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Meta-Analysis
. 2017 Oct 15;65(8):1388-1395.
doi: 10.1093/cid/cix524.

Effectiveness of Influenza Vaccines in Asthma: A Systematic Review and Meta-Analysis

Eleftheria Vasileiou  1 , Aziz Sheikh  1 , Chris Butler  2   3 , Karim El Ferkh  1 , Beatrix von Wissmann  4 , Jim McMenamin  4 , Lewis Ritchie  5 , Jürgen Schwarze  6 , Nikolaos G Papadopoulos  7   8 , Sebastian L Johnston  9 , Lilly Tian  10 , Colin R Simpson  1
Affiliations
Meta-Analysis

Effectiveness of Influenza Vaccines in Asthma: A Systematic Review and Meta-Analysis

Eleftheria Vasileiou et al. Clin Infect Dis. .

Abstract

There is uncertainty about the effectiveness of influenza vaccination in persons with asthma and its impact on asthma outcomes, which may contribute to the suboptimal vaccination rates in persons with asthma. This systematic review and meta-analysis involved searching 12 international databases for randomized controlled trials (RCTs) and high-quality quasi-experimental and epidemiological studies (1970-2016). The risk of bias was low for 3 included RCTs. The quality of 3 included observational studies was moderate. The quality of evidence was very low for all study outcomes. Pooled vaccine effectiveness in 1825 persons with asthma from 2 test-negative design case-control studies was 45% (95% confidence interval [CI], 31%-56%) for laboratory-confirmed influenza. Pooled efficacy of live vaccines in reducing influenza was 81% (95% CI, 33%- 94%). Live vaccine reduced febrile illness by 72% (95% CI, 20%-90%). Influenza vaccine prevented 59%-78% of asthma attacks leading to emergency visits and/or hospitalizations. For persons with asthma, influenza vaccination may be effective in both reducing influenza infection and asthma attacks.

Keywords: asthma; immunization; influenza; laboratory confirmed influenza; vaccination.

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Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram.
Figure 2.
Figure 2.
Risk of bias summary. Review authors’ judgments about each risk of bias item are shown for each randomized controlled trial. This rating was based on the Cochrane guideline. VE, Vaccine efficacy/effectiveness.
Figure 3.
Figure 3.
Quality assessment of the nonrandomized controlled trials and observational studies using the Effective Public Health Practice Project quality assessment tool [22].
Figure 4.
Figure 4.
Vaccine efficacy/effectiveness against influenza infection for live attenuated influenza vaccine versus no vaccine (randomized controlled trials). Abbreviations: CI, confidence interval; RR, risk ratio.
Figure 5.
Figure 5.
Vaccine efficacy/effectiveness against laboratory-confirmed (confirmed with real-time polymerase chain reaction) influenza infection for seasonal influenza vaccine versus no vaccine (test-negative design studies). Abbreviations: CI, confidence interval; OR, odds ratio.
Figure 6.
Figure 6.
Vaccine efficacy/effectiveness against febrile illness for live attenuated influenza vaccine versus no vaccine (randomized controlled trials). Abbreviations: CI, confidence interval; RR, risk ratio.
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