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Comment: safety and efficacy of influenza vaccine in children

Senior Lecturer Department of General Practice, Room Ff305 Erasmus MC—University Medical Center Rotterdam PO Box 1738 3000 DR Rotterdam, the Netherlands fax 31 10 463 2127 j.vanderwouden{at}erasmusmc.nl

Herman J Bueving, MD

Director of Vocational Training Department of General Practice Erasmus MC—University Medical Center Rotterdam

Published Online, June 8, 2004. www.theannals.com, DOI 10.1345/aph.1D009a

In an early study, published in 1977, McIntosh et al.² found that systemic reactions were elevated in asthmatic children receiving the first dose of whole-virus vaccines compared with vaccinees without asthma. In adults with asthma 18–75 years of age, Nicholson et al.³ found an elevated risk of asthma exacerbations (defined as a fall in peak expiratory flow of >20%) in vaccine recipients compared with controls. Kramarz et al.⁴ did not find any proof of influenza vaccination resulting in acute asthma exacerbations in children. Perhaps the most important omission is the Cochrane Review carried out by Cates et al.⁵ The authors of this thorough systematic review concluded that there is not enough evidence to assess the benefits and risks of influenza vaccination for people with asthma. In summary, we question the validity of this review.

Footnotes

Comments on articles previously published are submitted to the authors of those articles. When no reply is published, either the author chose not to respond or did not do so in a timely fashion. Comments and replies are not peer reviewed.–ED.

References

1. Goldstein LGB. Safety and efficacy of influenza vaccine in children. Ann Pharmacother 2003;37: 1712-5. DOI 10.1345/aph.1D009[Abstract/Free Full Text]
2. McIntosh K, Foy H, Modlin JF, Boyer KM, Hilman BC, Gross PA. Multicenter two-dose trials of bivalent influenza A vaccines in asthmatic children aged six to 18 years. J Infect Dis 1977;136(suppl):S645 -7.
3. Nicholson KG, Nguyen-Van-Tam JS, Ahmed AH, Wiselka MJ, Leese J, Ayres J, et al. Randomised placebo-controlled crossover trial on effect of inactivated influenza vaccine on pulmonary function in asthma.Lancet 1998;351:326-31.[CrossRef][Medline]
4. Kramarz P, DeStefano F, Gargiullo PM, Davis RL, Chen RT, Mullooly JP, et al. Does influenza vaccination exacerbate asthma? Analysis of a large cohort of children with asthma. Vaccine Safety Datalink Team. Arch Fam Med 2000;9:617-23.[Abstract/Free Full Text]
5. Cates CJ, Jefferson TO, Bara AI, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev 2004;2:CD000364.

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