Vaccines for preventing influenza in healthy children

Updated
Authors: 
Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V

Review aim

The aim of this Cochrane Review, first published in 2007, was to summarise research on immunising healthy children up to the age of 16 with influenza vaccines during influenza seasons. We used randomised trials comparing either one of two types of vaccines with dummy vaccines or nothing. One type of vaccine is based on live but weakened influenza viruses (live attenuated influenza vaccines) and is given via the nose. The other is prepared by killing the influenza viruses with a chemical (inactivated virus) and is given by injection through the skin. We analysed the number of children with confirmed influenza and those who had influenza-like illness (ILI) (headache, high temperature, cough, and muscle pain) and harms from vaccination. Future updates of this review will be made only when new trials or vaccines become available. Data from 33 observational studies included in previous versions of the review have been retained for historical reasons but have not been updated due to their lack of influence on the review conclusions.

Key messages

Live attenuated and inactivated vaccines can reduce the proportion of children who have influenza and ILI. Variation in the results of studies means that we are uncertain about the effects of these vaccines across different seasons.

What was studied in this review?

Over 200 viruses cause ILI and produce the same symptoms (fever, headache, aches, pains, cough, and runny nose) as influenza. Doctors cannot distinguish between them without laboratory tests because both last for days and rarely cause serious illness or death.

The types of virus contained in the vaccines are usually those that are expected to circulate in the following influenza seasons, according to recommendations of the World Health Organization (seasonal vaccine). Pandemic vaccine contains only the virus strain that is responsible for the pandemic (e.g. the type A H1N1 for the 2009 to 2010 pandemic).

Main results

We found 41 randomised studies. Most studies included children older than two years of age and were conducted in the USA, Western Europe, Russia, and Bangladesh.

Compared with placebo or do nothing, live attenuated vaccines probably reduced the proportion of children who had confirmed influenza from 18% to 4% (moderate-certainty evidence), and may reduce ILI from 17% to 12% (low-certainty evidence). Seven children would need to be vaccinated for one child to avoid influenza, and 20 children would need to prevent one child from experiencing an ILI. We found data from one study that showed similar risk of ear infection in the two groups. There was insufficient information available to assess school absence and parents needing to take time off work. We found no data on hospitalisation, and harms were not consistently reported.

Compared with placebo or no vaccination, inactivated vaccines reduce the risk of influenza from 30% to 11% (high-certainty evidence), and they probably reduce ILI from 28% to 20% (moderate-certainty evidence). Five children would need to be vaccinated for one child to avoid influenza, and 12 children would need to be vaccinated to prevent one case of ILI. The risk of otitis media is probably similar between vaccinated children and unvaccinated children (31% versus 27%, moderate-certainty evidence). There was insufficient information available to assess school absenteeism due to very low-certainty evidence from one study. We identified no data on parental working time lost, hospitalisation, fever, or nausea.

One brand of monovalent pandemic vaccine was associated with a sudden loss of muscle tone triggered by the experience of an intense emotion (cataplexy) and a sleep disorder (narcolepsy) in children.

Only a few studies were well designed and conducted, and the impact of studies at high risk of bias varied across the outcomes evaluated. Influenza and otitis media were the only outcomes where our confidence in the results was not affected by bias.

How up to date is this review?

The evidence is current to 31 December 2016.

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