BMJ Qual Saf 20:432-439 doi:10.1136/bmjqs.2010.047316
  • Original research

Flu and pneumococcal immunisations in HIV-infected children: methodological quality of current recommendations

  1. Alfredo Guarino1
  1. 1Department of Paediatrics, University ‘Federico II,’ Naples, Italy
  2. 2Paediatric Clinic, L Sacco Hospital, University of Milan, Milan, Italy
  1. Correspondence to Professor Alfredo Guarino, Department of Paediatrics, University ‘Federico II,’ Via S Pansini 5, 80131, Naples, Italy; alfguari{at}
  • Accepted 20 December 2010
  • Published Online First 2 February 2011


Objective To assess the quality of guidelines, consensus statements and systematic reviews on flu and pneumococcal immunisations in HIV-infected children.

Method The authors screened PubMed and Embase databases until the year 2009 for guidelines, consensus statements and systematic reviews on flu and pneumococcal immunisations in HIV-infected patients. The authors also explored relevant websites of agencies/institutions involved with HIV infection, immunisation or guidelines. The Appraisal of Guidelines for Research and Evaluation instrument and the checklists of the Scottish Intercollegiate Guidelines Network were used to evaluate the scientific quality of guidelines and systematic reviews.

Results Eighteen articles were identified. Only one guideline was of good overall quality. Generally the weakest domains were ‘Applicability’ and ‘Editorial Independence.’ Although of poor methodological quality, the main recommendations on flu and pneumococcus vaccinations were similar. There were minor differences in the type of pneumococcal vaccines in relation to patient's age, namely based on the settings in which recommendations were produced.

Conclusions Although guidelines and systematic reviews on flu and pneumococcal vaccination in HIV-infected children came from authoritative institutions, their overall quality is poor, with the weakest fields being the methodological domains.


  • Funding The study was partially supported by a grant from the Italian Ministry of Health (Cdr 188BGCTRGU).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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