44 per 1000 (95% CI 1 17–1 75) in children under 6 years in Leice

44 per 1000 (95% CI 1.17–1.75) in children under 6 years in Leicester in 2001–2002,30 and 1.57 per 1000 in children under 5 years in East London in 2002–2004.31 Like us, the authors of the meta-analysis found that the highest rate of severe influenza in children in developed countries was in infants under 6 months of age, 340 per 100,00 (95%

CI 230–500) (personal communication Dr. H. Nair) which is very similar to our estimate of 330 (95% CI 318–342). Our analyses indicate that additional strategies are needed to reduce the remaining morbidity and mortality in the high-risk and elderly populations, and to protect healthy children who are currently not offered the benefits of vaccination. Children play a key role in transmission of influenza and their vaccination is likely to bring additional herd immunity benefits.4

Vaccine coverage among pregnant women needs to improve click here both for their own protection and that of their infants during the first 6 months of life when influenza morbidity is highest. Annual age-stratified serological studies are needed to help understand the transmission dynamics of seasonal influenza and BIBF 1120 cost to document the impact on transmission of the annual vaccination of children aged 2–16 years which is now recommended in the United Kingdom to complement the age and risk-based policy in place since 2000.3 The same features in influenza burden may be present in other developed countries with a similar age and risk-based influenza vaccination Quisqualic acid programme; hence there may be value in considering similar policies in such settings. DC and

AJVH were funded by the Research and Development Directorate of the United Kingdom Department of Health, grant reference number 039/031. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. DC, EM, WJE and MJ conceived and designed the study; DF extracted and analysed data on consultations in general practice and proportion of patient in clinical risk groups; AJVH analysed Hospital Episode Statistics data; DC carried out the statistical modelling; DC, EM, AJVH and MJ wrote the manuscript with input from DF and WJE. All authors meet ICMJE criteria for authorship, and agree with manuscript results and conclusions. WJE’s partner works for GlaxoSmithKline. DMF has served as an advisor to several pharmaceutical companies (including GlaxoSmithKline) on matters relating to the epidemiology of influenza and the effectiveness of influenza vaccination, and has received support to attend international meetings relating to influenza. We thank Julia Stowe and Pauline Kaye for extracting HES and LabBase2 data respectively, as well as Marc Baguelin for helpful discussions.

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