Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis |
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| Institution: | 1. Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada;2. Public Health Branch, Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada;3. University of Manitoba Libraries, Winnipeg, Manitoba, Canada;4. George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada;5. Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada;6. Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada;1. Health Sciences North Research Institute, Sudbury, ON, Canada;2. Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada;1. Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore, Singapore;2. Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #09-01, 117549 Singapore, Singapore;3. Yale-NUS College, National University of Singapore, 16 College Avenue West #01-220, 138527 Singapore, Singapore;4. School of Tropical Medicine and Global Health, Nagasaki University Institute of Tropical Medicine, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan;5. London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;6. Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232 Singapore, Singapore;1. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands;2. Unit of Pharmacoepidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands;3. British Columbia Centre for Disease Control, Vancouver, BC, Canada;4. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada;5. Eindhoven University of Technology, Eindhoven, Netherlands;6. Institute of Environmental Science and Research, Wallaceville, New Zealand;7. Instituto de Salud Pública, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain;8. CIBER Epidemiología y Salud Pública, Spain;9. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;10. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;11. Unit for Vaccination Programs, Department of Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden;12. Lithuanian University of Health Sciences, Kaunas, Lithuania;13. Taiwan Centers for Disease Control, Taipei, Taiwan;14. National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa;15. Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;p. Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Japan;q. Department of General Practice and Primary Care, University of Auckland, New Zealand |
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| Abstract: | IntroductionOlder adults are prioritized for influenza vaccination but also have lowered antibody responses to the vaccine. Higher-doses of influenza antigen may increase immune response and thus be more effective. Our objectives were to compare the efficacy and safety of the high-dose influenza vaccine to the standard-dose influenza vaccine in the elderly (age > 65).MethodsData sources: Randomized trials (RCTs) from Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley), ClinicalTrials.gov, reference lists of relevant articles, and gray literature.Study selection: Two reviewers independently identified RCTs comparing high-dose influenza vaccine (60 μg of hemagglutinin per strain) to standard-dose influenza vaccine (15 μg of hemagglutinin per strain) in adults over the age of 65 years.Data extraction: Two reviewers independently extracted trial-level data including population characteristics, interventions, outcomes, and funding sources. Risk of bias was assessed using the Cochrane Risk of Bias tool.ResultsWe included seven eligible trials; all were categorized as having a low (n = 3) or unclear (n = 4) risk of bias. Patients receiving the high-dose vaccine had significantly less risk of developing laboratory-confirmed influenza infections (Relative Risk 0.76, 95%CI 0.65 to 0.90; I2 0%, 2 trials, 41,141 patients). Post-vaccination geometric mean titres and seroprotection rates were also higher in high-dose vaccine recipients. There were no protocol-defined serious adverse events in the included trials in either group.ConclusionsIn elderly adults, the high-dose influenza vaccine was well-tolerated, more immunogenic, and more efficacious in preventing influenza infections than the standard-dose vaccine. Further pragmatic trials are needed to determine if the higher efficacy translates into higher vaccine effectiveness in adults over the age of 65. |
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| Keywords: | Influenza Influenza vaccines High-dose Randomized control trial Systematic review Meta-analysis |
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