Impacts on influenza A(H1N1)pdm09 infection from cross-protection of seasonal trivalent influenza vaccines and A(H1N1)pdm09 vaccines: Systematic review and meta-analyses

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• 作者：Jiehui Kevin Yinp>ap>p> ; p>p>bp> ; Maria Yui Kwan Chowp>ap>p> ; p>p>bp> ; Gulam Khandakerp>ap>p> ; p>p>bp> ; Catherine Kingp>ap>p> ; p>p>bp> ; Peter Richmondp>cp>p> ; p>p>dp>p> ; p>p>ep> ; Leon Heronp>ap>p> ; p>p>bp>p> ; p>p>fp> ; Robert Booyp>ap>p> ; p>p>bp>p> ; p>p>fp>p> ; p>p>robert.booy@health.nsw.gov.aup>
• 关键词：A(H1N1)pdm09 ; Influenza vaccine ; seasonal ; Influenza vaccine ; pandemic ; Vaccine effectiveness ; Systematic review ; Meta-analysis
• 刊名：Vaccine
• 出版年：2012
• 期刊代码：89_0264410x
• 类别：imm
• 出版时间：2 May, 2012
• 卷：30
• 期：21
• 页码：3209-3222
• 文件大小：1289 K

摘要

Cross-protection by seasonal trivalent influenza vaccines (TIVs) against pandemic influenza A H1N1 2009 (now known as A[H1N1]pdm09) infection is controversial; and the vaccine effectiveness (VE) of A(H1N1)pdm09 vaccines has important health-policy implications. Systematic reviews and meta-analyses are needed to assess the impacts of both seasonal TIVs and A(H1N1)pdm09 vaccines against A(H1N1)pdm09.We did a systematic literature search to identify observational and/or interventional studies reporting cross-protection of TIV and A(H1N1)pdm09 VE from when the pandemic started (2009) until July 2011. The studies fulfilling inclusion criteria were meta-analysed. For cross-protection and VE, respectively, we stratified by vaccine type, study design and endpoint.<p>Seventeen studies (104,781 subjects) and 10 studies (2,906,860 subjects), respectively, reported cross-protection of seasonal TIV and VE of A(H1N1)pdm09 vaccines; six studies (17,229 subjects) reported on both. Thirteen studies (95,903 subjects) of cross-protection, eight studies (859,461 subjects) of VE, and five studies (9,643 subjects) of both were meta-analysed and revealed: (1) cross-protection for confirmed illness was 19%(95%confident interval = 13-42%) based on 13 case-control studies with notable heterogeneity. A higher cross-protection of 34%(9-52%) was found in sensitivity analysis (excluding five studies with moderate/high risk of bias). Further exclusion of studies that recruited early in the pandemic (when non-recipients of TIV were more likely to have had non-pandemic influenza infection that may have been cross-protective) dramatically reduced heterogeneity. One RCT reported cross-protection of 38%(19-53%) for confirmed illness. One case-control study reported cross-protection of 50%(40-59%) against hospitalisation. (2) VE of A(H1N1)pdm09 for confirmed illness was 86%(73-93%) based on 11 case-control studies and 79%(22-94%) based on two cohort studies; VE against medically-attended ILI was 32%(8-50%) in one cohort study.<p>TIVs provided moderate cross-protection against both laboratory-confirmed A(H1N1)pdm09 illness (based on eight case-control studies with low risk of bias and one RCT) and also hospitalisation. A finding of increased risk from seasonal vaccine was limited to cases recruited early in the pandemic. A(H1N1)pdm09 vaccines were highly effective against confirmed A(H1N1)pdm09 illness. Although cross-protection was less than the direct effect of strain-specific vaccination against A(H1N1)pdm09, TIV was generally beneficial before A(H1N1)pdm09 vaccine was available.