puig-Barbera J, Marquez-Calderon S, Masoliver-Fores A, Lloria-Paes F, Ortega-Dicha A, Gil-Martin M, et al. Reduction in hospital admissions for pneumonia in non-institutionalised elderly people as a result of influenza vaccination: a case-control study in Spain. Journal of Epidemiology and Community Health 1997;51(5):526-30. - PMC - PubMed
Puig‐Barberà 2004 {published data only}
    1. Puig-Barbera J, Diez-Domingo J, Perez Hoyos S, Belenguer Varea A, Gonzalez Vidal D. Effectiveness of the MF59-adjuvanted influenza vaccine in preventing emergency admissions for pneumonia in the elderly over 64 years of age. Vaccine 2004;23(3):283-9. - PubMed
Puig‐Barbera 2007 {published data only}
    1. Puig-Barberà J, Díez-Domingo J, Varea AB, Chavarri GS, Rodrigo JA, Hoyos SP et al. Effectiveness of MF59-adjuvanted subunit influenza vaccine in preventing hospitalisations for cardiovascular disease, cerebrovascular disease and pneumonia in the elderly. Vaccine 2007;25(42):7313-21. - PubMed
Ruben 1974 {published data only}
    1. Ruben FL, Johnston F, Streiff EJ. Influenza in a partially immunized aged population. Effectiveness of killed Hong Kong vaccine against infection with the England strain. JAMA 1974;230(6):863-6. - PubMed
Rudenko 2001 {published data only}
    1. Rudenko LG, Arden NH, Grigorieva E, Naychin A, Rekstin A, Klimov AI, et al. Immunogenicity and efficacy of Russian live attenuated and US inactivated influenza vaccines used alone and in combination in nursing home residents. Vaccine 2000;19(2-3):308-18. - PubMed
Saah 1986a {published data only}
    1. Saah AJ, Neufeld R, Rodstein M, La Montagne JR, Blackwelder WC, Gross P, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Archives of Internal Medicine 1986;146(12):2353-7. - PubMed
Saah 1986b {published data only}
    1. Saah AJ, Neufeld R, Rodstein M, La Montagne JR, Blackwelder WC, Gross P, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Archives of Internal Medicine 1986;146(12):2353-7. - PubMed
Saah 1986c {published data only}
    1. Saah AJ, Neufeld R, Rodstein M, La Montagne JR, Blackwelder WC, Gross P, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Archives of Internal Medicine 1986;146(12):2353-7. - PubMed
Saito 2002a {published data only}
    1. Saito R, Suzuki H, Oshitani H, Sakai T, Seki N, Tanabe N. The effectiveness of influenza vaccine against influenza A (H3N2) virus infections in nursing homes in Niigata, Japan, during the 1998-1999 and 1999-2000 seasons. Infection Control and Hospital Epidemiology 2002;23(2):82-6. - PubMed
Saito 2002b {published data only}
    1. Saito R, Suzuki H, Oshitani H, Sakai T, Seki N, Tanabe N. The effectiveness of influenza vaccine against influenza A (H3N2) virus infections in nursing homes in Niigata, Japan, during the 1998-1999 and 1999-2000 seasons. Infection Control and Hospital Epidemiology 2002;23(2):82-6. - PubMed
Schonberger 1979 {published data only}
    1. Schonberger LB, Bregman DJ, Sullivan-Bolyai JZ, Keenlyside RA, Ziegler DW, Retailliau HF, et al. Guillain-Barre syndrome following vaccination in the National Influenza Immunization Program, United States, 1976-1977. American Journal of Epidemiology 1979;110(2):105-23. - PubMed
Shapiro 2003 {published data only}
    1. Shapiro Y, Shemer J, Heymann A, Shalev V, Maharshak N, Chodik G, et al. Influenza vaccination: reduction in hospitalizations and death rates among members of "Maccabi Healthcare Services" during the 2000-2001 influenza season. Israel Medical Association Journal 2003;5(10):706-8. - PubMed
Strassburg 1986 {published data only}
    1. Strassburg MA, Greenland S, Sorvillo FJ, Lieb LE, Habel LA. Influenza in the elderly: report of an outbreak and a review of vaccine effectiveness reports. Vaccine 1986;4(1):38-44. - PubMed
Stuart 1969 {published data only}
    1. Stuart WH, Dull HB, Newton LH, McQueen JL, Schiff ER. Evaluation of monovalent influenza vaccine in a retirement community during the epidemic of 1965-66. JAMA 1969;209(2):232-8. - PubMed
Taylor 1992 {published data only}
    1. Taylor JL, Dwyer DM, Coffman T, Groves C, Patel J, Israel E. Nursing home outbreak of influenza A (H3N2): evaluation of vaccine efficacy and influenza case definitions. Infection Control and Hospital Epidemiology 1992;13(2):93-7. - PubMed
Treanor 1994 {published data only}
    1. Treanor J, Dumyati G, O'Brien D, Riley MA, Riley G, Erb S, et al. Evaluation of cold-adapted, reassortant influenza B virus vaccines in elderly and chronically ill adults. Journal of Infectious Diseases 1994;169(2):402-7. - PubMed
Voordouw 2003 {published data only}
    1. Voordouw BC, Linden PD, Simonian S, Lei J, Sturkenboom MC, Stricker BH. Influenza vaccination in community-dwelling elderly: impact on mortality and influenza-associated morbidity. Archives of Internal Medicine 2003;163(9):1089-94. - PubMed

References to studies excluded from this review

Allsup 2001 {published data only}
    1. Allsup SJ, Gosney M, Regan M, Haycox A, Fear S, Johnstone FC. Side effects of influenza vaccination in healthy older people: a randomised single-blind placebo-controlled trial. Gerontology 2001;47(6):311-4. - PubMed
Allsup 2003 {published data only}
    1. Allsup S, Gosney M, Haycox A, Regan M. Cost-benefit evaluation of routine influenza immunisation in people 65-74 years of age. Health Technology Assessment 2003;7(24):iii-x, 1-65. - PubMed
Anonymous 1995 {published data only}
    1. Influenza vaccination in the elderly: a bona fide clinical trial. Hospital Practice 1995;30(2):100.
Anonymous 2004b {published data only}
    1. Vaccination protects against influenza deaths in elderly. Pharmaceutical Journal 2004;273(7318):410.
Ansaldi 2002 {published data only}
    1. Ansaldi F, Tominz R, D'Agaro P, Michieletto F, Quadranti M, Cornelio G, et al. Influenza vaccination among the elderly in Trieste: comparison of a cross-sectional study and routine public health surveillance [Vaccinazione anti-influenzale negli anziani a Trieste: confronto fra uno studio trasversale ed il sistema di sorveglianza passivo]. Annali di Igiene: Medicina Preventiva e di Comunità 2002;14(4):305-11. - PubMed
Arden 1986 {published data only}
    1. Arden NH, Patriarca PA, Kendal P. Experiences in the use and efficacy of inactivated influenza vaccine in nursing homes. In: Kendal AP, Patriarca PA, editors(s). Options for the Control of Influenza. New York: Alan R. Liss, 1986:155-68.
Armstrong 2004 {published data only}
    1. Armstrong BG, Mangtani P, Fletcher A, Kovats S, McMichael A, Pattenden S, et al. Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people. BMJ 2004;329(7467):660. - PMC - PubMed
Arroyo 1988 {published data only}
    1. Arroyo JC, Jordan W, Milligan L. Upper respiratory tract infection and serum antibody responses in nursing home patients. American Journal of Infection Control 1988;16(4):152-8. - PMC - PubMed
Arya 2003 {published data only}
    1. Arya SC. Influenza and other vaccine uptake in the elderly in England. Vaccine 2003;21(25-6):3527. - PubMed
Ayala‐Montiel 2004 {published data only}
    1. Ayala-Montiel O, Mascarenas de los Santos C, Garcia-Hernandez D, Rendon-Muniz J, Garcia-Olvera L. Reactogenicity of the simultaneous administration of influenza and pneumococcal vaccines in adults over 55 years of age. Revista de Investigacion Clinica 2004;56(1):27-31. - PubMed
Baldo 1999 {published data only}
    1. Baldo V, Menegon T, Buoro S, Scalici C, Vesco A, Perale S, et al. Vaccination against influenza in the elderly. Experience with adjuvant vaccines. Annali di Igiene: Medicina Preventiva e di Comunità 1999;11(5):369-74. - PubMed
Barker 1980 {published data only}
    1. Barker WH, Mullooly JP. Influenza vaccination of elderly persons. Reduction in pneumonia and influenza hospitalizations and deaths. JAMA 1980;244(22):2547-9. - PubMed
Bektimirov 1993 {published data only}
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Belshe 2004 {published data only}
    1. Belshe RB, Nichol KL, Black SB, Shinefield H, Cordova J, Walker R, et al. Safety, efficacy, and effectiveness of live, attenuated, cold-adapted influenza vaccine in an indicated population aged 5-49 years. Clinical Infectious Diseases 2004;39(7):920-7. - PubMed
Ben‐Yehuda 2003 {published data only}
    1. Ben-Yehuda A, Joseph A, Barenholz Y, Zeira E, Even-Chen S, Louria-Hayon I, et al. Immunogenicity and safety of a novel IL-2-supplemented liposomal influenza vaccine (INFLUSOME-VAC) in nursing-home residents. Vaccine 2003;21(23):3169-78. - PubMed
Berg 2004 {published data only}
    1. Berg GD, Thomas E, Silverstein S, Neel CL, Mireles M. Reducing medical service utilization by encouraging vaccines: randomized controlled trial. American Journal of Preventive Medicine 2004;27(4):284-8. - PubMed
Buxton 2001 {published data only}
    1. Buxton JA, Skowronski DM, Ng H, Marion SA, Li Y, King A, et al. Influenza revaccination of elderly travelers: antibody response to single influenza vaccination and revaccination at 12 weeks. Journal of Infectious Diseases 2001;184(2):188-91. - PubMed
Carman 2000 {published data only}
    1. Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355(9198):93-7. - PubMed
Castilla 2006 {published data only}
    1. Castilla J, Arregui L, Baleztena J, Barricarte A, Brugos A, Carpintero M, et al. Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season. Anales del Sistema Sanitario de Navarra 2006;29(1):97-106. - PubMed
Chen 2004 {published data only}
    1. Chen YH, Liou SH, Chou CC, Su WL, Loh CH, Lin SH. Influenza and pneumococcal vaccination of the elderly in Taiwan. Vaccine 2004;22(21-2):2806-11. - PubMed
Chlibek 2002 {published data only}
    1. Chlibek R, Beran J, Splino M. Effectiveness of influenza vaccination in healthy adults - a fourfold decrease in influenza morbidity during one influenza season. Epidemiologie, Mikrobiologie, Imunologie 2002;51(2):47-51. - PubMed
Christenson 2002 {published data only}
    1. Christenson B, Lundbergh P. Comparison between cohorts vaccinated and unvaccinated against influenza and pneumococcal infection. Epidemiology and Infection 2002;129(3):515-24. - PMC - PubMed
Chumakov 1992 {published data only}
    1. Chumakov MP, Beregovskii NA, Linev MB, Reizin FN, Malyshkina LP, Matrosovich MN, et al. Use of highly purified subvirion trivalent flu vaccine ("Grippovak") in groups with a high risk of complications. Zhurnal Mikrobiologii, Epidemiologii, i Immunobiologii 1992;3:55-7. - PubMed
Cohen 2004 {published data only}
    1. Cohen J. Vaccine policy. Immunizing kids against flu may prevent deaths among the elderly. Science 2004;306(5699):1123. - PubMed
Conne 1997 {published data only}
    1. Conne P, Gauthey L, Vernet P, Althaus B, Que JU, Finkel B, et al. Immunogenicity of trivalent subunit versus virosome-formulated influenza vaccines in geriatric patients. Vaccine 1997;15(15):1675-9. - PubMed
Cruijff 1999 {published data only}
    1. Cruijff M, Thijs C, Govaert T, Aretz K, Dinant GJ, Knottnerus A. The effect of smoking on influenza, influenza vaccination efficacy and on the antibody response to influenza vaccination. Vaccine 1999;17(5):426-32. - PMC - PubMed
D'Alessandro 2004 {published data only}
    1. D'Alessandro D, Ciriminna S, Rossini A, Bossa MC, Fara GM. Requests of medical examinations after pneumococcal & influenza vaccination in the elderly. Indian Journal of Medical Research 2004;119(Suppl):108-14. - PubMed
de Bernardi 2002 {published data only}
    1. Bernardi di Valserra M, Zanasi A, Ragusa S, Gluck R, Herzog C. An open-label comparison of the immunogenicity and tolerability of intranasal and intramuscular formulations of virosomal influenza vaccine in healthy adults. Clinical Therapeutics 2002;24(1):100-11. - PubMed
de Bruijn 2004 {published data only}
    1. Bruijn IA, Nauta J, Gerez L, Palache AM. Virosomal influenza vaccine: a safe and effective influenza vaccine with high efficacy in elderly and subjects with low pre-vaccination antibody titers. Virus Research 2004;103(1-2):139-45. - PubMed
Deguchi 2000a {published data only}
    1. Deguchi Y, Takasugi Y. Efficacy of influenza vaccine in the elderly: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic for the elderly in nursing homes. International Journal of Clinical & Laboratory Research 2000;30(1):1-4. - PubMed
Deguchi 2000b {published data only}
    1. Deguchi Y, Takasugi Y, Tatara K. Efficacy of influenza vaccine in the elderly in welfare nursing homes: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic. Journal of Medical Microbiology 2000;49(6):553-6. - PubMed
Deguchi 2000c {published data only}
    1. Deguchi Y, Takasugi Y, Nishimura K. Vaccine effectiveness for influenza in the elderly in welfare nursing homes during an influenza A (H3N2) epidemic. Epidemiology and Infection 2000;125(2):393-7. - PMC - PubMed
Deibel 1970 {published data only}
    1. Deibel R, Decher W, Jacobs J. Observations during Hong Kong influenza epidemic. New York State Journal of Medicine 1970;70(22):2799-805. - PubMed
De Serres 2004 {published data only}
    1. De Serres G, Skowronski DM, Guay M, Rochette L, Jacobsen K, Fuller T, et al. Recurrence risk of oculorespiratory syndrome after influenza vaccination: randomized controlled trial of previously affected persons. Archives of Internal Medicine 2004;164(20):2266-72. - PubMed
Elder 1996 {published data only}
    1. Elder AG, O'Donnell B, McCruden EA, Symington IS, Carman WF. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313(7067):1241-2. - PMC - PubMed
Ender 2001 {published data only}
    1. Ender PT, DeRussy PK, Caldwell MM, Taylor SE, Trevino SC, Ybarra D. The effect of a multivitamin on the immunologic response to the influenza vaccine in the elderly. In: Infectious Diseases in Clinical Practice. Vol. 10. Lippincott Williams & Wilkins, Inc., 2001:81-5.
Erofeeva 2001 {published data only}
    1. Erofeeva MK, Paramonova MS, Maksakova VL, Kolyvanova IL, Nikolaeva EV, Shadrin AS. Vaccine prophylaxis in elderly patients. Zhurnal Mikrobiologii, Epidemiologii, i Immunobiologii 2001;3:91-3. - PubMed
Fedson 1992 {published data only}
    1. Fedson DS, Wajda A, Nicol JP, Roos LL. Disparity between influenza vaccination rates and risks for influenza-associated hospital discharge and death in Manitoba in 1982-1983. Annals of Internal Medicine 1992;116(7):550-5. - PubMed
Fedson 1993 {published data only}
    1. Fedson DS, Waida A, Nicol JP, Roos LL. "The old man's friend". Lancet 1993;342(8870):561. - PubMed
Fitzner 2001 {published data only}
    1. Fitzner KA, Shortridge KF, McGhee SM, Hedley AJ. Cost-effectiveness study on influenza prevention in Hong Kong. Health Policy 2001;56(3):215-34. - PubMed
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Galasso 1977 {published data only}
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Garcia‐Doval 2001 {published data only}
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Garcia‐Garcia 2009 {published data only}
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Heymann 2004 {published data only}
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Jackson 1999 {published data only}
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Jackson 2002 {published data only}
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Jani 1994 {published data only}
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Modlin 1977 {published data only}
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Nichol 1999b {published data only}
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Nichol 1999d {published data only}
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Voordouw 2004 {published data only}
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References to other published versions of this review

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