Hospital Pharmacy - April 2012 - (Page 258)

Hosp Pharm 2012;47(4):258 2012 Ó Thomas Land Publishers, Inc. www.thomasland.com doi: 10.1310/hpj4704-258 Editorial Influenza Vaccine Effectiveness – We Can Do Better Dennis J. Cada, PharmD, FASHP, FASCPp he perception that vaccines are currently good enough is a barrier to development of vaccines that are much better. Are current vaccines only just good enough? A recent, rigorous analysis1 has raised questions regarding the evidence for effectiveness of the present generation of inﬂuenza vaccines in the elderly and those at risk for medical complications. Applying strict criteria to attempt to eliminate bias, the authors screened 5,707 studies published from January 1, 1967 to February 15, 2011 that used RT-PCR (reverse transcriptase-polymerase chain reaction) or culture for conﬁrmation of inﬂuenza. Authors searched MEDLINE for randomized controlled trials (RCTs) evaluating a reduction in inﬂuenza risk of all circulating inﬂuenza viruses during ﬂu seasons after vaccination (efﬁcacy) as well as observational studies meeting strict inclusion criteria (effectiveness). A US research team identiﬁed only 31 eligible studies they felt provided reliable evidence regarding efﬁcacy and effectiveness of ﬂu vaccines. Seventeen RCTs and 14 observational studies were identiﬁed. They estimated pooled efﬁcacy for trivalent inactivated vaccine (TIV) and live attenuated inﬂuenza vaccine (LAIV) when these data were available for statistical analysis. The team found efﬁcacy of TIV was demonstrated in 8 of the 12 (67%) seasons analyzed in 10 RCTs with a pooled efﬁcacy of 59% in adults aged 18 to 65 years. No trials met the inclusion criteria for children aged 2 to 17 years or adults 65 years or older. Efﬁcacy of LAIV was demonstrated in 9 (75%) of 12 seasons analyzed in 10 RCTs in children aged 6 months to 7 years. No trials met inclusion criteria for children aged 8 to 17 years. Vaccine effectiveness was variable for seasonal inﬂuenza with 6 of 17 analyses in 9 studies showing signiﬁcant protection against inﬂuenza in the outpatient or inpatient settings. This meta-analysis differs from others published in that eligible studies of both vaccines were restricted to T those that used virus detection as primary endpoints. Second, it excluded RTCs in which the comparison group did not receive either placebo or a vaccine other than for inﬂuenza. In summary, what does this mean? It means that ﬂu vaccines work, but not as well as is needed. Osterholm and colleagues1 conclude that ‘‘based on a track record of substantial safety and moderate efﬁcacy in many seasons, we believe the current inﬂuenza vaccines will continue to have a role in reduction of inﬂuenza morbidity until more effective interventions are available. However, evidence for consistent high-level protection is elusive for the present generation of vaccines, especially in individuals at risk of medical complications or those aged 65 years or older.’’(p42) The authors also call for a new generation of more effective and cross-protective vaccines that can be manufactured rapidly. We must keep in mind that current vaccines provide a moderate level of protection and the evidence still supports their use but that a partnership between industry and government may be required to guarantee the prospects for much better ﬂu vaccines. Pandemic inﬂuenza would seriously threaten the global economy. There is optimism in the scientiﬁc community that better vaccines are within reach if we have the will to develop them.2 By targeting sections of the virus that rarely mutate, it may be possible to develop a single inﬂuenza vaccination with only follow-up boosters necessary. REFERENCES 1. Osterholm M, Kelly N, Sommer A, Belongia E. Efﬁcacy and effectiveness of inﬂuenza vaccines: a systematic review and meta-analysis. Lancet Inf Dis. 2012;1:36-44. 2. University of Adelaide. Universal ﬂu vaccine study yields success in mice. ScienceDaily. Published February 18, 2011. http://www.sciencedaily.com/releases/2011/02/110218092541. htm. Accessed January 30, 2012. g *Executive Editor, The Formulary, and Editor, Off-Label Drug Facts, e-mail: Dennis.Cada@wolterskluwer.com 258 Volume 47, April 2012 http://www.thomasland.com http://www.sciencedaily.com/releases/2011/02/110218092541.htm http://www.sciencedaily.com/releases/2011/02/110218092541.htm

Table of Contents for the Digital Edition of Hospital Pharmacy - April 2012

Hospital Pharmacy - April 2012
Editorial
ISMP Medication Error Report Analysis
ISMP Adverse Drug Reactions
Cancer Chemotherapy Update
Off-Label Drug Uses
Original Article
Symptomatic Bradycardia, Syncope, and Prolonged Qtc Interval Associated With Dronedarone Therapy
Extended Stability of Magnesium Sulfate Infusions Prepared in Polyolefin Bags
Formulary Drug Reviews
Continuing Education Case Study Quiz (0.15 CEU)
Current FDA-Related Drug Information
Pharmacy Automation and Technology
Director’s Forum
Hospital Pharmacy Pulse
Index to Advertisers

Hospital Pharmacy - April 2012