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## Complete Summary

#### GUIDELINE TITLE

Prevention of influenza in the general population: recommendation
statement from the Canadian Task Force on Preventive Health Care.

#### BIBLIOGRAPHIC SOURCE(S)

Langley JM, Faughnan ME. Prevention of influenza in the general
population: recommendation statement from the Canadian Task Force on
Preventive Health Care. CMAJ 2004 Nov 9;171(10):1169-70. \[11
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15534308)

#### GUIDELINE STATUS

This is the current release of the guideline.

A complete list of planned reviews, updates and revisions is available
under the What\'s New section at the [Canadian Task Force on Preventive
Health Care (CTFPHC) Web site](http://www.ctfphc.org/).

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory information
has been released:

-   [April 02, 2008, Relenza
    (zanamivir)](http://www.fda.gov/medwatch/safety/2008/safety08.htm#Relenza):
    GlaxoSmithKline informed healthcare professionals of changes to the
    warnings and precautions sections of prescribing information for
    Relenza. There have been reports (mostly from Japan) of delirium and
    abnormal behavior leading to injury in patients with influenza who
    are receiving neuraminidase inhibitors, including Relenza.

-   [March 4, 2008, Tamiflu (oseltamivir
    phosphate)](http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tamiflu):
    Roche and the U.S. Food and Drug Administration (FDA) informed
    healthcare professionals of neuropsychiatric events associated with
    the use of Tamiflu, in patients with influenza. Roche has updated
    the PRECAUTIONS section of the package insert to include the new
    information and guidance under the Neuropsychiatric Events heading.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Influenza

#### GUIDELINE CATEGORY

Prevention\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Infectious Diseases\
Internal Medicine\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To systematically review the evidence for the prevention of influenza
infection in the general population

#### TARGET POPULATION

Healthy adults, children and adolescents

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Immunization with injectable inactivated influenza vaccine or
    nasally administered live-attenuated vaccine in healthy adults or
    children before each winter respiratory virus season

2.  Prophylactic administration of neuraminidase inhibitors (oseltamavir
    and zanamavir) to household or close contacts within 36 to 48 hours
    of symptom onset of influenza in the index case

#### MAJOR OUTCOMES CONSIDERED

-   Incidence of influenza virus infection (laboratory-confirmed
    infection, influenza-like illness, febrile illness during peak
    influenza period, severe febrile illness, upper respiratory tract
    illness)

-   Economic outcomes associated with respiratory illnesses not
    confirmed by laboratory methods to be influenza (lost work days due
    to illness, health care provider visits and use of prescription
    antibiotics and over-the-counter medications)

-   Efficacy of neuraminidase inhibitors

-   Adverse effects of interventions

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Extraction of Evidence**

Relevant articles were sought using MEDLINE between the years 1966 to
March 2003, using the following search strategy for influenza
vaccination trials: ((\"influenza vaccine\"\[Medical Subject Heading
(MeSH) Terms\] AND Clinical Trial\[ptyp\]) AND ((\"human\"\[MeSH Terms\]
OR \"hominidae\"\[MeSH Terms\]) OR \"Human\"\[MeSH Terms\])) AND
(\"1966\"\[PDat\] : \"2003/03\"\[PDat\])). The search strategy for the
effectiveness of neuraminidase inhibitor prophylaxis was the following:
(((\"Neuraminidase/antagonists and inhibitors\"\[MESH\] AND Clinical
Trial\[ptyp\]) AND ((\"human\"\[MeSH Terms\] OR \"hominidae\"\[MeSH
Terms\]) OR \"Human\"\[MeSH Terms\])) AND (\"1966\"\[PDat\] :
\"2003/03\"\[PDat\])) AND (clinical trials or randomized clinical
trials) for the antiviral search. The Cochrane Collaboration Library was
also searched using the MESH terms \"influenza vaccine\" and
\"neuraminidase\" for these two searches respectively.

The inclusion criteria for this review were: 1) any randomized
controlled trial of influenza vaccines or neuraminidase inhibitors in
humans, and 2) an outcome measured of clinical efficacy against
prevention of naturally occurring influenza in healthy persons. A trial
was considered randomized if the authors described assignment of study
drug/vaccine by random allocation or quasi-random allocation
(alternation, case record number, etc.) and controlled if there was a
concurrent comparison group. Clinical efficacy measurement had to be
determined by either a clinical definition of influenza or laboratory
diagnosis; studies that measured only immunogenicity of vaccine were
excluded. Studies were excluded if they were not in English or French or
were targeted at high-risk groups, since recommendations already exist
for these groups.

The MEDLINE search for influenza vaccine trials yielded 533 studies and
the Cochrane search identified four reviews. All of the studies
identified through the Cochrane search (Cochrane) were also found
through the MEDLINE search. Review of the 533 titles led to exclusion of
3 of the Cochrane reviews (ineligible patient population) and of
individual studies for the following reasons: high risk populations
(n=149 studies), language other than French or English (n= 56), and
interventions other than influenza vaccine (e.g. educational,
compliance, *Haemophilus influenzae*) (n=81). Review of the abstracts of
the remaining 247 titles identified led to the exclusion of 182 studies.
The most common reason was that the study outcome was vaccine
immunogenicity or that it was a review article. Review of the methods of
the 65 remaining studies identified 33 satisfying inclusion and
exclusion criteria. The antiviral search identified two reviews in the
Cochrane database and 43 studies in MEDLINE. Review of these articles
identified five satisfying inclusion and exclusion criteria and one
Cochrane review.

#### NUMBER OF SOURCE DOCUMENTS

537

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**[Levels of Evidence]{.underline}**

**Research Design Rating**

**I**: Evidence from randomized controlled trial(s)

**II-1**: Evidence from controlled trial(s) without randomization

**II-2**: Evidence from cohort or case-control analytic studies,
preferably from more than one centre or research group

**II-3**: Evidence from comparisons between times or places with or
without the intervention; dramatic results from uncontrolled studies
could be included here

**III**: Opinions of respected authorities, based on clinical
experience; descriptive studies or reports of expert committees

**Quality Rating**

**Good**: A study (including meta-analyses or systematic reviews) that
meets all design- specific criteria\* well

**Fair**: A study (including meta-analyses or systematic reviews) that
does not meet (or it is not clear that it meets) at least one
design-specific criterion\* but has no known \"fatal flaw\"

**Poor**: A study (including meta-analyses or systematic reviews) that
has at least one design-specific\* \"fatal flaw\", or an accumulation of
lesser flaws to the extent that the results of the study are not deemed
able to inform recommendations

\*General design-specific criteria are outlined in Harris RP, Helfand M,
Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D. Current Methods of
the U.S. Preventive Services Task Force: A Review of the Process. Am J
Prev Med 2001; 20 (suppl 3):21-35.

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The Task Force reviewed 1) the initial analytic framework and key
questions for the proposed review; 2) the subsequent drafts of the
complete manuscript providing critical appraisal of the evidence
prepared by the lead authors, including identification and double,
independent critical appraisal of key studies or recent systematic
reviews, and ratings of the quality of this evidence using the task
force\'s established methodological hierarchy (See Appendix 1 of the
original guideline document); and 3) a summary of the evidence and
proposed recommendations.

Evidence for this topic was presented by the lead authors and
deliberated upon during task force meetings in January 2000, February
2001, and June 2003. Expert panelists addressed critical issues,
clarified ambiguous concepts and analyzed the synthesis of the evidence.
At the end of this process, the specific clinical recommendations
proposed by the lead authors were discussed, as were issues related to
clarification of the recommendations for clinical application and any
gaps in evidence. The results of this process are reflected in the
description of the decision criteria presented with the specific
recommendations. The group and lead authors arrived at final decisions
on recommendations unanimously.

Procedures to achieve adequate documentation, consistency,
comprehensiveness, objectivity and adherence to the Task Force
methodology were maintained at all stages during review development, the
consensus process, and beyond. These were managed by the Task Force
Office, under supervision of the Chair, and ensured uniformity and
impartiality throughout the review process.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Recommendations Grades for Specific Clinical Preventive Actions**

**A**: The Canadian Task Force (CTF) concludes that there is **good**
evidence to recommend the clinical preventive action.

**B**: The CTF concludes that there is **fair** evidence to recommend
the clinical preventive action.

**C**: The CTF concludes that the existing evidence is **conflicting**
and does not allow making a recommendation for or against use of the
clinical preventive action; however, other factors may influence
decision-making.

**D**: The CTF concludes that there is **fair** evidence to recommend
against the clinical preventive action.

**E**: The CTF concludes that there is **good** evidence to recommend
against the clinical preventive action.

**I**: The CTF concludes that there is **insufficient** evidence (in
quantity and/or quality) to make a recommendation; however, other
factors may influence decision-making.

#### COST ANALYSIS

Published cost analyses were reviewed. Six trials of immunization in
adults used outcome measures that capture the economic burden associated
with respiratory illnesses not confirmed by laboratory methods to be
influenza: lost work days due to illness, health care provider visits
and use of prescription antibiotics and over-the-counter medications.
These showed no reduction to modest reductions in lost time from
respiratory illness. A cost benefit analysis of one of these influenza
vaccination trials in healthy working adults using days of work missed,
days working but at reduced effectiveness, and days with a health
provider visit for an influenza-like symptom showed that vaccination
(live attenuated intranasal vaccine) reduced costs associated with all
these outcomes. The mean break-even cost for the vaccine and its
administration was US\$43.07 using Monte Carlo analysis.

#### METHOD OF GUIDELINE VALIDATION

Comparison with Guidelines from Other Groups\
External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

**Peer Review**

After final revision, the manuscript was sent by the Task Force to two
experts in the field (identified by Task Force members at the meeting).
Feedback from these experts was incorporated into a subsequent draft of
the manuscript which was incorporated into the technical report.

**Recommendations of Others**

Recommendations on prevention of influenza in the general population
from the following groups were discussed: the United States Preventive
Services Task Force (USPSTF), the US Centers for Disease Control and
Prevention, and the National Advisory Committee on Immunization
(Canada).

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Recommendation grades **\[A-E, I\]** and levels of evidence **\[I, II-1,
II-2, II-3, III, good, fair, poor\]** are indicated after each
recommendation. Definitions for these grades and levels are provided at
the end of the \"Major Recommendations\" field.

The Canadian Task Force on Preventive Health Care (CTFPHC) recommends
influenza vaccination in healthy adults **(A recommendation)** and
children **(A recommendation)** (Powers et al., 1995, **\[I, good\]**;
Edwards et al., 1994 **\[I, good\]**; Keitel, Cate, & Couch 1988 **\[I,
good\]**; Monto, Miller, & Massab, 1982 **\[I, good\]**; Mair, Sansome,
& Tillett, 1974 **\[I, good\]**; Bridges et al., 2000 **\[I, good\]**;
Nichol et al., 1999 **\[I, good\]**; Nichol et al., 1995 **\[I,
good\]**; Williams et al., 1973 **\[I, good\]**; Waldman & Coggins, 1972
**\[I, good\]**; Hobson et al., 1970 **\[I, good\]**; Hammond et al.,
1978 **\[I, fair\]**; Rytel et al., 1977 **\[I, fair\]**; Leibovitz et
al., 1971 **\[I, fair\]**; Tannock et al., 1984 **\[I, fair\]**; Mixeu
et al., 2002 **\[I, fair\]**; Edmonson, Graham, & Warburton, 1970 **\[I,
fair\]**; Eddy & Davies, 1970 **\[I, fair\]**; Neuzil et al., 2001
**\[I, good\]**; Belshe et al., 2000 **\[I, good\]**; Belshe et al.,
1998 **\[I, good\]**; Gruber et al., 1996 **\[I, good\]**; Clover et
al., 1991 **\[I, good\]**; Gruber et al., 1990 **\[I, good\]**; Hoskins
et al., 1973 **\[I, good\]**; Rudenko et al., 1993 **\[I, good\]**;
Alexandrova et al., 1986 **\[I, good\]**; Feldman et al., 1985 **\[I,
fair\]**; Hurwitz et al., 2000 **\[I, fair\]**; Colombo et al., 2001
**\[I, fair\]**; Maynard et al., 1968 **\[I, fair\]**; Khan et al., 1996
**\[I, fair\]**; Wesselius de Casparius, Masurel, & Kerrebijn, 1972
**\[I, fair\]**)

There is good evidence to support neuraminidase inhibitor prophylaxis in
the household setting if it can be initiated within 36 to 48 hours of
symptom onset in the index case. **(A recommendation)** (Hayden et al.,
\"Use of the oral neuraminidase inhibitor,\" 1999 **\[I, good\]**;
Hayden et al., \"Use of the selective oral neuraminidase inhibitor,\"
1999 **\[I, good\]**; Welliver et al., 2001 **\[I, good\]**; Kaiser et
al., 2000 **\[I, good\]**; Hayden et al., 2000 **\[I, good\]**; Monto et
al., 2002 **\[I, good\]**)

**[Definitions]{.underline}**:

**Levels of Evidence**

*Research Design Rating*

**I**: Evidence from randomized controlled trial(s)

**II-1**: Evidence from controlled trial(s) without randomization

**II-2**: Evidence from cohort or case-control analytic studies,
preferably from more than one centre or research group

**II-3**: Evidence from comparisons between times or places with or
without the intervention; dramatic results in uncontrolled studies could
be included here

**III**: Opinions of respected authorities, based on clinical
experience; descriptive studies or reports of expert committees

**Quality Rating**

**Good**: A study that meets all design-specific criteria\* well

**Fair**: A study that does not meet (or it is not clear that it meets)
at least one design-specific criterion\* but has no known \"fatal flaw\"

**Poor**: A study that has at least one design-specific\* \"fatal
flaw\", or an accumulation of lesser flaws to the extent that the
results of the study are not deemed able to inform recommendations

\*General design-specific criteria are outlined in Harris RP, Helfand M,
Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D. Current Methods of
the U.S. Preventive Services Task Force: A Review of the Process. Am J
Prev Med 2001; 20 (suppl 3):21-35.

**Recommendations Grades for Specific Clinical Preventive Actions**

**A**: The Canadian Task Force (CTF) concludes that there is **good**
evidence to recommend the clinical preventive action.

**B**: The CTF concludes that there is **fair** evidence to recommend
the clinical preventive action.

**C**: The CTF concludes that the existing evidence is **conflicting**
and does not allow making a recommendation for or against use of the
clinical preventive action; however, other factors may influence
decision-making.

**D**: The CTF concludes that there is **fair** evidence to recommend
against the clinical preventive action.

**E**: The CTF concludes that there is **good** evidence to recommend
against the clinical preventive action.

**I**: The CTF concludes that there is **insufficient** evidence (in
quantity and/or quality) to make a recommendation; however, other
factors may influence decision-making.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=6525)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

*Maneuver*: Influenza vaccination in the healthy adult

-   *Level of Evidence*: I, good to fair (systematic review of 18
    randomized controlled trials \[RCTs\])

*Maneuver*: Influenza vaccination in children

-   *Level of Evidence:* I, good to fair (systematic review of 15 RCTs)

*Maneuver*: Prevention of Influenza with neuraminidase inhibitors

-   *Level of Evidence*: I, good (systematic review of 6 RCTs)

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Prevention of influenza in the person receiving the vaccine or
    antiviral agent

-   Decreased economic disruption from lost work days and health care
    provider visits

#### POTENTIAL HARMS

-   Discomfort at the injection site for 24 to 48 hours after
    vaccination

-   Rhinorrhea and sore throat may occur in recipients of nasally
    administered live-attenuated vaccine

-   Nausea and vomiting may occur in recipients of oseltamivir

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The Canadian Task Force on Preventive Health Care (CTFPHC) recognizes
that in many cases, patient-specific factors need to be considered and
discussed, such as the value the patient places on the clinical
preventive action; its possible positive and negative outcomes; and the
context and/or personal circumstances of the patient (medical and
other). In certain circumstances where the evidence is complex,
conflicting, or insufficient, a more detailed discussion may be
required.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Quick Reference Guides/Physician Guides

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Langley JM, Faughnan ME. Prevention of influenza in the general
population: recommendation statement from the Canadian Task Force on
Preventive Health Care. CMAJ 2004 Nov 9;171(10):1169-70. \[11
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15534308)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2004 Nov

#### GUIDELINE DEVELOPER(S)

Canadian Task Force on Preventive Health Care - National Government
Agency \[Non-U.S.\]

#### SOURCE(S) OF FUNDING

The Canadian Task Force on Preventive Health Care (CTFPHC) is funded
through a partnership between the Provincial and Territorial Ministries
of Health and Health Canada.

#### GUIDELINE COMMITTEE

Canadian Task Force on Preventive Health Care (CTFPHC)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Primary Authors*: Joanne M. Langley, Associate Professor, Departments
of Pediatrics and of Community Health and Epidemiology, Dalhousie
University, Halifax, NS; Marie E. Faughnan, Assistant Professor,
Department of Medicine, Division of Respirology, St. Michael\'s Hospital
and University of Toronto, Toronto, Ont

*Chair*: Dr. John W. Feightner, Professor, Department of Family
Medicine, The University of Western Ontario, London, Ont

*Vice-Chair*: Dr. Harriet MacMillan, Associate Professor, Departments of
Psychiatry and Behavioural Neurosciences and of Pediatrics, Canadian
Centre for Studies of Children at Risk, McMaster University, Hamilton,
Ont

*Members*: Drs. Paul Bessette, Professeur titulaire, Département
d\'obstétrique-gynécologie, Université de Sherbrooke, Sherbrooke, Que.;
R. Wayne Elford, Professor Emeritus, Department of Family Medicine,
University of Calgary, Calgary, Alta.; Denice S. Feig, Assistant
Professor, Departments of Medicine, of Obstetrics and Gynecology, and of
Health Policy Management and Evaluation, University of Toronto, Toronto,
Ont.; Joanne M. Langley, Associate Professor, Departments of Pediatrics
and of Community Health and Epidemiology, Dalhousie University, Halifax,
NS; Valerie Palda, Assistant Professor, Department of General Internal
Medicine, University of Toronto, Toronto, Ont.; Christopher Patterson,
Professor, Division of Geriatric Medicine, Department of Medicine,
McMaster University, Hamilton, Ont.; Bruce A. Reeder, Professor,
Department of Community Health and Epidemiology, University of
Saskatchewan, Saskatoon, Sask

*Resource Staff*: Ruth Walton, Research Associate; Jana Fear, Research
Assistant, Canadian Task Force on Preventive Health Care, Department of
Family Medicine, The University of Western Ontario, London, Ont

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

*Competing interests*: None declared.

#### GUIDELINE STATUS

This is the current release of the guideline.

A complete list of planned reviews, updates and revisions is available
under the What\'s New section at the [Canadian Task Force on Preventive
Health Care (CTFPHC) Web site](http://www.ctfphc.org/).

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [Canadian Task Force on Preventive
Health Care (CTFPHC) Web
site](http://www.cmaj.ca/cgi/content/full/171/10/1169).

Print copies: Available from the Canadian Task Force on Preventive
Health Care, Clinical Skills Building, 2nd Floor, Department of Family
Medicine, University of Western Ontario, London, ON, N6A 5C1.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Stachenko S. Preventive guidelines: their role in clinical
    prevention and health promotion. Ottawa: Health Canada, 1994.
    Available from the [Canadian Task Force on Preventive Health Care
    (CTFPHC) Web site](http://www.ctfphc.org/).

-   CTFPHC history/methodology. Ottawa: Health Canada, 1997. Available
    from the [Canadian Task Force on Preventive Health Care (CTFPHC) Web
    site](http://www.ctfphc.org/).

-   Quick tables of current recommendations. Ottawa: Health
    Canada, 1997. Available from the [Canadian Task Force on Preventive
    Health Care (CTFPHC) Web site](http://www.ctfphc.org/).

-   Langley, J.M., Faughnan, M.E., and the Canadian Task Force on
    Preventive Health Care. Preventive Health Care, 2003 Update:
    prevention of influenza in the general population: systematic review
    and recommendations. CTFPHC Technical Report. March 2005. London,
    ON: Canadian Task Force. Available from the [CTFPHC Web
    site](http://www.ctfphc.org/).

-   Langley, J.M., Faughnan, M.E., and the Canadian Task Force on
    Preventive Health Care. Preventive Health Care, 2004 Update:
    prevention of influenza in the general population. Recommendation
    table. Available from the [CTFPHC Web site](http://www.ctfphc.org/).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on August 11, 2005. The
information was verified by the guideline developer on August 25, 2005.
This summary was updated by ECRI on November 21, 2006 following the FDA
advisory on Tamiflu. This summary was updated by ECRI Institute on March
10, 2008 following the U.S. Food and Drug Administration (FDA) advisory
on Tamiflu (oseltamivir phosphate). This summary was updated by ECRI
Institute on April 9, 2008 following the U.S. Food and Drug
Administration (FDA) advisory on Relenza (zanamivir).

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

Summaries of the Canadian Task Force on Preventive Health Care (CTFPHC)
guidelines are available for public use and may be downloaded from the
NGC Web site and/or transferred to an electronic storage and retrieval
system for personal use. Notification of CTFPHC (telephone:
519-850-2511, e-mail: <John.Feightner@schulich.uwo.ca>) for any other
use of these summaries is appreciated but not required.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008