Hospitalization for infection appears to be a short-term risk factor for stroke,863 although it is unclear what, if any, management implications this has for patients. An increase in cardiovascular deaths has long been observed in association with influenza.864,865 A retrospec- tive study found that treatment with an antiviral agent within 2 days of an influenza diagnosis was associated with a 28% reduction (HR, 0.72; 95% CI, 0.62 0.82) in the risk of stroke or TIA over the ensuing 6 months.866 One case-control study867 of influenza vaccination demonstrate a reduced risk of stroke associated with vaccination. A pro- spective study in Taiwan found that influenza vaccination of people >65 years of age was associated with lower all-cause mortality, including a 65% reduction in stroke (HR, 0.35; 95% However, because of the risk of bias, ran- domized trials have been advocated.870 Although all people at increased risk of complications from influenza should receive influenza vaccinations on the basis of evidence including ran- domized trials, influenza vaccination is recommended by the AHA/ACC for the secondary prevention of CVD. There have been no recommendations for influenza vaccination in the primary prevention of stroke. No studies have identified any increase in the risk of stroke after influenza vaccinations.871 Inflammation and Infection: Recommendations 1. Patients with chronic inflammatory disease such as RA or SLE should be considered at increased risk of stroke (Class I; Level of Evidence B). 2. Annual influenza vaccination can be useful in lower- ing stroke risk in patients at risk of stroke (Class IIa; Level of Evidence B). 3. 