Efficacy and effectiveness of seasonal and pandemic A (H1N1) 2009 influenza vaccines in low and middle-income countries: a systematic review and meta-analysis. Influenza vaccination is recommended in low and middle-income countries (LICs and MICs) for at-risk populations. A search in 3 medical databases for English, French, Spanish or Portuguese papers on the effectiveness and efficacy of flu vaccine in these countries from 1960- 2011 yielded 41 studies. In MICs, flu vaccine showed pooled efficacy 72% and 81% for 1 and 2 year follow-up in children and 43% and 58% pooled efficacy for live attenuated and inactivated vaccines respectively in the elderly. Inactivated vaccine reduced cardiovascular outcomes in at-risk patients. Effectiveness was similar to that in high-income countries. Data for LICs and other at-risk groups in MICs were limited. Breteler JK et al. Vaccine. 2013 Oct 25;31(45):5168-77. doi: 10.1016/j.vaccine.2013.08.056. Epub 2013 Sep 5. Read the publication: http://www.ncbi.nlm.nih.gov/pubmed/24012574