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 -