title: The efficacy of influenza vaccine for healthy children: a meta-analysis evaluating potential sources of variation in efficacy estimates including study quality.
abstract: BACKGROUND
  Two systematic reviews evaluating influenza vaccine efficacy in healthy children have recently been published. Although quantitative summary estimates were similar, authors' conclusions were quite contrasting. We carried out another meta-analysis reevaluating study inclusion criteria and using metaregression techniques in addition to sensitivity and subgroups analyses to evaluate potential sources of heterogeneity of efficacy estimates, including methodologic quality of studies.
  
  
  METHODS
  Only randomized clinical studies assessing the efficacy of influenza vaccine in healthy children/adolescents (age < or =18 years) for preventing naturally occurring influenza and/or acute otitis media cases were included. Summary estimates of effect were obtained using a random effects model. The methodologic quality of each study was assessed using 3 systems: Chalmers scale, Jadad scale and Schulz components (randomization, allocation concealment and double-blinding).
  
  
  RESULTS
  The overall vaccination efficacy was 36% (95% confidence interval: 31-40%) against clinically diagnosed illnesses (evaluated by 19 randomized clinical studies for a total of 247,517 children); 67% (51-78%) against laboratory-confirmed cases (18 trials, n = 8574); and 51% (21-70%) against acute otitis media (11 trials, n = 11,349). Significant sources of between-study heterogeneity were participants' age and study quality both directly correlated with the efficacy. When the analysis was performed excluding USSR studies, the overall efficacy of the vaccine in preventing clinical cases substantially increased (from 36% to 61%).
  
  
  CONCLUSIONS
  These findings may indicate that the vaccine efficacy might be greater than the overall estimates. Although no safety and cost considerations are addressed in this analysis, the present findings support vaccination as a possible option for the prevention of influenza in healthy children and adolescents.
authors.affiliation: Section of Epidemiology and Public Health, Department of Medicine and Aging Sciences, University G. d'Annunzio, Chieti, Italy. lmanzoli@post.harvard.edu
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Schioppa
authors.forename: Antonio
authors.initials: A
authors.lastname: Boccia
authors.forename: Paolo
authors.initials: P
authors.lastname: Villari
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007252:Influenza Vaccines / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D010033:Otitis Media / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012107:Research Design
chemical_list: D007252:Influenza Vaccines