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Meta-Analysis
. 2021 Nov;15(6):813-823.
doi: 10.1111/irv.12871. Epub 2021 Jun 3.

Effectiveness of the MF59-adjuvanted trivalent or quadrivalent seasonal influenza vaccine among adults 65 years of age or older, a systematic review and meta-analysis

Brenda L Coleman  1   2   3 , Ruth Sanderson  1 , Mendel D M Haag  4 , Ian McGovern  5
Affiliations
Meta-Analysis

Effectiveness of the MF59-adjuvanted trivalent or quadrivalent seasonal influenza vaccine among adults 65 years of age or older, a systematic review and meta-analysis

Brenda L Coleman et al. Influenza Other Respir Viruses. 2021 Nov.

Abstract

Background: Standard-dose seasonal influenza vaccines often produce modest immunogenic responses in adults ≥65 years old. MF59 is intended to elicit a greater magnitude and increased breadth of immune response.

Objective: To determine the effectiveness of seasonal MF59-adjuvanted trivalent/quadrivalent influenza vaccine (aTIV/aQIV) relative to no vaccination or vaccination with standard or high-dose egg-based influenza vaccines among people ≥65 years old.

Methods: Cochrane methodological standards and PRISMA-P guidelines were followed. Real-world evidence from non-interventional studies published in peer-reviewed journals and gray literature from 1997 through to July 15, 2020, including cluster-randomized trials, were eligible. Two reviewers independently extracted data; risk of bias was assessed using the ROBINS-I tool.

Results: Twenty-one studies conducted during the 2006/07-2019/20 influenza seasons were included in the qualitative review; 16 in the meta-analyses. Meta-analysis of test-negative studies found that aTIV reduced medical encounters due to lab-confirmed influenza with pooled estimates of 40.7% (95% CI: 21.9, 54.9; I2 = 0%) for non-emergency outpatient visits and 58.5% (40.7, 70.9; I2 = 52.9%) for hospitalized patients. The pooled estimate of VE from case-control studies was 51.3% (39.1, 61.1; I2 = 0%) against influenza- or pneumonia-related hospitalization. The pooled estimates for the relative VE of aTIV for the prevention of influenza-related medical encounters were 13.9% (4.2, 23.5; I2 = 95.9%) compared with TIV, 13.7% (3.1, 24.2; I2 = 98.8%) compared with QIV, and 2.8% (-2.9, 8.5; I2 = 94.5%) compared with HD-TIV.

Conclusions: Among adults ≥65 years, aTIV demonstrated significant absolute VE, improved relative VE compared to non-adjuvanted standard-dose TIV/QIV, and comparable relative VE to high-dose TIV.

Keywords: MF59-adjuvanted influenza vaccine; older adults; real-world evidence; systematic literature review; vaccine effectiveness.

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Conflict of interest statement

BLC and RS were employed by Sinai Health which received funding from Seqirus for this review. MDMH and IM are employed by Seqirus.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram for literature review comparing the effectiveness of the MF59‐adjuvanted trivalent or quadrivalent seasonal influenza vaccine (FLUAD® or FLUAD® quadrivalent) for adults 65 years of age or older. PRISMA: Preferred reporting items for systematic review and meta‐analysis
FIGURE 2
FIGURE 2
Forest plot of adjusted aTIV VE estimates for preventing (A) non‐emergency department outpatient visits or (B) laboratory‐confirmed influenza (any type/strain) in hospital patients. Adults 65 years or older, test‐negative design studies. VE: vaccine effectiveness; I sq, I 2. Pooling weight based on DerSimonian and Laird random‐effects meta‐analysis
FIGURE 3
FIGURE 3
Forest plot of adjusted aTIV VE estimates for preventing influenza or pneumonia in hospitalized adults 65 years or older, case‐control design studies. I sq, I 2, VE: vaccine effectiveness. Pooling weight based on DerSimonian and Laird random‐effects meta‐analysis
FIGURE 4
FIGURE 4
Forest plot of adjusted aTIV relative VE estimates compared with (A) standard‐dose TIV, (B) standard‐dose QIV, and (C) high‐dose TIV for preventing influenza with/without pneumonia. Adults 65 years or older, cohort study design studies (hospital, ED, or non‐ED outpatients). *Cocchio may have included some QIV in later seasons. aTIV, adjuvanted trivalent inactivated vaccine; ED, emergency department; GP, general practitioner; I sq, I 2; rVE, relative vaccine effectiveness; TIV, trivalent inactivated vaccine; VE, vaccine effectiveness. Pooling weight based on DerSimonian and Laird random‐effects meta‐analysis
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