A busy PCP asks: “What is the current evidence-based literature saying about vaccines for preventing influenza in healthy children?” Christina (Tina) Winstead, Linda Whiteford, Monica Winters (Picture from )

Reference Interview with Dr. X -What outcomes are you looking for exactly? -I'm looking for a couple of good evidence-based articles or something similar that I can use with parents in my practice when they ask me about whether they should get their kids a flu shot every fall. -Can you describe your patients? -They are typically healthy 'well child' kids" with some parents that are "vaccine-aversive, mostly because of what they read on the internet! -What are the demographics (ethnicity, age, etc.) of your patients? -There's a range of demographics – all ethnicities and kids of all ages. -Are you interested in finding alternatives to the vaccines? -No.

MEDLINE-BASED SEARCH STRATEGIES PubMed Central - MeSH search builder Ovid MEDLINE - Multi-Field Search EBSCO - Advanced Search default Search terms: influenza vaccines, child, evidence-based Filters: publication year, abstract available, meta-analysis Other: choosing the “Related Citations” link under an ideal article in PubMed helped give us other ideas for MeSH terms to add

MEDLINE-BASED RESULTS All database searches retrieved a large list of results (hundreds) Filtered by “publication date” and “abstract available” - still retrieved a large list of results Filtered by “meta-analysis” - reasonable number Preventing influenza in younger children. Detail Only Available By: Esposito, S.; Tagliabue, C.; Tagliaferri, L.; Semino, M.; Longo, M. R.; Principi, N. Clinical Microbiology & Infection. Oct2012 Supplement, Vol. 18, p p. DOI: /j x. Preventing influenza in younger children. Vaccines for preventing influenza in healthy children. Vaccines for preventing influenza in healthy children. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E. Cochrane Database Syst Rev Aug 15;8:CD Review. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Lancet Infect Dis Jan;12(1): doi: /S (11)70295-X. Epub 2011 Oct 25. Review. Erratum in: Lancet Infect Dis Sep;12(9):655.

Non-MEDLINE Evidence-Based Database Research Strategies National Guideline Clearinghouse Using “Advanced Search,” we put in the keyword “Influenza Vaccine” and checked the boxes for “Adolescent,” “Child” and “Infant” under “Age of Target Population,” and “Effectiveness” under “Institute of Medicine Domain.” TRIP database Using Advanced search, under "This exact phrase" we put "Healthy child" and "Influenza vaccine.” Also we put in the "Start year" as "2011" and the "End year" as "2012." PubMed Health Only basic search available. We entered the search terms “influenza” “vaccinations” and “children.”

Non-MEDLINE Evidence-Based Database Results Received a smaller number of results (20-30 articles) with these evidence-based sources Refining results by “Clinical Guides” or “Full Text” seemed to produce many false postivies The “Dare Reviews” filter in PubMed Health seemed to narrow down the results, but most were at least 5 years old -Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) -- United States, influenza season Apr (revised 2012 Aug 17). NGC: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) -- United States, influenza season. -Moore, D.L. (2012). Influenza vaccine recommendations for children and youth for the 2012/2013 season. Paediatric Child Health, 17(8), Esposito, S., et al. (2012). Preventing influenza in younger children. Clinical Microbiology and Infection, 18(s5), Manzoli L, De Vito C, Salanti G, D'Addario M, Villari P, Ioannidis JP. Meta-analysis of the immunogenicity and tolerability of pandemic influenza A 2009 (H1N1) vaccines. PLoS ONE 2011; 6(9):e [PubMed]PubMed -Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E. Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD DOI: / CD pub4. Link to Cochrane Library. [PubMed] Link to Cochrane LibraryPubMed