Effectiveness of Influenza Vaccination in Institutionalized Older Adults: A Systematic Review |
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| Affiliation: | 1. Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China;2. Division of Geriatrics, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China;3. Division of Infectious Disease, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China;1. Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia;2. Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK;3. Centre of International Child Health, Section of Paediatrics, Department of Medicine, Imperial College London, St Mary''s Campus, London, UK;1. Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands;2. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30 001, 9700 RB Groningen, the Netherlands;3. Medical Research Council Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge. UK. CB2 0SR;4. Toronto Health Economics and Technology Assessment collaborative, University of Toronto, 144 College st. Rm:685, Toronto ON M5S3M2, Canada;5. Department of Respiratory Infections of the Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands;1. Gérontopôle, Service de Médecine Interne Gériatrique du Pr B. Vellas, CHU Toulouse Hôpital Casselardit, Toulouse, France;2. Pôle Cardiovasculaire et Métabolique, CHU Hopital Rangueil, Toulouse, France;3. Inserm U1027, Toulouse, France;1. INSERM, UMR_S 912, «Sciences Economiques & Sociales de la Santé et Traitement de l’Information Médicale» (SESSTIM), F-13385 Marseille, France;2. ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, F-13006 Marseille, France;3. Aix Marseille University, Department of General Practice, Marseille, France;4. Aix Marseille Université, UMR_S 912, IRD, Marseille, F-13385 Marseille, France;1. Sanofi Pasteur, 1 Discovery Drive, Swiftwater, PA 18370, United States;2. Vanderbilt University Medical Center, A2200 MCN 1161 21st Ave S, Nashville, TN 37232, United States;3. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States;1. Novartis Vaccines & Diagnostics, GmbH Marburg, Germany;2. Seqirus Netherlands B.V., Amsterdam, The Netherlands;3. Novartis Vaccines and Diagnostics, S.p.A., Siena, Italy;4. Biologics Consulting Group, Inc., Alexandria, VA, USA;5. Seqirus Inc., Cambridge, MA, USA |
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| Abstract: | IntroductionInfluenza infection is common among institutionalized older adults. Many nonrandomized observational studies on influenza vaccination suggested that it could reduce influenza-related hospitalizations and mortality in institutionalized older adults. Criticism regarding the effectiveness of influenza vaccine estimated by nonrandomized observational studies include the frailty selection bias and use of nonspecific outcome, such as all-cause mortality.MethodsWe conducted a systematic review of studies of influenza vaccination in institutionalized older adults to determine the effects on clinical outcomes. We searched for studies from 3 databases from 1946 to June 2013 assessing effectiveness against influenza infection. We selected studies with good comparability between vaccine group and control group. We expressed vaccine effectiveness (VE) as a proportion, using the formula VE = 1–relative risk or 1–odds ratio. We focused on the following outcomes: influenza-like illness (ILI), laboratory confirmed influenza, hospitalizations due to ILI, or pneumonia and death due to influenza or pneumonia. We did not include all-cause mortality.ResultsEleven studies that satisfied the inclusion criteria were identified, representing 11,262 institutionalized older adults. After meta-analysis, we found a significant reduction in pneumonia (VE: 37%, 95% confidence interval [CI]: 18%–53%, P = .001) and death due to pneumonia or influenza (VE: 34%, CI: 10%–53%, P = .01). There was no significant heterogeneity between studies. There was no significant publication bias.ConclusionInfluenza vaccination in institutionalized older adults could reduce pneumonia and death due to pneumonia or influenza. Influenza vaccination is recommended for institutionalized older adults. |
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| Keywords: | Influenza vaccination efficacy institutionalized older adults review meta-analysis |
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