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Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis.
Vaccine 2017; 35(21):2775-2780V

Abstract

INTRODUCTION

Older adults are prioritized for influenza vaccination but also have lowered antibody responses to the vaccine. Higher-doses of influenza antigen may increase immune response and thus be more effective. Our objectives were to compare the efficacy and safety of the high-dose influenza vaccine to the standard-dose influenza vaccine in the elderly (age>65).

METHODS

Data sources: Randomized trials (RCTs) from Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley), ClinicalTrials.gov, reference lists of relevant articles, and gray literature.

STUDY SELECTION

Two reviewers independently identified RCTs comparing high-dose influenza vaccine (60μg of hemagglutinin per strain) to standard-dose influenza vaccine (15μg of hemagglutinin per strain) in adults over the age of 65years.

DATA EXTRACTION

Two reviewers independently extracted trial-level data including population characteristics, interventions, outcomes, and funding sources. Risk of bias was assessed using the Cochrane Risk of Bias tool.

RESULTS

We included seven eligible trials; all were categorized as having a low (n=3) or unclear (n=4) risk of bias. Patients receiving the high-dose vaccine had significantly less risk of developing laboratory-confirmed influenza infections (Relative Risk 0.76, 95%CI 0.65 to 0.90; I2 0%, 2 trials, 41,141 patients). Post-vaccination geometric mean titres and seroprotection rates were also higher in high-dose vaccine recipients. There were no protocol-defined serious adverse events in the included trials in either group.

CONCLUSIONS

In elderly adults, the high-dose influenza vaccine was well-tolerated, more immunogenic, and more efficacious in preventing influenza infections than the standard-dose vaccine. Further pragmatic trials are needed to determine if the higher efficacy translates into higher vaccine effectiveness in adults over the age of 65.

Authors+Show Affiliations

Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Public Health Branch, Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada. Electronic address: wilkinsk@myumanitoba.ca.Public Health Branch, Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada.University of Manitoba Libraries, Winnipeg, Manitoba, Canada.Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28431815

Citation

Wilkinson, Krista, et al. "Efficacy and Safety of High-dose Influenza Vaccine in Elderly Adults: a Systematic Review and Meta-analysis." Vaccine, vol. 35, no. 21, 2017, pp. 2775-2780.
Wilkinson K, Wei Y, Szwajcer A, et al. Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis. Vaccine. 2017;35(21):2775-2780.
Wilkinson, K., Wei, Y., Szwajcer, A., Rabbani, R., Zarychanski, R., Abou-Setta, A. M., & Mahmud, S. M. (2017). Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis. Vaccine, 35(21), pp. 2775-2780. doi:10.1016/j.vaccine.2017.03.092.
Wilkinson K, et al. Efficacy and Safety of High-dose Influenza Vaccine in Elderly Adults: a Systematic Review and Meta-analysis. Vaccine. 2017 05 15;35(21):2775-2780. PubMed PMID: 28431815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis. AU - Wilkinson,Krista, AU - Wei,Yichun, AU - Szwajcer,Andrea, AU - Rabbani,Rasheda, AU - Zarychanski,Ryan, AU - Abou-Setta,Ahmed M, AU - Mahmud,Salaheddin M, Y1 - 2017/04/18/ PY - 2016/08/19/received PY - 2017/03/08/revised PY - 2017/03/31/accepted PY - 2017/4/23/pubmed PY - 2018/1/9/medline PY - 2017/4/23/entrez KW - High-dose KW - Influenza KW - Influenza vaccines KW - Meta-analysis KW - Randomized control trial KW - Systematic review SP - 2775 EP - 2780 JF - Vaccine JO - Vaccine VL - 35 IS - 21 N2 - INTRODUCTION: Older adults are prioritized for influenza vaccination but also have lowered antibody responses to the vaccine. Higher-doses of influenza antigen may increase immune response and thus be more effective. Our objectives were to compare the efficacy and safety of the high-dose influenza vaccine to the standard-dose influenza vaccine in the elderly (age>65). METHODS: Data sources: Randomized trials (RCTs) from Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley), ClinicalTrials.gov, reference lists of relevant articles, and gray literature. STUDY SELECTION: Two reviewers independently identified RCTs comparing high-dose influenza vaccine (60μg of hemagglutinin per strain) to standard-dose influenza vaccine (15μg of hemagglutinin per strain) in adults over the age of 65years. DATA EXTRACTION: Two reviewers independently extracted trial-level data including population characteristics, interventions, outcomes, and funding sources. Risk of bias was assessed using the Cochrane Risk of Bias tool. RESULTS: We included seven eligible trials; all were categorized as having a low (n=3) or unclear (n=4) risk of bias. Patients receiving the high-dose vaccine had significantly less risk of developing laboratory-confirmed influenza infections (Relative Risk 0.76, 95%CI 0.65 to 0.90; I2 0%, 2 trials, 41,141 patients). Post-vaccination geometric mean titres and seroprotection rates were also higher in high-dose vaccine recipients. There were no protocol-defined serious adverse events in the included trials in either group. CONCLUSIONS: In elderly adults, the high-dose influenza vaccine was well-tolerated, more immunogenic, and more efficacious in preventing influenza infections than the standard-dose vaccine. Further pragmatic trials are needed to determine if the higher efficacy translates into higher vaccine effectiveness in adults over the age of 65. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/28431815/Efficacy_and_safety_of_high_dose_influenza_vaccine_in_elderly_adults:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(17)30444-9 DB - PRIME DP - Unbound Medicine ER -