Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis |
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| Institution: | 1. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada;2. University of Toronto, Toronto, Ontario M5S 1A1, Canada;3. McMaster University, Hamilton, Ontario L8S 4L8, Canada;4. Hamilton Health Sciences, Hamilton, Ontario L8N 3Z5, Canada;5. Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario L8S 4L8, Canada;6. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada;1. WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia;2. Department of Infectious Diseases/Infection Prevention, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia;3. Fielding School of Public Health, University of California, Los Angeles, USA;4. School of Population and Global Health, University of Melbourne, Melbourne, Australia;1. WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China;2. Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital and Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China;3. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China;4. WHO Collaborating Center for Reference and Research on Influenza at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia;5. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA;6. Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia;1. The University of Sydney, School of Public Health, Sydney, New South Wales 2006, Australia;2. National Centre for Immunisation Research and Surveillance, Westmead, New South Wales 2145, Australia;3. Robinson Research Institute and Adelaide Medical School, University of Adelaide and Women''s and Children''s Health Network, Adelaide, South Australia 5006, Australia;4. Discipline of Paediatrics, School of Medicine and Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, GPO Box D184, Perth, Western Australia 6840, Australia;5. Perth Children’s Hospital, Hospital Avenue, Nedlands, Western Australia 6009, Australia;6. The University of Sydney, Discipline of Child and Adolescent Health, Sydney, New South Wales 2006, Australia;7. The University of Sydney, Susan Wakil School of Nursing and Midwifery, 88 Mallett St, Camperdown, New South Wales 2006, Australia;8. The University of Sydney, Sydney Health Ethics, Sydney, NSW 2006, Australia;1. Department of Health Sciences, University of Genoa, Genoa, Italy;2. Vaccines Research Unit, FISABIO-Public Health, Valencia, Spain;1. Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal (QC) Canada;2. Research Institute – CHU Sainte Justine, Montreal (QC) Canada;3. Faculty of Nursing, University of Alberta, Edmonton (AB) Canada;4. Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver (BC) Canada;5. Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver (BC) Canada;6. Department of Pediatric Laboratory Medicine, CHU Sainte-Justine, Montreal (QC) Canada;7. Infection Prevention & Control, CHU Sainte-Justine, Montreal (QC) Canada |
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| Abstract: | IntroductionVaccination against influenza on an annual basis is widely recommended, yet recent studies suggest consecutive vaccination may reduce vaccine effectiveness (VE).PurposeTo assess whether when examining the entirety of existing data consecutive influenza vaccination reduces VE compared to current season influenza vaccination.Data sourcesMEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 26, 2017; citations of included studies.Study selectionRandomized, controlled trials (RCTs) and observational studies of children, adults and/or the elderly that reported laboratory-confirmed influenza infection over 2 or more consecutive influenza seasons were eligible.Data extractionData related to study characteristics, participant demographics, cases of influenza infection by vaccination group and risk of bias assessment was extracted in duplicate.Data synthesisFive RCTs involving 11,987 participants did not show a significant reduction in VE when participants vaccinated in two consecutive seasons (VE 71%, 95% CI 62–78%) were compared to those vaccinated in the current season (VE 58%, 95% CI 48–66%) (odds ratio OR] 0.88, 95% CI 0.62–1.26, p = 0.49, I2 = 39%). Twenty-eight observational studies involving 28,627 participants also did not show a reduction (VE for two consecutive seasons 41%, 95% CI 30–51% compared to VE for current season 47%, 95% CI 39–54%; OR 1.14, 95% CI 0.98–1.32, p = 0.09, I2 = 63%). Results from subgroup analyses by influenza type/subtype, vaccine type, age, vaccine match and co-morbidity support these findings; however, dose–response results were inconsistent. Certainty in the evidence was assessed to be very low due to unexplained heterogeneity and imprecision.LimitationsThe inclusion of studies with relatively small sample sizes and low event rates contributed to the imprecision of summary VE and OR estimates, which were based on unadjusted data.ConclusionAvailable evidence does not support a reduction in VE with consecutive influenza vaccination, but the possibility of reduced effectiveness cannot be ruled out due to very low certainty in this evidence.Funding sourceCIHR Foundation Grant (PROSPERO: CRD42017059893). |
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| Keywords: | Influenza infection Consecutive vaccination Vaccine effectiveness Influenza vaccine Systematic review Meta-analysis |
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