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Future Directions for Research and Recommendations Related to Influenza Vaccine The relatively low effectiveness of influenza vaccine administered to older adults highlights the need for more immunogenic influenza vaccines for the elderly (345) and for additional research to understand potential biases in estimating the benefits of vaccination among older adults in reducing hospitalizations and deaths (90,346,347). Additional studies of the relative cost-effectiveness and cost utility of influenza vaccination among children and adults, especially those aged <65 years, are needed and should be designed to account for year-to-year variations in influenza attack rates, illness severity, hospitalization costs and rates, and vaccine effectiveness when evaluating the long-term costs and benefits of annual vaccination (348). Additional data also are needed to quantify the benefits of influenza vaccination of HCP in protecting their patients (259) and on the benefits of vaccinating children to reduce influenza complications among those at risk. Because of expansions in ACIP recommendations for vaccination and the potential for a pandemic, much larger networks are needed that can identify and assess the causality of very rare events that occur after vaccination, including GBS. Research on potential biologic or genomic risk factors for GBS also is needed. However, research to develop more immunogenic vaccines and document vaccine safety must be accompanied by a better understanding of how to motivate persons at risk to seek annual influenza vaccination. ACIP continues to review new vaccination strategies to protect against influenza, including the possibility of expanding routine influenza vaccination recommendations toward universal vaccination or other approaches that will help reduce or prevent the transmission of influenza and reduce the burden of severe disease (349-354). For example, expanding annual vaccination recommendations to include older children requires additional information on the potential communitywide protective effects and cost, additional planning to improve surveillance systems capable of monitoring effectiveness and safety, and further development of implementation strategies. In addition, as noted by the National Vaccine Advisory Committee, strengthening the U.S. influenza vaccination system will require improving vaccine financing and demand and implementing systems to help better understand the burden of influenza in the United States (355). Immunization programs capable of delivering annual influenza vaccination to a broad range of the population could potentially serve as a resilient and sustainable platform for delivering vaccines and monitoring outcomes for other urgently required public health interventions (e.g., vaccines for pandemic influenza or medications to prevent or treat illnesses caused by acts of terrorism). |