human
***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 : Children have high morbidity and hospitalization rates from seasonal influenza . Meta-analyses suggest that conventional inactivated influenza vaccines are of low efficacy in young children , making vaccines that induce greater and broader immune protection in this vulnerable population a medical priority . Adjuvanted influenza vaccines may offer a solution . Subjects and Methods : Unprimed healthy children ( 6 to < 36 months ) were enrolled in an observer-blinded study and r and omly assigned to receive 2 doses of MF59-adjuvanted vaccine ( Sub/MF59 , n = 130 ) or nonadjuvanted split vaccine ( split , n = 139 ) ; subgroups of these ( n = 43 and 46 , respectively ) received a booster dose 1 year later . Safety and clinical tolerability were assessed after each dose . Hemagglutination inhibition antibody titers were measured against influenza A and B strains included in the formulation of the vaccines and against mismatched strains . Results : Clinical tolerability and safety were generally comparable between vaccine groups , though some transient , mild solicited reactions were more frequent in the Sub/MF59 group . Postvaccination hemagglutination inhibition antibody titers to all 3 vaccine strains were significantly higher with Sub/MF59 than with split vaccine ( all comparisons P < 0.001 ) after each of the 3 vaccine doses . In addition , Sub/MF59 induced significantly higher cross-reactivity against A/H3N2 and A/H1N1 mismatched strains . Conclusion : MF59-adjuvanted influenza vaccine was well tolerated in healthy young children after each of 3 doses and induced greater , longer-lasting , and broader immune responses than a nonadjuvanted split vaccine . The enhanced immunogenicity of the adjuvanted vaccine was most evident in very young children and for the B vaccine strain Objective To evaluate the effects of influenza vaccination with or without heptavalent pneumococcal conjugate vaccination on  respiratory tract infections ( RTIs ) in children . Study design This was a r and omized , double-blind , placebo-controlled trial comprising 579 children age 18 to 72 months with a previous history of physician-diagnosed RTI , recruited between 2003 and 2005 . The children were assigned to 2 doses of parenteral inactivated trivalent subunit influenza plus heptavalent pneumococcal conjugate vaccination ( TIV+PCV7 ) , influenza plus placebo vaccination ( TIV+plac ) , or control hepatitis B virus vaccination plus placebo ( HBV+plac ) . Main outcome measures were febrile RTI and related polymerase chain reaction (PCR)-confirmed influenza , primary care visits , antibiotic prescriptions , and acute otitis media ( AOM ) episodes . Results During influenza seasons , febrile RTI were reduced by 24 % ( 95 % confidence interval [ CI ] = 1 % to 42 % ) in the TIV+PCV7 group and by 13 % ( 95 % CI = -12 % to 32 % ) in the TIV+plac group compared with the control group . The occurrence of PCR-confirmed influenza was reduced by 52 % ( 95 % CI = 7 % to 75 % ) in the TIV+PCV7 group and by 51 % ( 95 % CI = 3 % to 75 % ) in the TIV+plac group . Episodes of AOM were reduced by 57 % ( 95 % CI = 6 % to 80 % ) in the TIV+PCV7 group and by 71 % ( 95 % CI = 30 % to 88 % ) in the TIV+plac group . Outside of the influenza seasons , no significant effects of vaccinations were demonstrated on the studied outcomes . Conclusions During influenza seasons , influenza vaccination with or without pneumococcal conjugate vaccination substantially reduced cases of confirmed influenza and AOM episodes 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 BACKGROUND Influenza vaccine is considered to reduce influenza-related morbidity and mortality in patients with underlying chronic medical conditions . Yet in liver cirrhosis , influenza vaccines have received little attention in determining the potential benefits . OBJECTIVES We intended to evaluate the clinical benefits of influenza vaccination and clinical outcomes of influenza in patients with liver cirrhosis . METHODS We performed a controlled , prospect i ve clinical trial of 311 cirrhotic patients , who were enrolled in October 2004 . Among them , 198 patients were vaccinated with a trivalent influenza vaccine and the rest were not vaccinated .  Both groups were followed with respect to the occurrence of influenza-like illness ( ILI ) until May 2005 . RESULTS Overall incidences of ILI ( p=0.064 ) and culture positivity of influenza ( p=0.009 ) were remarkably higher in unvaccinated group compared to the vaccinated group . Most of the cirrhotic patients with influenza had fever ( 91.6 % ) and complained of myalgia ( 83.3 % ) without respiratory symptoms , which were not typical clinical presentations of influenza . Influenza vaccination also decreased influenza-related complication rates in patients with liver cirrhosis . CONCLUSION Influenza vaccination should be recommended to all cirrhotic patients . High suspicion is required for early diagnosis and antiviral treatment , allowing for the frequent hepatic decompensation among cirrhotic patients BACKGROUND Universal vaccination of children 6 to 59 months of age with trivalent inactivated influenza vaccine has recently been recommended by U.S. advisory bodies . To evaluate alternative vaccine approaches , we compared the safety and efficacy of intranasally administered live attenuated influenza vaccine with those of inactivated vaccine in infants and young children . METHODS Children 6 to 59 months of age , without a recent episode of wheezing illness or severe asthma , were r and omly assigned in a 1:1 ratio to receive either cold-adapted trivalent live attenuated influenza vaccine ( a refrigeration-stable formulation of live attenuated intranasally administered influenza vaccine ) or trivalent inactivated vaccine in a double-blind manner . Influenza-like illness was monitored with cultures throughout the 2004 - 2005 influenza season . RESULTS Safety data were available for 8352 children , and 7852 children completed the study according to the protocol . There were 54.9 % fewer cases of cultured-confirmed influenza in the group that received live attenuated vaccine than in the group that received inactivated vaccine ( 153 vs. 338 cases , P<0.001 ) . The superior efficacy of live attenuated vaccine , as compared with inactivated vaccine , was observed for both antigenically well-matched and drifted viruses . Among previously unvaccinated children , wheezing within 42 days after the administration of dose 1 was more common with live attenuated vaccine than with inactivated vaccine , primarily among children 6 to 11 months of age ; in this age group , 12 more episodes of wheezing were noted within 42 days after receipt of dose 1 among recipients of live attenuated vaccine ( 3.8 % ) than among recipients of inactivated vaccine ( 2.1 % , P=0.076 ) . Rates of hospitalization for any cause during the 180 days after vaccination were higher among the recipients of live attenuated vaccine who were 6 to 11 months of age ( 6.1 % ) than among the recipients of inactivated vaccine in this age group ( 2.6 % , P=0.002 ) . CONCLUSIONS Among young children , live attenuated vaccine had significantly better efficacy than inactivated vaccine . An evaluation of the risks and benefits indicates that live attenuated vaccine should be a highly effective , safe vaccine for children 12 to 59 months of age who do not have a history of asthma or wheezing . ( Clinical Trials.gov number , NCT00128167 [ Clinical Trials.gov ] . ) BACKGROUND The efficacy of influenza vaccines may vary annually . In 2004 - 2005 , when antigenically drifted viruses were circulating , a r and omized , placebo-controlled trial involving healthy adults showed that inactivated vaccine appeared to be efficacious , whereas live attenuated vaccine appeared to be less so . METHODS In 2005 - 2006 , we continued our trial , examining the absolute and relative efficacies of the live attenuated and inactivated vaccines in preventing laboratory-confirmed symptomatic influenza . RESULTS A total of 2058 persons were vaccinated in October and November 2005 . Study wide influenza activity was prolonged but of low intensity ; type A ( H3N2 ) virus was circulating , which was antigenically similar to the vaccine strain . The absolute efficacy of the inactivated vaccine was 16 % ( 95 % confidence interval [ CI ] , -171 % to 70 % ) for the virus identification end point ( virus isolation in cell culture or identification through polymerase chain reaction ) and 54 % ( 95 % CI , 4%-77 % ) for the primary end point ( virus isolation or increase in serum antibody titer ) . The absolute efficacies of the live attenuated vaccine  for these end points were 8 % ( 95 % CI , -194 % to 67 % ) and 43 % ( 95 % CI , -15 % to 71 % ) , respectively . CONCLUSIONS With serologic end points included , efficacy was demonstrated for the inactivated vaccine in a year with low influenza attack rates . The efficacy of the live attenuated vaccine was slightly less than that of the inactivated vaccine , but not statistically greater than that of the placebo BACKGROUND The efficacy of influenza vaccines may decline during years when the circulating viruses have antigenically drifted from those included in the vaccine . METHODS We carried out a r and omized , double-blind , placebo-controlled trial of inactivated and live attenuated influenza vaccines in healthy adults during the 2004 - 2005 influenza season and estimated both absolute and relative efficacies . RESULTS A total of 1247 persons were vaccinated between October and December 2004 . Influenza activity in Michigan began in January 2005 with the circulation of an antigenically drifted type A ( H3N2 ) virus , the A/California/07/2004-like strain , and of type B viruses from two lineages . The absolute efficacy of the inactivated vaccine against both types of virus was 77 % ( 95 % confidence interval [ CI ] , 37 to 92 ) as measured by isolating the virus in cell culture , 75 % ( 95 % CI , 42 to 90 ) as measured by either isolating the virus in cell culture or identifying it through real-time polymerase chain reaction , and 67 % ( 95 % CI , 16 to 87 ) as measured by either isolating the virus or observing a rise in the serum antibody titer . The absolute efficacies of the live attenuated vaccine were 57 % ( 95 % CI , -3 to 82 ) , 48 % ( 95 % CI , -7 to 74 ) , and 30 % ( 95 % CI , -57 
    Output:
    
agent
***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 : Children have high morbidity and hospitalization rates from seasonal influenza . Meta-analyses suggest that conventional inactivated influenza vaccines are of low efficacy in young children , making vaccines that induce greater and broader immune protection in this vulnerable population a medical priority . Adjuvanted influenza vaccines may offer a solution . Subjects and Methods : Unprimed healthy children ( 6 to < 36 months ) were enrolled in an observer-blinded study and r and omly assigned to receive 2 doses of MF59-adjuvanted vaccine ( Sub/MF59 , n = 130 ) or nonadjuvanted split vaccine ( split , n = 139 ) ; subgroups of these ( n = 43 and 46 , respectively ) received a booster dose 1 year later . Safety and clinical tolerability were assessed after each dose . Hemagglutination inhibition antibody titers were measured against influenza A and B strains included in the formulation of the vaccines and against mismatched strains . Results : Clinical tolerability and safety were generally comparable between vaccine groups , though some transient , mild solicited reactions were more frequent in the Sub/MF59 group . Postvaccination hemagglutination inhibition antibody titers to all 3 vaccine strains were significantly higher with Sub/MF59 than with split vaccine ( all comparisons P < 0.001 ) after each of the 3 vaccine doses . In addition , Sub/MF59 induced significantly higher cross-reactivity against A/H3N2 and A/H1N1 mismatched strains . Conclusion : MF59-adjuvanted influenza vaccine was well tolerated in healthy young children after each of 3 doses and induced greater , longer-lasting , and broader immune responses than a nonadjuvanted split vaccine . The enhanced immunogenicity of the adjuvanted vaccine was most evident in very young children and for the B vaccine strain Objective To evaluate the effects of influenza vaccination with or without heptavalent pneumococcal conjugate vaccination on  respiratory tract infections ( RTIs ) in children . Study design This was a r and omized , double-blind , placebo-controlled trial comprising 579 children age 18 to 72 months with a previous history of physician-diagnosed RTI , recruited between 2003 and 2005 . The children were assigned to 2 doses of parenteral inactivated trivalent subunit influenza plus heptavalent pneumococcal conjugate vaccination ( TIV+PCV7 ) , influenza plus placebo vaccination ( TIV+plac ) , or control hepatitis B virus vaccination plus placebo ( HBV+plac ) . Main outcome measures were febrile RTI and related polymerase chain reaction (PCR)-confirmed influenza , primary care visits , antibiotic prescriptions , and acute otitis media ( AOM ) episodes . Results During influenza seasons , febrile RTI were reduced by 24 % ( 95 % confidence interval [ CI ] = 1 % to 42 % ) in the TIV+PCV7 group and by 13 % ( 95 % CI = -12 % to 32 % ) in the TIV+plac group compared with the control group . The occurrence of PCR-confirmed influenza was reduced by 52 % ( 95 % CI = 7 % to 75 % ) in the TIV+PCV7 group and by 51 % ( 95 % CI = 3 % to 75 % ) in the TIV+plac group . Episodes of AOM were reduced by 57 % ( 95 % CI = 6 % to 80 % ) in the TIV+PCV7 group and by 71 % ( 95 % CI = 30 % to 88 % ) in the TIV+plac group . Outside of the influenza seasons , no significant effects of vaccinations were demonstrated on the studied outcomes . Conclusions During influenza seasons , influenza vaccination with or without pneumococcal conjugate vaccination substantially reduced cases of confirmed influenza and AOM episodes 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 BACKGROUND Influenza vaccine is considered to reduce influenza-related morbidity and mortality in patients with underlying chronic medical conditions . Yet in liver cirrhosis , influenza vaccines have received little attention in determining the potential benefits . OBJECTIVES We intended to evaluate the clinical benefits of influenza vaccination and clinical outcomes of influenza in patients with liver cirrhosis . METHODS We performed a controlled , prospect i ve clinical trial of 311 cirrhotic patients , who were enrolled in October 2004 . Among them , 198 patients were vaccinated with a trivalent influenza vaccine and the rest were not vaccinated .  Both groups were followed with respect to the occurrence of influenza-like illness ( ILI ) until May 2005 . RESULTS Overall incidences of ILI ( p=0.064 ) and culture positivity of influenza ( p=0.009 ) were remarkably higher in unvaccinated group compared to the vaccinated group . Most of the cirrhotic patients with influenza had fever ( 91.6 % ) and complained of myalgia ( 83.3 % ) without respiratory symptoms , which were not typical clinical presentations of influenza . Influenza vaccination also decreased influenza-related complication rates in patients with liver cirrhosis . CONCLUSION Influenza vaccination should be recommended to all cirrhotic patients . High suspicion is required for early diagnosis and antiviral treatment , allowing for the frequent hepatic decompensation among cirrhotic patients BACKGROUND Universal vaccination of children 6 to 59 months of age with trivalent inactivated influenza vaccine has recently been recommended by U.S. advisory bodies . To evaluate alternative vaccine approaches , we compared the safety and efficacy of intranasally administered live attenuated influenza vaccine with those of inactivated vaccine in infants and young children . METHODS Children 6 to 59 months of age , without a recent episode of wheezing illness or severe asthma , were r and omly assigned in a 1:1 ratio to receive either cold-adapted trivalent live attenuated influenza vaccine ( a refrigeration-stable formulation of live attenuated intranasally administered influenza vaccine ) or trivalent inactivated vaccine in a double-blind manner . Influenza-like illness was monitored with cultures throughout the 2004 - 2005 influenza season . RESULTS Safety data were available for 8352 children , and 7852 children completed the study according to the protocol . There were 54.9 % fewer cases of cultured-confirmed influenza in the group that received live attenuated vaccine than in the group that received inactivated vaccine ( 153 vs. 338 cases , P<0.001 ) . The superior efficacy of live attenuated vaccine , as compared with inactivated vaccine , was observed for both antigenically well-matched and drifted viruses . Among previously unvaccinated children , wheezing within 42 days after the administration of dose 1 was more common with live attenuated vaccine than with inactivated vaccine , primarily among children 6 to 11 months of age ; in this age group , 12 more episodes of wheezing were noted within 42 days after receipt of dose 1 among recipients of live attenuated vaccine ( 3.8 % ) than among recipients of inactivated vaccine ( 2.1 % , P=0.076 ) . Rates of hospitalization for any cause during the 180 days after vaccination were higher among the recipients of live attenuated vaccine who were 6 to 11 months of age ( 6.1 % ) than among the recipients of inactivated vaccine in this age group ( 2.6 % , P=0.002 ) . CONCLUSIONS Among young children , live attenuated vaccine had significantly better efficacy than inactivated vaccine . An evaluation of the risks and benefits indicates that live attenuated vaccine should be a highly effective , safe vaccine for children 12 to 59 months of age who do not have a history of asthma or wheezing . ( Clinical Trials.gov number , NCT00128167 [ Clinical Trials.gov ] . ) BACKGROUND The efficacy of influenza vaccines may vary annually . In 2004 - 2005 , when antigenically drifted viruses were circulating , a r and omized , placebo-controlled trial involving healthy adults showed that inactivated vaccine appeared to be efficacious , whereas live attenuated vaccine appeared to be less so . METHODS In 2005 - 2006 , we continued our trial , examining the absolute and relative efficacies of the live attenuated and inactivated vaccines in preventing laboratory-confirmed symptomatic influenza . RESULTS A total of 2058 persons were vaccinated in October and November 2005 . Study wide influenza activity was prolonged but of low intensity ; type A ( H3N2 ) virus was circulating , which was antigenically similar to the vaccine strain . The absolute efficacy of the inactivated vaccine was 16 % ( 95 % confidence interval [ CI ] , -171 % to 70 % ) for the virus identification end point ( virus isolation in cell culture or identification through polymerase chain reaction ) and 54 % ( 95 % CI , 4%-77 % ) for the primary end point ( virus isolation or increase in serum antibody titer ) . The absolute efficacies of the live attenuated vaccine  for these end points were 8 % ( 95 % CI , -194 % to 67 % ) and 43 % ( 95 % CI , -15 % to 71 % ) , respectively . CONCLUSIONS With serologic end points included , efficacy was demonstrated for the inactivated vaccine in a year with low influenza attack rates . The efficacy of the live attenuated vaccine was slightly less than that of the inactivated vaccine , but not statistically greater than that of the placebo BACKGROUND The efficacy of influenza vaccines may decline during years when the circulating viruses have antigenically drifted from those included in the vaccine . METHODS We carried out a r and omized , double-blind , placebo-controlled trial of inactivated and live attenuated influenza vaccines in healthy adults during the 2004 - 2005 influenza season and estimated both absolute and relative efficacies . RESULTS A total of 1247 persons were vaccinated between October and December 2004 . Influenza activity in Michigan began in January 2005 with the circulation of an antigenically drifted type A ( H3N2 ) virus , the A/California/07/2004-like strain , and of type B viruses from two lineages . The absolute efficacy of the inactivated vaccine against both types of virus was 77 % ( 95 % confidence interval [ CI ] , 37 to 92 ) as measured by isolating the virus in cell culture , 75 % ( 95 % CI , 42 to 90 ) as measured by either isolating the virus in cell culture or identifying it through real-time polymerase chain reaction , and 67 % ( 95 % CI , 16 to 87 ) as measured by either isolating the virus or observing a rise in the serum antibody titer . The absolute efficacies of the live attenuated vaccine were 57 % ( 95 % CI , -3 to 82 ) , 48 % ( 95 % CI , -7 to 74 ) , and 30 % ( 95 % CI , -57 
    Output:
    