Influenza vaccination for immunocompromised patients: summary of a systematic review and meta-analysis

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

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

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

In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed

OBJECTIVE: To evaluate in-hospital formula supplementation among first time mothers who intended to exclusively breastfeed and determined if in-hospital formula supplementation shortens breastfeeding duration after adjusting for breastfeeding intention. STUDY DESIGN: We assessed strength of breastfeeding intentions prenatally in a diverse cohort of expectant primiparae and followed infant feeding practices through day 60. Among mothers planning to exclusively breastfed their healthy term infants for ≥1 week, we determined predictors, reasons, and characteristics of in-hospital formula supplementation; and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding days 30–60 and breastfeeding cessation by day 60 with in-hospital formula supplementation (n=393). RESULTS: 210 (53%) infants exclusively breastfed during the maternity stay and 183 (47%) received in-hospital formula supplementation. The most prevalent reasons mothers cited for inhospital formula supplementation were: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). Prevalence of not fully breastfeeding days 30–60 was 67.8% vs 36.7%, ARR 1.8 [95% CI, 1.4–2.3], in-hospital formula supplementation vs exclusively breastfed groups respectively, and breastfeeding cessation by day 60 was 32.8% vs 10.5%, ARR 2.7 [95% CI,1.7–4.5]. Odds of both adverse outcomes increased with more in-hospital formula supplementation feeds (not fully breastfeeding days 30–60, P=.003 and breastfeeding cessation, P=.011). CONCLUSIONS: Among women intending exclusively breastfed, in-hospital formula supplementation was associated with nearly 2-fold greater risk of not fully breastfeeding days 30–60 and nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions. Strategies should be sought to avoid unnecessary in-hospital formula supplementation and to support breastfeeding when in-hospital formula supplementation is unavoidable