Rights statement: Copyright: 2011 Beck et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Influenza vaccination for immunocompromised patients
T2 - systematic review and meta-analysis from a public health policy perspective
AU - Beck, Charles R
AU - McKenzie, Bruce C
AU - Hashim, Ahmed B
AU - Harris, Rebecca C
AU - Zanuzdana, Arina
AU - Agboado, Gabriel
AU - Orton, Elizabeth
AU - Béchard-Evans, Laura
AU - Morgan, Gemma
AU - Stevenson, Charlotte
AU - Weston, Rachel
AU - Mukaigawara, Mitsuru
AU - Enstone, Joanne
AU - Augustine, Glenda
AU - Butt, Mobasher
AU - Kim, Sophie
AU - Puleston, Richard
AU - Dabke, Girija
AU - Howard, Robert
AU - O'Boyle, Julie
AU - O'Brien, Mary
AU - Ahyow, Lauren
AU - Denness, Helene
AU - Farmer, Siobhan
AU - Figureroa, Jose
AU - Fisher, Paul
AU - Greaves, Felix
AU - Haroon, Munib
AU - Haroon, Sophie
AU - Hird, Caroline
AU - Isba, Rachel
AU - Ishola, David A
AU - Kerac, Marko
AU - Parish, Vivienne
AU - Roberts, Jonathan
AU - Rosser, Julia
AU - Theaker, Sarah
AU - Wallace, Dean
AU - Wigglesworth, Neil
AU - Lingard, Liz
AU - Vinogradova, Yana
AU - Horiuchi, Hiroshi
AU - Peñalver, Javier
AU - Nguyen-Van-Tam, Jonathan S
N1 - Copyright: 2011 Beck et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2011/12/22
Y1 - 2011/12/22
N2 - Background: Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.Methodology/Principal Findings: Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results weresynthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I2 and publication bias was assessed using Begg’s funnel plot and Egger’s regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p,0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patients compared to placebo or unvaccinated controls.We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonalinfluenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.Conclusions/Significance: Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed isgenerally weak, although the directions of effects are consistent. Areas for further research are identified.
AB - Background: Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.Methodology/Principal Findings: Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results weresynthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I2 and publication bias was assessed using Begg’s funnel plot and Egger’s regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p,0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patients compared to placebo or unvaccinated controls.We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonalinfluenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.Conclusions/Significance: Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed isgenerally weak, although the directions of effects are consistent. Areas for further research are identified.
U2 - 10.1371/journal.pone.0029249
DO - 10.1371/journal.pone.0029249
M3 - Journal article
C2 - 22216224
VL - 6
SP - e29249
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 12
ER -