Institute for Medical Microbiology and Hygiene, Saarland University Hospital and Medical Faculty of Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany.
Clinic of Gastroenterology and Infectiology, Ernst von Bergmann Klinikum, Charlottenstraße 72, 14467 Potsdam, Germany.
Vaccine. 2022 May 11;40(22):2999-3008. doi: 10.1016/j.vaccine.2022.04.019. Epub 2022 Apr 19.
There is an urgent need for improved influenza vaccines especially for older adults due to the presence of immunosenescence. It is therefore highly relevant to compare enhanced influenza vaccines with traditional influenza vaccines with respect to their effectiveness.
To compare vaccine efficacy and effectiveness of adjuvanted influenza vaccines (aTIV/aQIV) vs. non-adjuvanted standard-dose (TIV/QIV) and high-dose (TIV-HD/QIV-HD) influenza vaccines regarding influenza-related outcomes in older adults, complementing findings from the European Centre for Disease Prevention and Control (ECDC)'s systematic review of enhanced seasonal influenza vaccines from February 2020.
A systematic literature search was conducted in Embase and MEDLINE to identify randomised controlled trials, observational studies and systematic reviews, published since ECDC's systematic review (between 7 February 2020 and 6 September 2021). Included studies were appraised with either the Cochrane Risk of Bias tool, ROBINS-I or AMSTAR 2.
Eleven analyses from nine real-world evidence (RWE) studies comprising ∼53 million participants and assessing the relative vaccine effectiveness (rVE) of aTIV vs. TIV, QIV and/or TIV-HD in adults aged ≥65 years over the 2006/07-2008/09 and 2011/12-2019/20 influenza seasons were identified. Nine analyses found that aTIV was significantly more effective than TIV and QIV in reducing influenza-related outcomes by clinical setting and suspected influenza outbreaks (rVE ranging from 7.5% to 25.6% for aTIV vs. TIV and 7.1% to 36.3% for aTIV vs. QIV). Seven analyses found similar effectiveness of aTIV vs. TIV-HD in reducing influenza-related medical encounters, inpatient stays and hospitalisations/emergency room visits. In three analyses, aTIV was significantly more effective than TIV-HD in reducing influenza-related medical encounters and office visits (rVE ranging from 6.6% to 16.6%). Risk of bias of identified studies was moderate to high.
Our study suggests that both adjuvanted and high-dose vaccines are effective alternatives for vaccination programmes in older adults and preferable over conventional standard-dose vaccines.
由于免疫衰老的存在，迫切需要改进流感疫苗，尤其是针对老年人。因此，比较增强型流感疫苗与传统的流感疫苗在预防老年人流感相关疾病方面的效果非常重要。
本研究旨在比较含佐剂（aTIV/aQIV）和不含佐剂的标准剂量（TIV/QIV）和高剂量（TIV-HD/QIV-HD）流感疫苗在预防老年人流感相关结局方面的疫苗效果和效力，对欧洲疾病预防控制中心（ECDC）2020 年 2 月系统综述中增强型季节性流感疫苗的发现进行补充。
在 Embase 和 MEDLINE 中进行系统文献检索，以确定自 ECDC 系统综述（2020 年 2 月 7 日至 2021 年 9 月 6 日）以来发表的随机对照试验、观察性研究和系统综述。使用 Cochrane 偏倚风险工具、ROBINS-I 或 AMSTAR 2 对纳入的研究进行评估。
共确定了 11 项来自 9 项真实世界证据（RWE）研究的分析，纳入了 5300 多万名年龄≥65 岁的参与者，评估了 2006/07-2008/09 和 2011/12-2019/20 流感季节含佐剂 TIV 与 TIV、QIV 和/或 TIV-HD 相比的相对疫苗效力（rVE 在含佐剂 TIV 与 TIV 比较中为 7.5%-25.6%，含佐剂 TIV 与 QIV 比较中为 7.1%-36.3%）。9 项分析发现，在临床环境和疑似流感暴发时，含佐剂 TIV 比 TIV 和 QIV 更能有效降低流感相关结局（rVE 在含佐剂 TIV 与 TIV 比较中为 7.5%-25.6%，含佐剂 TIV 与 QIV 比较中为 7.1%-36.3%）。7 项分析发现，含佐剂 TIV 与 TIV-HD 降低流感相关医疗接触、住院和急诊就诊的效果相似。在 3 项分析中，含佐剂 TIV 比 TIV-HD 更能有效降低流感相关医疗接触和门诊就诊（rVE 在含佐剂 TIV 与 TIV-HD 比较中为 6.6%-16.6%）。纳入研究的偏倚风险为中度至高度。
本研究表明，含佐剂和高剂量疫苗都是老年人疫苗接种计划的有效替代方案，优于传统的标准剂量疫苗。
