Zhao L, Young K, Gemmill I
Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON.
NACI Influenza Working Group Chair.
Can Commun Dis Rep. 2019 Jun 6;45(6):149-155. doi: 10.14745/ccdr.v45i06a01.
Many different influenza vaccines are authorized for use in Canada and new evidence on influenza and vaccines is continually emerging. The National Advisory Committee on Immunization (NACI) provides annual recommendations regarding the use of seasonal influenza vaccines to the Public Health Agency of Canada (PHAC) for the upcoming influenza season.
To summarize NACI recommendations regarding the use of seasonal influenza vaccines for the 2019-2020 influenza season, including conclusions from reviews of evidence on 1) a new split virus quadrivalent inactivated influenza vaccine and 2) the comparative effectiveness and immunogenicity of subunit and split virus inactivated influenza vaccines in adults 65 years of age and older.
For both topics, the NACI Influenza Working Group developed a predefined search strategy to identify all eligible studies, assessed their quality, summarized and analyzed the findings and, according to the NACI evidence-based process, proposed recommendations and identified the grade of evidence that supported them. In light of the evidence, the recommendations were then considered and approved by NACI.
NACI concluded that the new split virus quadrivalent inactivated influenza vaccine has a safety and immunogenicity profile comparable to the quadrivalent inactivated influenza vaccines already authorized for adults and children 5 years of age and older (Grade B Evidence). Therefore, NACI recommended that this new vaccine may be considered among the quadrivalent inactivated influenza vaccines offered to adults and children five years of age and older (Discretionary NACI Recommendation). However, NACI concluded that the evidence is not sufficient (Grade I Evidence) to support specific recommendations on the differential use of subunit and split virus inactivated influenza vaccines in adults 65 years of age and older.
NACI continues to recommend that an age-appropriate influenza vaccine should be offered annually to anyone six months of age and older who does not have contraindications to the vaccine, with focus on the groups for whom influenza vaccination is particularly recommended. This includes people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk, people who provide essential community services and people in direct contact with poultry infected with avian influenza during culling operations.
加拿大已批准多种不同的流感疫苗投入使用,且有关流感和疫苗的新证据不断涌现。国家免疫咨询委员会(NACI)每年都会就即将到来的流感季节季节性流感疫苗的使用向加拿大公共卫生署(PHAC)提供建议。
总结NACI关于2019 - 2020流感季节季节性流感疫苗使用的建议,包括对以下两方面证据审查的结论:1)一种新的裂解病毒四价灭活流感疫苗;2)65岁及以上成年人中,亚单位和裂解病毒灭活流感疫苗的比较有效性和免疫原性。
对于这两个主题,NACI流感工作组制定了预定义的检索策略,以识别所有符合条件的研究,评估其质量,总结并分析研究结果,并根据NACI基于证据的流程提出建议,确定支持这些建议的证据等级。根据这些证据,NACI随后对建议进行审议并批准。
NACI得出结论,新的裂解病毒四价灭活流感疫苗的安全性和免疫原性与已批准用于5岁及以上成人和儿童的四价灭活流感疫苗相当(B级证据)。因此,NACI建议在提供给5岁及以上成人和儿童的四价灭活流感疫苗中可考虑使用这种新疫苗(NACI酌情建议)。然而,NACI得出结论,证据不足(I级证据),无法支持关于65岁及以上成年人中使用亚单位和裂解病毒灭活流感疫苗的差异使用的具体建议。
NACI继续建议,每年应向6个月及以上无疫苗接种禁忌的任何人提供适合其年龄的流感疫苗,重点是特别推荐接种流感疫苗的人群。这包括有流感相关并发症或住院高风险的人群、能够将流感传播给高风险人群的人、提供基本社区服务的人员以及在扑杀行动期间直接接触感染禽流感家禽的人员。