Beck, Charles R and McKenzie, Bruce C and Hashim, Ahmed B and Harris, Rebecca C and Zanuzdana, Arina and Agboado, Gabriel and Orton, Elizabeth and Béchard-Evans, Laura and Morgan, Gemma and Stevenson, Charlotte and Weston, Rachel and Mukaigawara, Mitsuru and Enstone, Joanne and Augustine, Glenda and Butt, Mobasher and Kim, Sophie and Puleston, Richard and Dabke, Girija and Howard, Robert and O'Boyle, Julie and O'Brien, Mary and Ahyow, Lauren and Denness, Helene and Farmer, Siobhan and Figureroa, Jose and Fisher, Paul and Greaves, Felix and Haroon, Munib and Haroon, Sophie and Hird, Caroline and Isba, Rachel and Ishola, David A and Kerac, Marko and Parish, Vivienne and Roberts, Jonathan and Rosser, Julia and Theaker, Sarah and Wallace, Dean and Wigglesworth, Neil and Lingard, Liz and Vinogradova, Yana and Horiuchi, Hiroshi and Peñalver, Javier and Nguyen-Van-Tam, Jonathan S (2011) Influenza vaccination for immunocompromised patients : systematic review and meta-analysis from a public health policy perspective. PLoS ONE, 6 (12). e29249. ISSN 1932-6203
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Abstract
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 were synthesised 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 seasonal influenza 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 is generally weak, although the directions of effects are consistent. Areas for further research are identified.