Influenza Vaccination for Immunocompromised Patients: Systematic Review and Meta-analysis by Etiology

Abstract

Many national guidelines recommend annual influenza vaccination of immunocompromised patients, although the decision to vaccinate is usually at clinical discretion. We conducted a systematic review and meta-analyses to assess the evidence for influenza vaccination in this group, and we report our results by etiology. Meta-analyses showed significantly lower odds of influenza-like illness after vaccination in patients with human immunodeficiency virus (HIV) infection, patients with cancer, and transplant recipients and of laboratory-confirmed influenza in HIV-positive patients, compared with patients receiving placebo or no vaccination. Pooled odds of seroconversion and seroprotection were typically lower in HIV-positive patients, patients with cancer, and transplant recipients, compared with immunocompetent controls. Vaccination was generally well tolerated, with variation in mild adverse events between etiological groups. Limited evidence of a transient increase in viremia and a decrease in the percentage of CD4(+) cells in HIV-positive patients was found although not accompanied by worsening of clinical symptoms. Clinical judgment remains important when discussing the benefits and safety profile with immunocompromised patients.

Influenza vaccination for immunocompromised patients: summary of a systematic review and meta‐analysis

“…There was limited evidence of a transient increase in viraemia and a decrease in CD4% in HIV patients although this was not accompanied by a worsening of clinical symptoms. Further exposition of the evidence including statistical detail from our meta‐analyses of outcome measures stratified by aetiology of immunocompromise has been published elsewhere 7, 8…”

“…The methodology used in this study has been previously described, and an abbreviated protocol is also available from the National Institute for Health Research international prospective register of systematic reviews (PROSPERO) 7, 8, 9. We defined the study population according to policy documents published by the World Health Organization and United Kingdom Departments of Health for persons with primary or secondary immunodeficiency 2, 10.…”

“…Two manuscripts arising from this work have been published and report our findings through a public health policy interpretation and a sub‐analysis by aetiology of immunocompromise 7, 8…”

Vaccination of chemotherapy patients—effect of guideline implementation

“…These illnesses may also compromise cancer treatment by delaying chemotherapy, and result in substantial costs to healthcare providers [2]. Although concerns have been raised regarding the efficacy of vaccination in patients with malignant disease, studies demonstrate that patients with cancer-including those treated with chemotherapy-remain able to respond to vaccination and that influenza immunisation in this group reduces mortality [3,4]. Side-effects of both influenza and pneumococcal vaccines are mild, and similar to those experienced by the general population [3,[5][6][7].…”

“…Although concerns have been raised regarding the efficacy of vaccination in patients with malignant disease, studies demonstrate that patients with cancer-including those treated with chemotherapy-remain able to respond to vaccination and that influenza immunisation in this group reduces mortality [3,4]. Side-effects of both influenza and pneumococcal vaccines are mild, and similar to those experienced by the general population [3,[5][6][7]. Consequently, the UK Department of Health (DH) and the US Center for Disease Control (CDC) recommend that in the absence of contraindications, patients planned for cytotoxic therapy should be vaccinated against both S.pneumoniae and influenza [8,9].…”