Dataset Information

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

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 I(2) 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 patie nts 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.

SUBMITTER: Beck CR

PROVIDER: S-EPMC3245259 | biostudies-literature | 2011

REPOSITORIES: biostudies-literature

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Publications

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Beck Charles R CR McKenzie Bruce C BC Hashim Ahmed B AB Harris Rebecca C RC Zanuzdana Arina A Agboado Gabriel G Orton Elizabeth E Béchard-Evans Laura L Morgan Gemma G Stevenson Charlotte C Weston Rachel R Mukaigawara Mitsuru M Enstone Joanne J Augustine Glenda G Butt Mobasher M Kim Sophie S Puleston Richard R Dabke Girija G Howard Robert R O'Boyle Julie J O'Brien Mary M Ahyow Lauren L Denness Helene H Farmer Siobhan S Figureroa Jose J Fisher Paul P Greaves Felix F Haroon Munib M Haroon Sophie S Hird Caroline C Isba Rachel R Ishola David A DA Kerac Marko M Parish Vivienne V Roberts Jonathan J Rosser Julia J Theaker Sarah S Wallace Dean D Wigglesworth Neil N Lingard Liz L Vinogradova Yana Y Horiuchi Hiroshi H Peñalver Javier J Nguyen-Van-Tam Jonathan S JS

PloS one 20111222 12

<h4>Background</h4>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.<h4>Methodology/principal findings</h4>Electronic databases and grey literature were searched and records were screene ...[more]

PMID: 22216224

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Project description:Prior experience and the persisting threat of influenza pandemic indicate the need for global and local preparedness and public health response capacity. The pandemic of 2009 highlighted the importance of such planning and the value of prior efforts at all levels. Our review of the public health response to this pandemic in Pune, India, considers the challenges of integrating global and national strategies in local programmes and lessons learned for influenza pandemic preparedness.Global, national and local pandemic preparedness and response plans have been reviewed. In-depth interviews were undertaken with district health policy-makers and administrators who coordinated the pandemic response in Pune.In the absence of a comprehensive district-level pandemic preparedness plan, the response had to be improvised. Media reporting of the influenza pandemic and inaccurate information that was reported at times contributed to anxiety in the general public and to widespread fear and panic. Additional challenges included inadequate public health services and reluctance of private healthcare providers to treat people with flu-like symptoms. Policy-makers developed a response strategy that they referred to as the Pune plan, which relied on powers sanctioned by the Epidemic Act of 1897 and resources made available by the union health ministry, state health department and a government diagnostic laboratory in Pune.The World Health Organization's (WHO's) global strategy for pandemic control focuses on national planning, but state-level and local experience in a large nation like India shows how national planning may be adapted and implemented. The priority of local experience and requirements does not negate the need for higher level planning. It does, however, indicate the importance of local adaptability as an essential feature of the planning process. Experience and the implicit Pune plan that emerged are relevant for pandemic preparedness and other public health emergencies.

Dataset Information

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Background

Methodology/principal findings

Conclusions/significance

Publications

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

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