Cold-adapted live influenza vaccine versus inactivated vaccine: systemic vaccine reactions, local and systemic antibody response, and vaccine efficacy A meta-analysis
Cold-adapted live influenza vaccine versus inactivated vaccine: systemic vaccine reactions, local and systemic antibody response, and vaccine efficacy A meta-analysis
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DOI：
10.1016/s0264-410x(01)00471-6
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发表时间：
2002-01-31
期刊：
影响因子：
5.5
通讯作者：
Osterhaus, ADME
中科院分区：
文献类型：
--
作者：
Beyer, WEP;Palache, AM;Osterhaus, ADME
从20世纪40年代开始。流感疫苗是灭活和纯化的病毒或病毒亚单位制剂(IIV)，通过肌肉注射途径给予。几十年来。已经有人尝试建造。作为替代方案，减毒流感活疫苗(LIV)用于鼻腔给药。目前，最成功的Liv来自冷适应主株A/Ann Arbor/6/60(H_2N_2)和B/Ann Arbor/1/66(AA-Liv，用于ANN-Arbor衍生的流感活疫苗)。有研究称，AA-Liv比静脉注射更有效。为了评估两种疫苗在系统反应性、抗体反应和有效性方面的差异，我们对18项随机比较临床试验进行了荟萃分析，总共涉及5000种各个年龄段的疫苗。根据随机效应模型计算合并优势比(AA-LIV与IIV)。这两种疫苗与类似的低频率全身疫苗反应有关(合并优势比：0.96，95%可信区间：0.74-1.24)。与IIV相比，AA-LiV诱导的血清血凝抑制抗体水平显著降低，而局部IgA抗体水平显著升高(用ELISA法检测鼻腔冲洗标本中流感病毒特异性呼吸道IgA9)。现在还不行。虽然它们主要刺激不同的抗体隔间，但这两种疫苗在预防培养阳性流感疾病方面同样有效。在所有评估临床疗效的试验中。优势比与1(等价点)无显著差异，甲型H3N1流感的合并优势比为1.50(95%CI：0.80~2.82)，甲型H1N1流感的合并优势比为1.03(95%CI：0.58~1.82)。在两种疫苗类型之间的选择应基于对AA-Liv诱人的非侵入性给药模式的优势与对大规模使用传染性流感病毒固有的生物风险的严重担忧之间的权衡。特别是与非人类流感病毒株基因重组的危险。(C)2002爱思唯尔科学有限公司。保留所有权利。
Since the 1940s. influenza vaccines are inactivated and purified virus or virus subunit preparations (IIV) administered by the intramuscular route. Since decades. attempts have been made to construct. as an alternative, attenuated live influenza vaccines (LIV) for intranasal administration. Presently, the most successful LIV is derived from the cold-adapted master strains A/Ann Arbor/6/60 (H2N2) and B/Ann Arbor/1/66(AA-LIV, for Ann-Arbor-derived live influenza vaccine). It has been claimed that AA-LIV is more efficacious than IIV. In order to assess differences between the two vaccines with respect to systemic reactogenicity, antibody response, and efficacy, we performed a meta-analysis on eighteen randomised comparative clinical trials involving a total of 5000 vaccines of all ages. Pooled odds ratios (AA-LIV versus IIV) were calculated according to the random effects model. The two vaccines were associated with similarly low frequencies of systemic vaccine reactions (pooled odds ratio: 0.96, 95% confidence interval: 0.74-1.24). AA-LIV induced significantly lower levels of serum haemagglutination inhibiting antibody and significantly greater levels of local IgA antibody (influenza virus-specific respiratory IgA 9 assayed by ELISA in nasal wash specimens) than IIV. Yet. although they predominantly stimulate different antibody compartments, the two vaccines were similarly efficacious in preventing culture-positive influenza illness. In all trials assessing clinical efficacy. the odds ratios were not significantly different from one (point of equivalence), The pooled odds ratio for influenza A-H3N2 was 1.50 (95% CI: 0.80-2.82), and for A-H1N1, 1.03 (95% CI: 0.58-1.82). The choice between the two vaccine types should be based on weighing the advantage of the attractive non-invasive mode of administration of AA-LIV, against serious concerns about the biological risks inherent to large-scale use of infectious influenza virus. in particular the hazard of gene reassortment with non-human influenza virus strains. (C) 2002 Elsevier Science Ltd. All rights reserved.