The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundInfluenza infection is a common disease with a huge disease burden. Influenza vaccination has been widely used, but concerns regarding vaccine efficacy exist, especially in the elderly. Probiotics are live microorganisms with immunomodulatory effects and may enhance the immune responses to influenza vaccination.MethodsWe conducted a systematic review and meta-analysis to determine the influence of prebiotics/probiotics/synbiotics supplementation on vaccine responses to influenza vaccination. Studies were systematically identified from electronic databases up to July 2017. Information regarding study population, influenza vaccination, components of supplements, and immune responses were extracted and analyzed. Twelve studies, investigating a total of 688 participants, were included in this review.ResultsPatients with prebiotics/probiotics supplements were found to have higher influenza hemagglutination inhibition antibody titers after vaccination (for A/H1N1, 42.89 vs 35.76, mean difference =7.14, 95% CI =2.73, 11.55, P=0.002; for A/H3N2, 105.4 vs 88.25, mean difference =17.19, 95% CI =3.39, 30.99, P=0.01; for B strain, 34.87 vs 30.73, mean difference =4.17, 95% CI =0.37, 7.96, P=0.03).ConclusionSupplementation with prebiotics or probiotics may enhance the influenza hemagglutination inhibition antibody titers in all A/H1N1, A/H3N2, and B strains (20%, 19.5%, and 13.6% increases, respectively). Concomitant prebiotics or probiotics supplementation with influenza vaccination may hold great promise for improving vaccine efficacy. However, high heterogeneity was observed and further studies are warranted.

Mapping Host-Related Correlates of Influenza Vaccine-Induced Immune Response: An Umbrella Review of the Available Systematic Reviews and Meta-Analyses

“…Three SRs [58,64,65] evaluated the effect of using pro-/pre-/symbiotics on IV-induced immunogenicity. All three papers included only RCTs with at least two intervention arms, i.e., (i) intervention group: use of pro-/pre-/symbiotics and (ii) control group: placebo or other dietary supplements not containing pro-/pre-/symbiotics.…”

“…The SRMA by Lei et al [58] pooled binary outcomes (SCs and SRs), while Yeh et al [64] pooled post-vaccination HAI titers that were deemed to be "mean titers" throughout the results. Zimmermann et al [65] did not conduct any MA.…”

“…A total of 23 meta-analytical estimates with at least two pooled primary RCTs were extracted from the two SRMAs [58,64]; the number of pooled studies ranged from 2 to 12, and more than half were statistically significant (p < 0.05) (Supplementary Material, Table S3). Briefly, Lei et al [58] reported a statistically significant advantage of taking pro-/prebiotics in terms of immunogenicity with regard to all-age SC against type B and SP against A/H1N1 and A/H3N2.…”

“…Briefly, Lei et al [58] reported a statistically significant advantage of taking pro-/prebiotics in terms of immunogenicity with regard to all-age SC against type B and SP against A/H1N1 and A/H3N2. Yeh et al [64] reported better results in the treatment arms in terms of the magnitude of the HAI titer against all three (sub)types; however, heterogeneity was extremely high (I 2 = 94%-100%), casting doubt on the appropriateness of pooling single estimates. The narrative synthesis by Zimmermann et al [65] concluded that the beneficial effect of probiotics on the IV-induced immune response was seen in 5 out of 12 (42%) studies analyzed.…”

“…Zimmermann et al [65] did not conduct any MA. Some concerns regarding the pooling technique used by Yeh et al [64] emerged. Specifically, (i) no transformation (e.g., log e ) of the skewed summary antibody titers was undertaken, as shown by forest plots; (ii) an enormous variation in SDs; (iii) arithmetic and geometric means were pooled together.…”