Vaccines for the prevention of seasonal influenza in patients with diabetes: systematic review and meta-analysis
Vaccines for the prevention of seasonal influenza in patients with diabetes: systematic review and meta-analysis
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DOI：
10.1186/s12916-015-0295-6
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发表时间：
2015-03-17
期刊：
影响因子：
9.3
通讯作者：
Harder, Thomas
中科院分区：
文献类型：
--
作者：
Remschmidt, Cornelius;Wichmann, Ole;Harder, Thomas
背景：糖尿病患者患严重流感疾病的风险增加；因此，世界卫生组织和几个国家免疫技术咨询小组建议对这些患者进行流感疫苗接种。然而，尚无系统评价评估流感疫苗对糖尿病患者的效果。方法：我们通过检索 Medline、Embase、Cochrane 对照试验中央注册库和 ClinicalTrials 进行系统评价和荟萃分析。 gov 从成立到 2014 年 11 月。我们纳入了所有类型的研究，报告流感疫苗接种对所有年龄段 1 型和 2 型糖尿病患者的功效、有效性和/或安全性。我们使用纽卡斯尔-渥太华量表来评估观察性研究中的偏倚风险。通过将流感季节期间的疫苗有效性（VE）估计值与淡季期间获得的疫苗有效性（VE）估计值进行比较，解决了残留的混杂因素。使用 GRADE 方法评估每个结果的证据质量。结果：在审查 1,444 篇文章后，纳入了 11 项观察性研究，总共有 170,924 名参与者。在工作年龄（18-64 岁）的糖尿病患者中，流感疫苗接种可预防全因住院，综合 VE 为 58%（95% CI，6-81%）以及因流感或肺炎而住院（VE 43%；95% CI，28-54%），但未观察到对全因死亡率和流感样疾病 (ILI) 的影响。在老年人（65岁以上）中，流感疫苗接种可预防全因死亡率（VE 38%；95% CI，32-43%）、全因住院（VE 23%；95% CI，1-40%）、流感或肺炎住院（VE 45%；95% CI，34-53%）和流感样损伤（VE 13%；95% CI， 10-16%）。然而，对几种结果的显着淡季估计表明存在残留的混杂因素，特别是在老年患者中。所有结果的证据质量均为低至极低。没有报告实验室确诊的流感感染。 结论：由于大多数已确定的研究存在强烈的残留混杂因素，现有证据不足以确定糖尿病患者从季节性流感疫苗接种中获得的益处程度。迫切需要使用实验室确认的流感特异性结果进行充分有力的随机对照试验或准实验研究。
Background: Patients with diabetes are at increased risk of severe influenza disease; influenza vaccination for these patients is therefore recommended by the World Health Organization and several National Immunization Technical Advisory Groups. However, no systematic review has evaluated the effects of influenza vaccines for patients with diabetes.Methods: We conducted a systematic review and meta-analysis by searching Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials. gov from inception until November 2014. We included all types of studies reporting on the efficacy, effectiveness, and/or safety of influenza vaccination in patients with type 1 and type 2 diabetes of all ages. We used the Newcastle-Ottawa scale to assess risk of bias in observational studies. Residual confounding was addressed by comparing estimates of vaccine effectiveness (VE) during influenza seasons to those obtained during off-seasons. Quality of the evidence for each outcome was assessed using the GRADE methodology.Results: Following review of 1,444 articles, 11 observational studies with a total of 170,924 participants were included. In diabetic patients of working-age (18-64 years), influenza vaccination prevented all-cause hospitalization with a pooled VE of 58% (95% CI, 6-81%) and hospitalization due to influenza or pneumonia (VE 43%; 95% CI, 28-54%), whereas no effects on all-cause mortality and influenza-like illness (ILI) were observed. In the elderly (65+), influenza vaccination prevented all-cause mortality (VE 38%; 95% CI, 32-43%), all-cause hospitalization (VE 23%; 95% CI, 1-40%), hospitalization due to influenza or pneumonia (VE 45%; 95% CI, 34-53%), and ILI (VE 13%; 95% CI, 10-16%). However, significant off-season estimates for several outcomes indicated residual confounding, particularly in elderly patients. Quality of the evidence was low to very low for all outcomes. Laboratory-confirmed influenza infections were not reported.Conclusions: Due to strong residual confounding in most of the identified studies, the available evidence is insufficient to determine the magnitude of benefit that diabetic people derive from seasonal influenza vaccination. Adequately powered randomized controlled trials or quasi-experimental studies using laboratory-confirmed influenza-specific outcomes are urgently needed.