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Flu is a major public health problem, particularly for older people, and creates an important clinical and economic burden. A high mortality rate was reported in Spain during the period 2015 to 2016; 3,101 serious cases were hospitalised with a confirmed diagnosis of flu, of which 11% died (352 cases). Furthermore, financial and health costs are greatly increased by the complications of flu; people aged over 65 years represent approximately 64% of the total costs. Seasonal flu vaccination is the fundamental strategy, as demonstrated by cost-benefit and cost-effectiveness studies. A priority objective is to improve the vaccine's immune response and the search for and inclusion of adjuvants and immunostimulants in vaccines is a major line of research. This positioning report evaluates vaccination for older people and the importance of the adjuvanted vaccine in the elderly in strengthening immunogenicity, by means of a critical review of the literature based on the best evidence available on its immunogenicity and effectiveness, and an economic assessment.

Influenza is a significant health problem, particularly in those persons susceptible to having associated complications, older people, children less than 2 years, patients with chronic diseases, immunocompromised patients, and pregnant women. But influenza also has a large impact on the health system, with an increase in the healthcare demand and a spectacular increase in outpatient visits, overloading the emergency and hospital services. During epidemic outbreaks, the hospital admission rates of people over 65 years are at a maximum, and the mortality notified for the 2017/2018 influenza season was 960 deaths. The seasonal anti-influenza vaccine is the method with a better cost-effective ratio of primary prevention of influenza, reducing associated respiratory diseases, the number of hospital admissions, and deaths in high risk individuals, as well as work absenteeism in adults. In the last few years, influenza B has received little attention in the scientific literature, although in the periods between epidemics influenza B can be one of the main causes of seasonal epidemics, causing considerable morbidity and mortality and an increase in costs. The quadrivalent vaccine has a second-line immunological protection against influenza B, and according to a critical review of the scientific literature, it provides wider protection without affecting immunogenicity of the other three vaccine strains common to the trivalent and tetravalent vaccine. The quadrivalent vaccine is cost-effective in reducing the number of influenza cases, and is always a worthwhile intervention, with a significant cost saving for the health system and for society, by reducing the hospital admission rates and mortality associated with the complications of influenza. Supplement information: This article is part of a supplement entitled 'Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine' which is sponsored by Sanofi-Aventis, S.A.

Flu is a major public health problem, particularly for older people, and creates an important clinical and economic burden. A high mortality rate was reported in Spain during the period 2015 to 2016; 3,101 serious cases were hospitalised with a confirmed diagnosis of flu, of which 11% died (352 cases). Furthermore, financial and health costs are greatly increased by the complications of flu; people aged over 65 years represent approximately 64% of the total costs. Seasonal flu vaccination is the fundamental strategy, as demonstrated by cost-benefit and cost-effectiveness studies. A priority objective is to improve the vaccine's immune response and the search for and inclusion of adjuvants and immunostimulants in vaccines is a major line of research. This positioning report evaluates vaccination for older people and the importance of the adjuvanted vaccine in the elderly in strengthening immunogenicity, by means of a critical review of the literature based on the best evidence available on its immunogenicity and effectiveness, and an economic assessment.

Seasonal flu is a very serious public health problem in the elderly due to its morbidity and mortality and financial and social costs arising from this. The aim of this review is to describe the magnitude and importance of seasonal flu in this population group, and its prevention by means of vaccination. For this reason, an updated account of the composition of the vaccine, its dosage and administration route, vaccine safety and the evaluation of the immunogenicity and effectiveness of vaccination. There is variation between different countries and official organisations on the age at which flu vaccination must be established in the elderly. New flu vaccination strategies need to be introduced, to further improve flu vaccination cover in Spain.

Introduccion Los pacientes sin bazo presentan mayor riesgo de infeccion por bacterias encapsuladas, especialmente por Streptococcus pneumoniae, Haemophilus influenzae tipo b y Neisseria meningitidis. Objetivos Conocer la cobertura vacunal frente a S. pneumoniae de los pacientes esplenectomizados en el Hospital Clinico San Carlos (HCSC) y la identificacion de las variables relacionadas con los niveles de cobertura vacunal alcanzados. Metodos Se realizo un estudio de cohorte retrospectivo de todos los pacientes esplenectomizados desde el 1 de enero de 1999 hasta el 31 de diciembre de 2004 en el HCSC. Los pacientes se identificaron mediante la base de datos del Servicio de Archivos y Documentacion Clinica y los registros de vacunacion del Servicio de Medicina Preventiva. Resultados Durante el periodo de estudio se llevaron a cabo 248 esplenectomias. La mediana de edad fue de 61,0 anos, rango intercuartilico (39,0-71,0). Las neoplasias del aparato digestivo (34,7%) fueron la causa mas frecuente de esplenectomia. La cobertura vacunal frente S. pneumoniae alcanzada durante el periodo de estudio fue del 48,4%, detectandose una tendencia ascendente estadisticamente significativa (p Conclusiones Las coberturas vacunales se han incrementado todos los anos desde la implantacion del protocolo. Sin embargo, seria necesario difundir y ampliar el programa de vacunacion dentro de la practica clinica diaria.

Seasonal flu is a very serious public health problem in the elderly due to its morbidity and mortality and financial and social costs arising from this. The aim of this review is to describe the magnitude and importance of seasonal flu in this population group, and its prevention by means of vaccination. For this reason, an updated account of the composition of the vaccine, its dosage and administration route, vaccine safety and the evaluation of the immunogenicity and effectiveness of vaccination. There is variation between different countries and official organisations on the age at which flu vaccination must be established in the elderly. New flu vaccination strategies need to be introduced, to further improve flu vaccination cover in Spain.

Patients in whom the spleen has been removed have a higher risk of acquiring infection by capsulated microorganisms, particularly Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis.Determine the vaccination coverage against S. pneumoniae of splenectomized patients in Hospital Clínico San Carlos (HCSC, Madrid) and to identify variables related to the level of vaccination coverage reached.From January 1, 1999 to December 31, 2004, a retrospective cohort study of all splenectomized patients was carried out in HCSC. Patients were identified from the Medical Records Department and the vaccination registry of the Preventive Medicine Service.During the study period, 248 splenectomies were carried out. The median age was 61.0 years (interquartile range, 39.0-71.0). The most frequent reason for splenectomy was malignant gastrointestinal neoplasm (34.7%). Overall vaccination coverage against S. pneumoniae for the period studied was 48.4%. A significant increase in vaccination coverage per year was observed (P.001). Multivariate analysis identified the following variables associated with a greater risk of not being vaccinated: male sex, patients proceeding from surgical services, and patients undergoing splenectomy during 1999 to 2001.Vaccination coverage has increased every year since implementation of the protocol. Nevertheless, it necessary to extend the vaccination program within daily clinical practice.

Publication of a scientific work is the final and obligatory stage of any research. Among the various existing types of medical publications, the research original article is the prototype of scientific article. Its finality is to communicate the investigation undertaken to the reader in a coherent, clear and precise manner. With that purpose, the discoveries found by the authors as an answer to a hypothesis are presented and discussed. To send the original article to a biomedical journal, the manuscript should present some adequate formal characteristics, in addition to contain scientifically valid information. That can be achieved by complying with the rules past by the International Committee of Biomedical Journal Editors which have been adopted by a great number of scientific journals as publication requisites. The objective of this article is to describe the structure of the various parts (first page, abstract, introduction, material and methods, results, discussion, and bibliographic references) that constitute the format of the research original article, exposing the main adverse to be avoided during its preparation.

The design of an epidemiological study includes the procedures, methods and techniques by which the researcher tries to obtain valid (avoiding systematic errors or bias) and precise (avoiding random errors) answers to the research question posed. This principal question aimed to be answered is the specific objective of the study, which guides the election of an adequate type of design. The objective of this article is to describe the classification criteria (finality, temporal sequence, directionality, and control of the assignation of different study factors) of the different types of epidemiological studies (experimental, almost-experimental, and observational) and the main advantages, disadvantages, utilities and objectives of each investigation design.