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BackgroundUntil recently, trivalent influenza vaccines (TIV) have contained one influenza B virus, recommended annually by the WHO vaccine selection committee. Quadrivalent Influenza Vaccines (QIV) add protection against a second B lineage; preventing the threat of a vaccine mismatched season, which often occurs in the Northern Hemisphere, leading to reduced vaccine effectiveness (VE) and increased influenza morbidity and mortality. Young children have one of the highest clinical burdens in Ireland, with the highest age-specific rate for influenza cases admitted to critical care units generally in children aged 0–4 years. Additionally, school-aged children are a major source of community transmission.AimTo assess the benefit of a QIV in the Irish paediatric population.MethodsA literature review was conducted comparing QIV to TIV, focusing on VE and cost-effectiveness (CE). The VE of live-attenuated influenza vaccine (LAIV) compared to inactivated influenza vaccine (IIV) in children was also studied. The Cochrane database of systematic reviews, the Cochrane Central Register of Controlled Trials, PubMed, the Lancet, and publications from the European projects I-MOVE/I-MOVE+ and VENICE were searched for publications between 2009–2018.ResultsRecent influenza seasons suggest a higher VE of QIV compared to TIV. Studies have shown that QIV is as effective as TIV for the strains included in both; however QIV has superior immunogenicity for the additional B strain when there is a mismatch season. These results are also reflected in pre-licensing studies of the immunogenicity of QIVs that are now approved.LAIV has been recommended due to higher VE against influenza B strains and the ease and acceptability of the intranasal vaccination compared to the injectable IIV.QIV are more expensive than TIV, however CE analyses indicate that QIV delivers substantial savings in terms of preventing direct healthcare costs through reductions in infection numbers, hospitalisations and deaths; resulting in quality-adjusted life years gained. There are also substantial societal benefits through indirect savings in productivity (preventing employee/caregiver absences). Rolling out QIV to children was the most cost-effective vaccination strategy in the UK (aged 2–11 years) and in European countries (4–16 years) partaking in the I-MOVE+ project, with the exception of Portugal.ConclusionQIV would stabilise the VE across influenza seasons; eliminating the uncertainty of predicting the influenza B lineage, ultimately increasing public confidence in the vaccine, resulting in increased vaccine uptake. Broader protection in the paediatric population would directly reduce influenza transmission and indirectly protect vulnerable populations in the community.

For those who follow politics and read the daily newspaper, the Post-Gazette's endorsement of Republican James Roddey for Allegheny County executive was to be expected (\"Roddey for Executive,\" Oct. 24). What did come as a surprise were some of the misleading reasons for the endorsement. Furthermore, the endorsement leads readers to believe that those who support Roddey's opponent, Dr. Cyril Wecht, are old political hacks who are living in the past. The endorsement stated that Mr. Roddey was no career politician. While he may never have held an elective office, he is nonetheless, very political. According to your endorsement, Roddey has served on several boards of governmental agencies. Beyond that, many of the contracts held by his private enterprise are with governmental agencies. It is quite obvious that one doesn't have to hold an elected office to be a \"career politician.\" Cyril Wecht may be part of the old school, but he is very much attuned to the needs of Allegheny County and he is not afraid of change when he feels that it is necessary. If one wants a county executive who has a vision of moving this region forward but who remains sensitive to the needs of the common taxpayer, then Cyril Wecht is the clear choice for county executive.

Brett Kavanaugh has just been sworn in at a private ceremony as an associate justice on the U.S. Supreme Court. Hours after his confirmation by the full Senate voting in a dramatic Saturday session, 50 to 48, cementing Kavanaugh's lifelong appointment to the nation's highest court. Vice President Pence presiding over the historic moment set against the backdrop of protests on the Capitol steps. But neither demonstrators nor opposing Democratic senators could halt the momentum of recent days that push Kavanaugh past allegations of sexual misconduct. It's a victory for him, for Senate Republicans and President Trump who watched the vote while aboard Air Force One enroute to Kansas. In a tweet, Mister Trump congratulating the U.S. Senate for confirming, quote, \"Our great nominee.\"

Anti-Kavanaugh activists confronts GOP Senator hours before the stunning reversal of the Supreme Court nomination. Senator Jeff Flake said that he will support Brett Kavanaugh's nomination but after a few moments, he then said that he will if an FBI investigation will happen. This then provoked the President to order an FBI probe that he tried to prevent in the past few weeks. A hot mic moment catches senators debating Brett Kavanaugh's FBI investigation. President Trump on Friday ordered the FBI to conduct a limited supplemental background investigation into the allegations of sexual assault against Supreme Court nominee Brett Kavanaugh, as Senate Majority Leader Mitch McConnell said Republicans are moving forward with plans to vote. GUESTS: Margaret Judson, Gary Shteyngart, Barbara Boxer; Val Demings; Libby Casey; Shawn Henry; Nancy Erika Smith