Tags

Type your tag names separated by a space and hit enter

Vaccines for preventing influenza in people with asthma.

Abstract

BACKGROUND

Influenza vaccination is recommended for asthmatic patients in many countries as observational studies have shown that influenza infection can be associated with asthma exacerbations. However, influenza vaccination has the potential to cause wheezing and adversely affect pulmonary function. While an overview concluded that there was no clear benefit of influenza vaccination in patients with asthma, this conclusion was not based on a systematic search of the literature.

OBJECTIVES

The objective of this review was to assess the efficacy and safety of influenza vaccination in children and adults with asthma.

SEARCH METHODS

We searched the Cochrane Airways Group trials register and reviewed reference lists of articles. The latest search was carried out in November 2012.

SELECTION CRITERIA

We included randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. We excluded studies involving people with chronic obstructive pulmonary disease.

DATA COLLECTION AND ANALYSIS

Inclusion criteria and assessment of trial quality were applied by two review authors independently. Data extraction was done by two review authors independently. Study authors were contacted for missing information.

MAIN RESULTS

Nine trials were included in the first published version of this review, and nine further trials have been included in four updates. The included studies cover a wide diversity of people, settings and types of influenza vaccination, and we pooled data from the studies that employed similar vaccines. PROTECTIVE EFFECTS OF INACTIVATED INFLUENZA VACCINE DURING THE INFLUENZA SEASON: A single parallel-group trial, involving 696 children, was able to assess the protective effects of influenza vaccination. There was no significant reduction in the number, duration or severity of influenza-related asthma exacerbations. There was no difference in the forced expiratory volume in one second (FEV) although children who had been vaccinated had better symptom scores during influenza-positive weeks. Two parallel-group trials in adults did not contribute data to these outcomes due to very low levels of confirmed influenza infection. ADVERSE EFFECTS OF INACTIVATED INFLUENZA VACCINE IN THE FIRST TWO WEEKS FOLLOWING VACCINATION: Two cross-over trials involving 1526 adults and 712 children (over three years old) with asthma compared inactivated trivalent split-virus influenza vaccine with a placebo injection. These trials excluded any clinically important increase in asthma exacerbations in the two weeks following influenza vaccination (risk difference 0.014; 95% confidence interval -0.010 to 0.037). However, there was significant heterogeneity between the findings of two trials involving 1104 adults in terms of asthma exacerbations in the first three days after vaccination with split-virus or surface-antigen inactivated vaccines. There was no significant difference in measures of healthcare utilisation, days off school/symptom-free days, mean lung function or medication usage.EFFECTS OF LIVE ATTENUATED (INTRANASAL) INFLUENZA VACCINATION: There were no significant differences found in exacerbations or measures of lung function following live attenuated cold recombinant vaccine versus placebo in two small studies on 17 adults and 48 children. There were no significant differences in asthma exacerbations found for the comparison live attenuated vaccine (intranasal) versus trivalent inactivated vaccine (intramuscular) in one study on 2229 children (over six years of age).

AUTHORS' CONCLUSIONS

Uncertainty remains about the degree of protection that vaccination affords against asthma exacerbations that are related to influenza infection. Evidence from more recently published randomised trials of inactivated split-virus influenza vaccination indicates that there is no significant increase in asthma exacerbations immediately after vaccination in adults or children over three years of age. We were unable to address concerns regarding possible increased wheezing and hospital admissions in infants given live intranasal vaccination.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Population Health Sciences and Education, St George’s, University of London, London, UK.ccates@sgul.ac.uk.

    Source

    MeSH

    Adult
    Asthma
    Child
    Disease Progression
    Humans
    Influenza Vaccines
    Influenza, Human
    Randomized Controlled Trials as Topic
    Vaccines, Inactivated

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23450529

    Citation

    Cates, Christopher J., and Brian H. Rowe. "Vaccines for Preventing Influenza in People With Asthma." The Cochrane Database of Systematic Reviews, 2013, p. CD000364.
    Cates CJ, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev. 2013.
    Cates, C. J., & Rowe, B. H. (2013). Vaccines for preventing influenza in people with asthma. The Cochrane Database of Systematic Reviews, (2), p. CD000364. doi:10.1002/14651858.CD000364.pub4.
    Cates CJ, Rowe BH. Vaccines for Preventing Influenza in People With Asthma. Cochrane Database Syst Rev. 2013 Feb 28;(2)CD000364. PubMed PMID: 23450529.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vaccines for preventing influenza in people with asthma. AU - Cates,Christopher J, AU - Rowe,Brian H, Y1 - 2013/02/28/ PY - 2013/3/2/entrez PY - 2013/3/2/pubmed PY - 2013/3/30/medline SP - CD000364 EP - CD000364 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Influenza vaccination is recommended for asthmatic patients in many countries as observational studies have shown that influenza infection can be associated with asthma exacerbations. However, influenza vaccination has the potential to cause wheezing and adversely affect pulmonary function. While an overview concluded that there was no clear benefit of influenza vaccination in patients with asthma, this conclusion was not based on a systematic search of the literature. OBJECTIVES: The objective of this review was to assess the efficacy and safety of influenza vaccination in children and adults with asthma. SEARCH METHODS: We searched the Cochrane Airways Group trials register and reviewed reference lists of articles. The latest search was carried out in November 2012. SELECTION CRITERIA: We included randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. We excluded studies involving people with chronic obstructive pulmonary disease. DATA COLLECTION AND ANALYSIS: Inclusion criteria and assessment of trial quality were applied by two review authors independently. Data extraction was done by two review authors independently. Study authors were contacted for missing information. MAIN RESULTS: Nine trials were included in the first published version of this review, and nine further trials have been included in four updates. The included studies cover a wide diversity of people, settings and types of influenza vaccination, and we pooled data from the studies that employed similar vaccines. PROTECTIVE EFFECTS OF INACTIVATED INFLUENZA VACCINE DURING THE INFLUENZA SEASON: A single parallel-group trial, involving 696 children, was able to assess the protective effects of influenza vaccination. There was no significant reduction in the number, duration or severity of influenza-related asthma exacerbations. There was no difference in the forced expiratory volume in one second (FEV) although children who had been vaccinated had better symptom scores during influenza-positive weeks. Two parallel-group trials in adults did not contribute data to these outcomes due to very low levels of confirmed influenza infection. ADVERSE EFFECTS OF INACTIVATED INFLUENZA VACCINE IN THE FIRST TWO WEEKS FOLLOWING VACCINATION: Two cross-over trials involving 1526 adults and 712 children (over three years old) with asthma compared inactivated trivalent split-virus influenza vaccine with a placebo injection. These trials excluded any clinically important increase in asthma exacerbations in the two weeks following influenza vaccination (risk difference 0.014; 95% confidence interval -0.010 to 0.037). However, there was significant heterogeneity between the findings of two trials involving 1104 adults in terms of asthma exacerbations in the first three days after vaccination with split-virus or surface-antigen inactivated vaccines. There was no significant difference in measures of healthcare utilisation, days off school/symptom-free days, mean lung function or medication usage.EFFECTS OF LIVE ATTENUATED (INTRANASAL) INFLUENZA VACCINATION: There were no significant differences found in exacerbations or measures of lung function following live attenuated cold recombinant vaccine versus placebo in two small studies on 17 adults and 48 children. There were no significant differences in asthma exacerbations found for the comparison live attenuated vaccine (intranasal) versus trivalent inactivated vaccine (intramuscular) in one study on 2229 children (over six years of age). AUTHORS' CONCLUSIONS: Uncertainty remains about the degree of protection that vaccination affords against asthma exacerbations that are related to influenza infection. Evidence from more recently published randomised trials of inactivated split-virus influenza vaccination indicates that there is no significant increase in asthma exacerbations immediately after vaccination in adults or children over three years of age. We were unable to address concerns regarding possible increased wheezing and hospital admissions in infants given live intranasal vaccination. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/23450529/Vaccines_for_preventing_influenza_in_people_with_asthma_ L2 - https://doi.org/10.1002/14651858.CD000364.pub4 DB - PRIME DP - Unbound Medicine ER -