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:
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.
