Intervention Review

Vaccines for preventing influenza in the elderly

  1. Tom Jefferson1,*,
  2. Carlo Di Pietrantonj2,
  3. Lubna A Al-Ansary3,
  4. Eliana Ferroni4,
  5. Sarah Thorning5,
  6. Roger E Thomas6

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 17 FEB 2010

Assessed as up-to-date: 6 OCT 2009

DOI: 10.1002/14651858.CD004876.pub3

Database Title

Additional Information

How to Cite

Jefferson T, Di Pietrantonj C, Al-Ansary LA, Ferroni E, Thorning S, Thomas RE. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD004876. DOI: 10.1002/14651858.CD004876.pub3.

Author Information

  1. 1

    The Cochrane Collaboration, Vaccines Field, Roma, Italy

  2. 2

    Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Alessandria, Piemonte, Italy

  3. 3

    College of Medicine, King Saud University, Department of Family & Community Medicine, Holder of "Shaikh Abdullah S. Bahamdan" Research Chair for Evidence-Based Health Care and Knowledge Translation, Riyadh, Saudi Arabia

  4. 4

    Public Health Agency of Lazio Region, Infectious Diseases Unit, Rome, Italy

  5. 5

    Bond University, Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia

  6. 6

    University of Calgary, Department of Medicine, Calgary, Alberta, Canada

*Tom Jefferson, Vaccines Field, The Cochrane Collaboration, Via Adige 28a, Anguillara Sabazia, Roma, 00061, Italy. jefferson.tom@gmail.com. jefferson@assr.it.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 17 FEB 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Vaccines have been the main global weapon to minimise the impact of influenza in the elderly for the last four decades and are recommended worldwide for individuals aged 65 years or older. The primary goal of influenza vaccination in the elderly is to reduce the risk of complications among persons who are most vulnerable.

Objectives

To assess the effectiveness of vaccines in preventing influenza, influenza-like illness (ILI), hospital admissions, complications and mortality in the elderly.
To identify and appraise comparative studies evaluating the effects of influenza vaccines in the elderly.
To document types and frequency of adverse effects associated with influenza vaccines in the elderly.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register (The Cochrane Library 2009, issue 4); MEDLINE (January 1966 to October Week 1 2009); EMBASE (1974 to October 2009) and Web of Science (1974 to October 2009).

Selection criteria

Randomised controlled trials (RCTs), quasi-RCTs, cohort and case-control studies assessing efficacy against influenza (laboratory-confirmed cases) or effectiveness against influenza-like illness (ILI) or safety. Any influenza vaccine given independently, in any dose, preparation or time schedule, compared with placebo or with no intervention was considered.

Data collection and analysis

We grouped reports first according to the setting of the study (community or long-term care facilities) and then by level of viral circulation and vaccine matching. We further stratified by co-administration of pneumococcal polysaccharide vaccine (PPV) and by different types of influenza vaccines. We analysed the following outcomes: influenza, influenza-like illness, hospital admissions, complications and deaths.

Main results

We included 75 studies. Overall we identified 100 data sets. We identified one RCT assessing efficacy and effectiveness. Although this seemed to show an effect against influenza symptoms it was underpowered to detect any effect on complications (1348 participants). The remainder of our evidence base included non-RCTs. Due to the general low quality of non-RCTs and the likely presence of biases, which make interpretation of these data difficult and any firm conclusions potentially misleading, we were unable to reach clear conclusions about the effects of the vaccines in the elderly.

Authors' conclusions

The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older. To resolve the uncertainty, an adequately powered publicly-funded randomised, placebo-controlled trial run over several seasons should be undertaken.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Vaccines for preventing seasonal influenza and its complications in people aged 65 or older

Influenza vaccination of elderly individuals is recommended worldwide as people aged 65 and older are at a higher risk of complications, hospitalisations and deaths from influenza. This review looked at evidence from experimental and non-experimental studies carried out over 40 years of influenza vaccination. We included 75 studies. These were grouped first according to study design and then the setting (community or long-term care facilities). The results are mostly based on non-experimental (observational) studies, which are at greater risk of bias, as not many good quality trials were available. Trivalent inactivated vaccines are the most commonly used influenza vaccines. Due to the poor quality of the available evidence, any conclusions regarding the effects of influenza vaccines for people aged 65 years or older cannot be drawn. The public health safety profile of the vaccines appears to be acceptable.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

老年人中預防流感的疫苗

全世界都提倡於老年人施打流感疫苗。施打流感疫苗已被鎖定提供給老年人以及那些有較嚴重併發症風險之個案。

目標

我們的目標在於回顧流感疫苗在年齡65歲或以上的個體使用上的效果，效率與安全。

搜尋策略

我們利用了以下的資料庫作搜尋: 考科藍資料庫，考科藍對照試驗中央登錄系統(CENTRAL), 考科藍系統性回顧資料庫，以及效率回顧研究摘要的資料庫(Issue 1, 2006); MEDLINE(1966年一月至2006年3月的第三週);EMBASE(1974年至1979年的對話; SilverPlatter 至2005年十二月); 生物學摘要(SilverPlatter 1969年至2004年十二月); 以及科學期刊引用目錄(科學網1974年至2004年12月).

選擇標準

我們是針對評估流感(實驗室確認個案)或類流感疾病治療效果或安全性的隨機，準隨機試驗。任何跟流感疫苗有關，獨立地以任何劑量，調劑方式或時序投予，與安慰劑或沒有治療進行比較的都被接受考慮。

資料收集與分析

我們先依據實驗環境(社區或長照中心)進行分類，然後則是病毒循環程度以及疫苗的配對。我們進一步將有同時施打肺炎雙球菌多醣體疫苗(PPV)以及不同流感疫苗者加以分類。我們分析了以下的結果: 流感，類流感疾病，住院次，併發症以及死亡。

主要結論

在效果和效率的評估方面，有六十四篇研究被加入，形成九十六套資料。居住家里的老年人(擁有較佳的疫苗配對和高的病毒循環)，針對類流感疾病的效果為23%(6%至36%)而針對流感則是沒有顯著差異(相對危險性1.04: 95%信賴區間 0.43至2.51). 我們發現疫苗保謢效果和類流感疾病的發作沒有相關。配對佳的疫苗能夠預防肺炎(VE 46%; 30%至58%)，住院(VE 45%; 16%至64%)以及因流感或肺炎造成之死亡(VE 42%, 17%至59%)。住在社區的老年人，疫苗對流感(相對危險性0.19; 95%信賴區間0.02至2.01)，類流感疾病(相對危險性1.05; 95%信賴區間0.58至1.89)或肺炎(相對危險性0.88; 95%信賴區間0.64至1.20)的預防沒有顯著成效。配對良好的疫苗能夠預防因流感和肺炎(VE26%; 12%至38%)造成的住院以及所有死因造成的死亡(VE42%; 24%至55%)。經過調整擾亂因子之後，疫苗的表現在因流感或肺炎住院(VE* 27%; 21%至33%)，呼吸道疾病(VE* 22%; 15%至28%)以及心臟疾病(VE* 24%; 18%至30%); 以及所有死因造成的死亡(VE* 47%; 39%至54%) 都獲得改善。疫苗在公衛上的安全概況都顯示可被接受。

作者結論

在施打疫苗最有預防併發症效果的長照中心，施打疫苗運動的目標順利完成，至少在某種程度上。然而，根據可靠的證據顯示社區中施打疫苗需審慎。疫苗在預防任何原因的死亡有明顯過高的效率，反映健康狀況底線的不平衡以及兩組參與的成員有其他系統性的差異。

翻譯人

本摘要由臺灣大學附設醫院林祖燊翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

這項回顧研究在於觀察疫苗是否能夠預防季節性流感以及它在年齡65歲或更高的老年人所造成的併發症。全球建議在年長者使用疫苗，因齡65歲或更高的老年人有較高的風險產生併發症，住院以及因流感而死亡。這項回顧研究觀察了40年來一些來自實驗和非實驗有關流感疫苗研究的文獻。71篇文章被挑選以及先依據實驗的設計和環境(社區或長照中心)分類。這些文章進一步依病毒循環的程度和疫苗的配對分類。這些回顧研究的結果大都基於非實驗性(觀察性)研究，相對來說有較大的誤差，因為目前沒有太多品質佳的試驗。非活性三價流感疫苗是目前最常用的疫苗。目前疫苗最有效地預防臨床疾病以及併發症可在住在長照中心(例如養護中心)觀察得到。這些個案鄉，疫苗可以預防45%的肺炎，住院次數和流感導致之死亡。居住在開放社區中的老年人其效用則需要更審慎考慮，不論其實驗結果或是設計: 疫苗大約有25%的效用在於預防25%因流感住院或發生呼吸道疾病。這在所有死因的死亡率(一個敏感度較低的結果)有明顯好處只是來自於觀察性研究。同時有可能反映接種和非接種族群(例如社經特徵，健康狀況，行為態度)的差異甚於疫苗的實際效用。疫苗在公衛上的安全概況都顯示可被接受。

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