Inactivated influenza vaccines: Methods, policies, and politics

Abstract

The critical evaluation of existing policies is necessary, but fraught with difficulties. Perhaps the best example of this statement are policies identifying influenza as a worthwhile target for prevention using trivalent inactivated vaccines (TIVs). At a first glance, influenza vaccines are a global intervention and extensive vaccination policies are in place in many countries [ [1] WHO. Who position paper : influenza vaccines http://www.who.int/wer/2005/wer8033.pdf Accessed January 22, 2008). Google Scholar ]. Most policy-makers do not dispute the burden of influenza disease and its complications, nor the effectiveness of TIV in dealing with such a burden. However, a suite of Cochrane reviews of the effects of TIV and detailed methodological work [ 2 Simonsen L. Taylor R.J. Viboud C. Miller M.A. Jackson L.A. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis. 2007; 7: 658-666 Abstract Full Text Full Text PDF PubMed Scopus (436) Google Scholar , 3 Simonsen L. Reichert T.A. Viboud C. Blackwelder W.C. Taylor R.J. Miller M.A. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med. 2005; 165: 265-272 Crossref PubMed Scopus (439) Google Scholar , 4 Jackson L.A. Jackson M.L. Nelson J.C. Neuzil K.M. Weiss N.S. Evidence of bias in estimates of influenza vaccine effectiveness in seniors. Int J Epidemiol. 2006; 35: 337-344 Crossref PubMed Scopus (357) Google Scholar , 5 Jackson L.A. Nelson J.C. Benson P. Neuzil K.M. Reid R.J. Psaty B.M. et al. Functional status is a confounder of the association of influenza vaccine and risk of all cause mortality in seniors. Int J Epidemiol. 2006; 35: 345-352 Crossref PubMed Scopus (215) Google Scholar ] have cast doubt on the scientific basis of the current consensus.