We used microbiological and epidemiological surveillance data for England and Wales to estimate health outcomes attributable to influenza and other respiratory pathogens under the existing age- and risk-based national influenza vaccination programme. Our study shows that despite targeting vaccination at these vulnerable groups their disease burden is still disproportionately high compared with individuals in the same age group without co-morbidities, particularly in those under

65 years of age. Among 65+ year olds, the effect of underlying co-morbidities on hospitalisation and case fatality rates was less marked. Overall this age group contributed 93% all INCB018424 solubility dmso influenza-attributable deaths in hospital though only 29% of all admissions due to influenza (Table 3). Healthy children under 5 years of age had the highest influenza-attributable hospital admission rates, over 5 fold higher than 65+ year olds. Nearly 40% of the hospital admissions and consultations for influenza were in children under 15 years of age though annual mortality in this age group was low

at around 1.3/million population. Our study provides evidence to support the approach adopted in many developed countries Alectinib in vitro of targeting influenza vaccination at high-risk individuals and the

elderly. However, it also shows the limitation of such selective approaches in mitigating the consequences of disease in these vulnerable groups and suggests the need for additional prevention strategies. Vaccine coverage in England among those aged 65 years and over has been around 75% since 2005/6,17 meeting the target uptake recommended by the European Union Council for this age group.18 However, the relatively low vaccine efficacy in those aged 65 years and over19 limits its impact on morbidity and mortality 4-Aminobutyrate aminotransferase in this age group. Vaccine coverage in high-risk individuals under 65 years of age, such as those with cardiac, pulmonary or metabolic disorders, is low and has remained at around 50% since 2008/9 in England20 despite the recent experience with AH1N1 (2009) pandemic influenza which demonstrated the substantially higher morbidity and mortality in these groups.21 and 22 While vaccine uptake in these high-risk individuals needs to be improved, it is unlikely that this would be sufficient to abolish their morbidity and mortality differential given that vaccine efficacy against confirmed infection is only around 70% in a matched year in healthy adults23 and, if hospitalised with influenza, high-risk individuals have substantially higher case fatality rates (Table 3).