Alternative-Dose versus Standard-Dose Trivalent Influenza Vaccines for Immunocompromised Patients: A Meta-Analysis of Randomised Control Trials

Abstract

The study compared immunogenicity and safety between alternative higher-dose and standard-dose trivalent vaccines in immunocompromised individuals. A literature search was performed using the PubMed, Embase, and Cochrane databases from inception until March 2019 to identify studies comparing the immunogenicity of alternative higher-dose (including high-dose, double-dose, and booster-dose vaccines) and standard-dose trivalent influenza vaccines in patients who underwent transplantation or chemotherapy. Effect estimates from the individual studies were derived and calculated using the DerSimonian and Laird random-effect model. The protocol for this systematic review is registered with PROSPERO (number CRD42019129220). Eight relevant studies involving 1020 patients were included in the systematic review and meta-analysis. The meta-analysis demonstrated that the higher-dose strategy provided had significantly superior seroconversion and seroprotection for A/H1N1 strains than the standard dose. Regarding H3N2 and B strains, no differences in immunogenicity responses were noted. No differences in safety were observed between the vaccination strategies. Alternative higher-dose vaccination strategies appear to associate with superior immunogenicity responses for A/H1N1 strains, and the strategies were generally well tolerated in immunocompromised populations. Future studies should clarify the optimal timing, frequency and dose of vaccination and assess whether these strategies improve vaccine immunogenicity and clinical outcomes.

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

“…Patients with hematologic cancers [ 58 ] had intermediate seroconversion rates (about 52%). Systematic reviews involving children [ 35 , 39 , 40 , 42 , 44 , 52 , 53 , 54 , 59 , 60 , 61 , 62 , 63 ] demonstrated findings consistent with those involving adults. An intervention that improved vaccine efficacy was the use of high-dose vaccines [ 35 , 37 , 42 , 44 , 45 , 51 ].…”

“…A total of 32 systematic reviews focused on non-COVID-19 vaccines ( Table 3 ). Several vaccines were studied, including inactivated hepatitis A vaccine [ 32 ], recombinant hepatitis B vaccine [ 33 , 34 , 35 , 36 , 37 , 38 ], recombinant human papillomavirus vaccines [ 39 , 40 ], inactivated influenza vaccine [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], live-attenuated measles vaccine (given post hematopoietic stem-cell transplantation [ 52 ] and in children living with human immunodeficiency virus [ 53 ]), pneumococcal conjugate and polysaccharide vaccines [ 46 , 49 , 54 , 55 , 56 ], live-attenuated and recombinant subunit zoster vaccines [ 57 , 58 ], live-attenuated yellow fever vaccine [ 59 ], and others [ 60 , 61 , 62 , 63 ]. Immunocompromised states studied included use of B-cell-depleting anti-CD20 therapy, chronic kidney failure, human immunodeficiency virus infection, immune-mediated inflammatory diseases, liver cirrhosis, malignancy, post-splenectomy status, and solid organ transplant recipients.…”

“…Although a substantial number of non-COVID-19 vaccine systematic reviews contained data from children [ 35 , 39 , 40 , 42 , 44 , 52 , 53 , 54 , 59 , 60 , 61 , 62 , 63 ] (13 out of 32), none of the COVID-19 vaccine systematic reviews included pediatric studies. Furthermore, none of the systematic reviews had long-term vaccine efficacy or effectiveness results, and none were performed for oral vaccines (e.g., oral rotavirus, oral cholera, oral polio, and oral typhoid).…”

Vaccination of immune compromised children—an overview for physicians

“…High-dose vaccine For vaccination against HBV per example, use of high-dose vaccine is recommended by some experts in HIV-infected adolescents (and adult), haemodialysis adult, and studies involving adults suggest it could be beneficial for oncological patients, or those with immune-mediated diseases [22]. Another example is the high-dose influenza vaccine being currently evaluated in immunocompromised individuals, including oncological patients, solid organ transplantation recipients and haemodialysis patients [35][36][37]. Data in paediatric patients, however, is scarce.…”

Estudo piloto randomizado controlado e aberto para avaliação da imunogenicidade e segurança de três esquemas de administração da vacina influenza trivalente em receptores de transplante renal

“…Anualmente, no mundo, estima-se a ocorrência de um bilhão de casos de influenza nas epidemias sazonais, sendo três a cinco milhões de casos graves e 290.000 a 650.000 de casos fatais(4,10). Indivíduos de maior risco de complicações relacionadas à influenza são gestantes, crianças com até 59 meses de idade, idosos, portadores de doenças crônicas como cardiopatias, pneumopatias, nefropatias, doenças metabólicas, hepatopatias, doenças hematológicas e doenças neurológicas com impacto no neurodesenvolvimento, portadores de condições imunossupressoras como pessoas vivendo com HIV/Aids, indivíduos sob quimioterapia ou em uso de corticoesteróides e portadores de neoplasia (12,13).…”