Contributions to the evidence base for reducing the impact of influenza in primary care

Influenza can have a significant impact on both individual and societal level. This can be reduced by vaccination and usage of point-of-care tests in specific settings like the Emergency Department. De general physician plays a key role in implementing influenza vaccination. The attitude of the Dutch general physician towards influenza vaccination is generally in favour of vaccination, which is reflected by a majority of the GPs that is vaccinated against the flu and advises practice personnel to get vaccinated. This thesis found indications of a possible relevant effect of influenza vaccination on mortality in the younger elderly. Also, after extensive ethical and methodological considerations, it appears unlikely that a randomized controlled trial evaluating the long-term effect of influenza vaccination on mortality will ever be conducted. This thesis stresses the potency of long-term follow-up of intervention studies and the importance of considering ethical and methodological aspects of research when it comes to developing new influenza vaccination trials.