重复接种对流感疫苗效力的影响：一项系统评价与荟萃分析

The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis.

作者信息

Ramsay Lauren C, Buchan Sarah A, Stirling Robert G, Cowling Benjamin J, Feng Shuo, Kwong Jeffrey C, Warshawsky Bryna F

机构信息

Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario, M5G 1V2, Canada.

Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.

出版信息

BMC Med. 2017 Aug 21;15(1):159. doi: 10.1186/s12916-017-0919-0.

BACKGROUND

Conflicting results regarding the impact of repeated vaccination on influenza vaccine effectiveness (VE) may cause confusion regarding the benefits of receiving the current season's vaccine.

METHODS

We systematically searched MEDLINE, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature from database inception to August 17, 2016, for observational studies published in English that reported VE against laboratory-confirmed influenza for four vaccination groups, namely current season only, prior season only, both seasons, and neither season. We pooled differences in VE (∆VE) between vaccination groups by influenza season and type/subtype using a random effects model. The study protocol is registered with PROSPERO (registration number: CRD42016037241).

RESULTS

We identified 3435 unique articles, reviewed the full text of 634, and included 20 for meta-analysis. Compared to prior season vaccination only, vaccination in both seasons was associated with greater protection against influenza H1N1 (∆VE = 26%; 95% CI, 15% to 36%) and B (∆VE = 24%; 95% CI, 7% to 42%), but not H3N2 (∆VE = 10%; 95% CI, -6% to 25%). Compared to no vaccination for either season, individuals who received the current season's vaccine had greater protection against H1N1 (∆VE = 61%; 95% CI, 50% to 70%), H3N2 (∆VE = 41%; 95% CI, 33% to 48%), and B (∆VE = 62%; 95% CI, 54% to 68%). We observed no differences in VE between vaccination in both seasons and the current season only for H1N1 (∆VE = 4%; 95% CI, -7% to 15%), H3N2 (∆VE = -12%; 95% CI, -27% to 4%), or B (∆VE = -8%; 95% CI, -17% to 1%).

CONCLUSIONS

From the patient perspective, our results support current season vaccination regardless of prior season vaccination. We found no overall evidence that prior season vaccination negatively impacts current season VE. It is important that future VE studies include vaccination history over multiple seasons in order to evaluate repeated vaccination in more detail.

背景

关于重复接种疫苗对流感疫苗效力（VE）的影响，研究结果存在冲突，这可能会使人们对接种当季疫苗的益处感到困惑。

方法

我们系统检索了MEDLINE、Embase、PubMed以及护理与联合健康文献累积索引数据库，检索时间从建库起至2016年8月17日，查找以英文发表的观察性研究，这些研究报告了四个接种疫苗组针对实验室确诊流感的疫苗效力，即仅接种当季疫苗、仅接种上一季疫苗、两季均接种以及两季均未接种。我们使用随机效应模型汇总了各流感季节以及各型/亚型的接种疫苗组之间的疫苗效力差异（∆VE）。该研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42016037241）。

结果

我们识别出3435篇独特文章，审阅了其中634篇的全文，纳入20篇进行荟萃分析。与仅接种上一季疫苗相比，两季均接种疫苗对甲型H1N1流感（∆VE = 26%；95%置信区间，15%至36%）和乙型流感（∆VE = 24%；95%置信区间，7%至42%）有更强的防护作用，但对甲型H3N2流感无此作用（∆VE = 10%；95%置信区间，-6%至25%）。与两季均未接种疫苗相比，接种当季疫苗的个体对甲型H1N1流感（∆VE = 61%；95%置信区间，50%至70%）、甲型H3N2流感（∆VE = 41%；95%置信区间，33%至48%）和乙型流感（∆VE = 62%；95%置信区间，54%至68%）有更强的防护作用。我们观察到，对于甲型H1N1流感（∆VE = 4%；95%置信区间，-7%至15%）、甲型H3N2流感（∆VE = -12%；95%置信区间，-27%至4%）或乙型流感（∆VE = -8%；95%置信区间，-17%至1%），两季均接种疫苗与仅接种当季疫苗的疫苗效力无差异。