Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events. Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I² and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p<0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified. Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.

The consumption of tobacco, alcohol and illegal drugs by young people is a public health concern. This study aimed to explore the associations between subjective wellbeing, living in a low-income household and substance use by schoolchildren. Data were analysed from a nationally representative cross-sectional survey of schoolchildren in England (Tellus4, 2009). Participants were 3903 children aged 10 and 15 years from two local authorities in the North West. Eligibility for free school meals provided a proxy for living in a low-income household. Multiple logistic regression was conducted with the main outcome measure, a composite indicator of self-reported regular substance use. More boys than girls had experimented with drugs or alcohol, but in the fourth year of secondary education, girls were significantly more likely than boys to have been drunk (P ≤ 0.001). In the multivariate analysis, older age was the most important factor associated with the consumption of substances. Living in a low-income household was associated with substance use, adjusting for age and subjective wellbeing (adj. OR = 1.78, 95% CI = 1.36–2.34). Respondents who reported being happy (adj. OR = 0.67, 95% CI = 0.52–0.86) or able to communicate with their family (adj. OR = 0.51, 95% CI = 0.39–0.65), were less likely to be regular users. Interventions to prevent regular substance use should be carefully targeted by age. Policies aimed at social determinants may be an important adjunct to individual-level interventions to reduce some inequalities in health associated with substance misuse.

From 1 January to 30 June 2012, 359 confirmed and 157 probable cases of measles were reported in Merseyside, England. The most affected age groups were children under five years and young adults from 15 years of age. Most cases have been sporadic. There have been few outbreaks in nurseries; however, no outbreaks have been reported in schools. Of the cases eligible for vaccination, only 3% of the confirmed cases were fully immunised.