The efficacy and safety of influenza vaccination in older people: An umbrella review of evidence from meta-analyses of both observational and randomized controlled studies |
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| Affiliation: | 1. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy;2. Primary Care Department, USL Toscana Sud Est-Grosseto, Italy;3. Primary Care Department, AAS3 Alto Friuli e Collinare e Medio Friuli, Udine, Italy;4. WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium;5. Geriatrics Department, Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), School of Medicine, Universitat Pompeu Fabra. Barcelona, Spain;6. Eskisehir City Hospital Department of Geriatric Medicine, Turkey;7. Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey;8. Neurosciences Department, University of Padua, Padua, Italy;9. Padua Neuroscience Center, University of Padua, Padua, Italy;10. Department of Medicine, University of Udine, Udine, Italy;11. Department of Biomedical, Metabolic and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy;12. The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK;13. Dept. Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy;14. Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy;15. Medical University of Geneva (CH), Switzerland;p. Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany;q. Clinic of Infectious Diseases, University of Bari, Italy;r. Italian Agency for Development Cooperation, Khartoum, Sudan;s. National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy |
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| Abstract: | Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination including systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for influenza/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for influenza/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes. |
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| Keywords: | Flu Influenza Vaccination Older people umbrella review |
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