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Influenza vaccination for immunocompromised patients: systematic review and meta-analysis by etiology

Research output: Contribution to Journal/MagazineJournal articlepeer-review

  • Charles R. Beck
  • Bruce C. McKenzie
  • Ahmed B. Hashim
  • Rebecca C. Harris
  • Jonathan S. Nguyen-Van-Tam
  • University of Nottingham Influenza and the ImmunoCompromised (UNIIC) Study Group,
  • Rachel Isba
<mark>Journal publication date</mark>2012
<mark>Journal</mark>The Journal of infectious diseases
Issue number8
Number of pages10
Pages (from-to)1250-1259
Publication StatusPublished
<mark>Original language</mark>English


Many national guidelines recommend annual influenza vaccination of immunocompromised patients, although the decision to vaccinate is usually at clinical discretion. We conducted a systematic review and meta-analyses to assess the evidence for influenza vaccination in this group, and we report our results by etiology. Meta-analyses showed significantly lower odds of influenza-like illness after vaccination in patients with human immunodeficiency virus (HIV) infection, patients with cancer, and transplant recipients and of laboratory-confirmed influenza in HIV-positive patients, compared with patients receiving placebo or no vaccination. Pooled odds of seroconversion and seroprotection were typically lower in HIV-positive patients, patients with cancer, and transplant recipients, compared with immunocompetent controls. Vaccination was generally well tolerated, with variation in mild adverse events between etiological groups. Limited evidence of a transient increase in viremia and a decrease in the percentage of CD4(+) cells in HIV-positive patients was found although not accompanied by worsening of clinical symptoms. Clinical judgment remains important when discussing the benefits and safety profile with immunocompromised patients.