***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Oral oseltamivir administration is effective treatment for influenza in adults . This study was conducted to determine the efficacy , safety and tolerability of oseltamivir in children with influenza . Methods . In this r and omized , double blind , placebo-controlled study , children 1 through 12 years with fever [ ≥100 ° F ( ≥38 ° C ) ] and a history of cough or coryza < 48 h duration received oseltamivir 2 mg/kg/dose or placebo twice daily for 5 days . The primary efficacy endpoint was the time to resolution of illness including mild/absent cough and coryza mild/absent , return to normal activity and euthermia . Results . Of 695 enrolled children 452 ( 65 % ) had influenza ( placebo , n = 235 ; oseltamivir , n = 217 ) . Among infected children the median duration of illness was reduced by 36 h ( 26 % ) in oseltamivir compared with placebo recipients ( 101 h ; 95 % confidence interval , 89 to 118 vs. 137 h ; 95 % confidence interval , 125 to 150;P < 0.0001 ) . Oseltamivir treatment also reduced cough , coryza and duration of fever . New diagnoses of otitis media were reduced by 44 % ( 12%vs . 21 % ) . The incidence of physician-prescribed antibiotics was significantly lower in influenza-infected oseltamivir ( 68 of 217 , 31 % ) than placebo ( 97 of 235 , 41%;P = 0.03 ) recipients . Oseltamivir therapy was generally well-tolerated , although associated with an excess frequency of emesis ( 5.8 % ) . Discontinuation because of adverse events was low in both groups ( 1.8 % with oseltamivir vs. 1.1 % with placebo ) . Oseltamivir treatment did not affect the influenza-specific antibody response . Conclusions . Oral oseltamivir administration is an efficacious and well-tolerated therapy for influenza in children when given within 48 h of onset of illness A double-blind , r and omized study of inhaled zanamivir for the prevention of influenza in families was conducted . Once a person with a suspected case of influenza was identified ( index patient ) , treatment of all other household members ( contacts ) > or = 5 years old was initiated . Contacts received either 10 mg zanamivir or placebo inhaled once daily for 10 days . Index patients received relief medication only . In total , 487 households ( 242 placebo and 245 zanamivir ) were enrolled , with 1291 contacts r and omly assigned to receive prophylaxis . Four percent of zanamivir versus 19 % of placebo households ( P<.001 ) had at least 1 contact who developed symptomatic , laboratory-confirmed influenza , representing 81 % protective efficacy ( 95 % confidence interval , 64%-90 % ) . Protective efficacy was similarly high for individuals ( 82 % ) and against both influenza types A and B ( 78 % and 85 % , respectively , for households ) . Zanamivir was well tolerated and was effective in preventing influenza types A and B within households where the index patient was not treated BACKGROUND Influenza causes lower respiratory tract complications ( LRTCs ) , particularly bronchitis and pneumonia , in both otherwise healthy adults and those with underlying conditions . The aim of this study was to assess the effect of oseltamivir treatment on the incidence of LRTCs leading to antibiotic treatment and hospitalizations following influenza illness . METHODS We analyzed prospect ively collected data on LRTCs and antibiotic use from 3564 subjects ( age range , 13 - 97 years ) with influenzalike illness enrolled in 10 placebo-controlled , double-blind trials of oseltamivir treatment .  RESULTS In adults and adolescents with a proven influenza illness , oseltamivir treatment reduced overall antibiotic use for any reason by 26.7 % ( 14.0 % vs 19.1 % with placebo ; P<.001 ) and the incidence of influenza-related LRTCs result ing in antibiotic therapy by 55 % ( 4.6 % vs 10.3 % with placebo ; P<.001 ) . In those subjects considered at increased risk of complications , 74 ( 18.5 % ) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 ( 12.2 % ) of 368 oseltamivir recipients ( 34.0 % reduction ; P = .02 ) . Hospitalization for any cause occurred in 18 ( 1.7 % ) of 1063 placebo recipients compared with 9 ( 0.7 % ) of 1350 oseltamivir-treated patients ( 59 % reduction ; P = .02 ) . In contrast , among subjects with an influenzalike illness but without a confirmed influenza infection , the incidence of LRTCs ( 6.7 % vs 5.3 % ) , overall antibiotic use ( 19.7 % vs 19.3 % ) , or hospitalizations ( 1.7 % vs 1.9 % ) was similar between placebo and oseltamivir recipients , respectively . CONCLUSION Oseltamivir treatment of influenza illness reduces LRTCs , antibiotic use , and hospitalization in both healthy and " at-risk " adults BACKGROUND Different types of influenza vaccines are currently produced worldwide . Vaccination of pregnant women is recommended internationally , while healthy adults are targeted in North America . OBJECTIVES To identify , retrieve and assess all studies evaluating the effects ( efficacy , effectiveness and harm ) of vaccines against influenza in healthy adults , including pregnant women . SEARCH METHODS We search ed the Cochrane Central Register of Controlled Trials ( CENTRAL ) ( The Cochrane Library 2013 , Issue 2 ) , MEDLINE ( January 1966 to May 2013 ) and EMBASE ( 1990 to May 2013 ) . SELECTION CRITERIA R and omised controlled trials ( RCTs ) or quasi- RCTs comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy individuals aged 16 to 65 years . We also included comparative studies assessing serious and rare harms . DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data . MAIN RESULTS We included 90 reports containing 116 data sets ; among these 69 were clinical trials of over 70,000 people , 27 were comparative cohort studies ( about eight million people ) and 20 were case-control studies ( nearly 25,000 people ) . We retrieved 23 reports of the effectiveness and safety of vaccine administration in pregnant women ( about 1.6 million mother-child couples).The  overall effectiveness of parenteral inactivated vaccine  against influenza-like illness ( ILI ) is limited , corresponding to a number needed to vaccinate ( NNV ) of 40 ( 95 % confidence interval ( CI ) 26 to 128 ) . The overall efficacy of inactivated vaccines in preventing confirmed influenza has a NNV of 71 ( 95 % CI 64 to 80 ) . The difference between these two values depends on the different incidence of ILI and confirmed influenza among the study population s : 15.6 % of unvaccinated participants versus 9.9 % of vaccinated participants developed ILI symptoms , whilst only 2.4 % and 1.1 % , respectively , developed laboratory-confirmed influenza . No RCTs assessing vaccination in pregnant women were found . The only evidence available comes from observational studies with modest method ological quality . On this basis , vaccination shows very limited effects : NNV 92 ( 95 % CI 63 to 201 ) against ILI in pregnant women and NNV 27 ( 95 % CI 18 to 185 ) against laboratory-confirmed influenza in newborns from vaccinated women . Live aerosol vaccines have an overall effectiveness corresponding to a NNV 46 ( 95 % CI 29 to 115).The performance of one-dose or two-dose whole virion p and emic vaccines was higher , showing a NNV of 16 ( 95 % CI 14 to 20 ) against ILI and a NNV of 35 ( 95 % CI 33 to 47 ) against influenza , while a limited impact on hospitalisation was found ( NNV 94 , 95 % CI 70 to 1022).Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates . Inactivated vaccines caused local harms . No evidence of association with serious adverse events was found , but the harms evidence base was limited . The overall risk of bias in the included trials is unclear because it was not possible to assess the real impact of bias . AUTHORS ' CONCLUSIONS Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population , including pregnant women . No evidence of association between influenza vaccination and serious adverse events was found in the comparative studies considered in the review . This review includes 90 studies , 24 of which ( 26.7 % ) were funded totally or partially by industry . Out of the 48 RCTs , 17 were industry-funded ( 35.4 % ) OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review We explored the prophylactic activity of zanamivir  after presumed exposure to influenza in the community . After close contacts with index cases of influenza-like illnesses , 575 subjects were r and omized in 4 treatment groups : 144 received placebo , 141 received intranasal zanamivir , 144 received inhaled zanamivir , and 146 received inhaled plus intranasal zanamivir for 5 days . Of 25 subjects ( 4 % ) who developed symptomatic influenza during the 5 days of prophylaxis , 9 ( 36 % ) were in the placebo group , 8 ( 32 % ) were in the intranasal zanamivir group ( odds ratio [ OR ] , 0.90 ; 95 % confidence interval [ CI ] , 0.30 - 2.72 ; P=.855 ) , 3 ( 12 % ) were in the inhaled zanamivir group ( OR , 0.27 ; 95 % CI , 0.07 - 1.05 ; P=.058 ) , and 5 ( 20 % ) were in the inhaled plus intranasal zanamivir group ( OR , 0.52 ; 95 % CI , 0.17 - 1.58 ; P=.247 ) . Short-term treatment with intranasal zanamivir was ineffective . However , inhaled zanamivir treatment reduced the rate of influenza , which was 2%-3 % among zanamivir recipients versus 6 % among placebo recipients . Additional studies assessing a longer duration of postcontact prophylaxis are warranted BACKGROUND Influenza can cause significant morbidity and mortality in subjects at high risk for complications , including the elderly ( age > or=65 years ) and those with chronic respiratory , cardiovascular , or metabolic conditions . Effective prophylaxis can significantly reduce the disease burden in this population . Previous studies conducted primarily in non-high-risk subjects have reported the efficacy of inhaled z 
    Output:
    
Clinical ly relevant treatment benefits of  NIs were small in healthy adults and children suffering from influenza-like illness ( GRADE high to moderate ) .
No evidence was available on the treatment benefits of NIs in elderly and at-risk groups and their effects on hospitalization and mortality .
In oseltamivir trials , nausea , vomiting and diarrhea were significant side-effects .
For zanamivir trials , no adverse effects have been reported .
The combination of diagnostic uncertainty , the risk for virus strain resistance , possible side effects and financial cost outweigh the small benefits of oseltamivir or zanamivir for the prophylaxis and treatment of healthy individuals .
No relevant benefits of these NIs on complications in at-risk individuals have been established