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Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis.
Vaccine 2018; 36(24):3434-3444V

Abstract

INTRODUCTION

Vaccination against influenza on an annual basis is widely recommended, yet recent studies suggest consecutive vaccination may reduce vaccine effectiveness (VE).

PURPOSE

To assess whether when examining the entirety of existing data consecutive influenza vaccination reduces VE compared to current season influenza vaccination.

DATA SOURCES

MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 26, 2017; citations of included studies.

STUDY SELECTION

Randomized, 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 EXTRACTION

Data related to study characteristics, participant demographics, cases of influenza infection by vaccination group and risk of bias assessment was extracted in duplicate.

DATA SYNTHESIS

Five 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.

LIMITATIONS

The 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.

CONCLUSION

Available 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 SOURCE

CIHR Foundation Grant (PROSPERO: CRD42017059893).

Authors+Show Affiliations

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.University of Toronto, Toronto, Ontario M5S 1A1, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.McMaster University, Hamilton, Ontario L8S 4L8, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada.Hamilton Health Sciences, Hamilton, Ontario L8N 3Z5, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada; Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario L8S 4L8, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada. Electronic address: loebm@mcmaster.ca.

Pub Type(s)

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

Language

eng

PubMed ID

29724509

Citation

Bartoszko, Jessica J., et al. "Does Consecutive Influenza Vaccination Reduce Protection Against Influenza: a Systematic Review and Meta-analysis." Vaccine, vol. 36, no. 24, 2018, pp. 3434-3444.
Bartoszko JJ, McNamara IF, Aras OAZ, et al. Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. Vaccine. 2018;36(24):3434-3444.
Bartoszko, J. J., McNamara, I. F., Aras, O. A. Z., Hylton, D. A., Zhang, Y. B., Malhotra, D., ... Loeb, M. (2018). Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. Vaccine, 36(24), pp. 3434-3444. doi:10.1016/j.vaccine.2018.04.049.
Bartoszko JJ, et al. Does Consecutive Influenza Vaccination Reduce Protection Against Influenza: a Systematic Review and Meta-analysis. Vaccine. 2018 06 7;36(24):3434-3444. PubMed PMID: 29724509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. AU - Bartoszko,Jessica J, AU - McNamara,Isabella F, AU - Aras,Oguz A Z, AU - Hylton,Danielle A, AU - Zhang,Yuan B, AU - Malhotra,Danya, AU - Hyett,Sarah L, AU - Morassut,Rita E, AU - Rudziak,Paulina, AU - Loeb,Mark, Y1 - 2018/05/01/ PY - 2018/01/20/received PY - 2018/04/13/revised PY - 2018/04/16/accepted PY - 2018/5/5/pubmed PY - 2018/9/27/medline PY - 2018/5/5/entrez KW - Consecutive vaccination KW - Influenza infection KW - Influenza vaccine KW - Meta-analysis KW - Systematic review KW - Vaccine effectiveness SP - 3434 EP - 3444 JF - Vaccine JO - Vaccine VL - 36 IS - 24 N2 - INTRODUCTION: Vaccination against influenza on an annual basis is widely recommended, yet recent studies suggest consecutive vaccination may reduce vaccine effectiveness (VE). PURPOSE: To assess whether when examining the entirety of existing data consecutive influenza vaccination reduces VE compared to current season influenza vaccination. DATA SOURCES: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 26, 2017; citations of included studies. STUDY SELECTION: Randomized, 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 EXTRACTION: Data related to study characteristics, participant demographics, cases of influenza infection by vaccination group and risk of bias assessment was extracted in duplicate. DATA SYNTHESIS: Five 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. LIMITATIONS: The 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. CONCLUSION: Available 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 SOURCE: CIHR Foundation Grant (PROSPERO: CRD42017059893). SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/29724509/Does_consecutive_influenza_vaccination_reduce_protection_against_influenza:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(18)30546-2 DB - PRIME DP - Unbound Medicine ER -