Comparing influenza vaccine efficacy against mismatched and matched strains: a systematic review and meta-analysis.
Comparing influenza vaccine efficacy against mismatched and matched strains: a systematic review and meta-analysis.
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DOI：
10.1186/1741-7015-11-153
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发表时间：
2013-06-25
期刊：
影响因子：
9.3
通讯作者：
Loeb M
中科院分区：
文献类型：
--
作者：
Tricco AC;Chit A;Soobiah C;Hallett D;Meier G;Chen MH;Tashkandi M;Bauch CT;Loeb M
当疫苗中的抗原与流行毒株的抗原相匹配时，流感疫苗最有效。然而，疫苗中所含的抗原并不总是与流行毒株相匹配。在目前的工作中，我们的目的是检查流感疫苗提供的疫苗效力（VE）时，他们没有很好地匹配的流行株。我们通过MEDLINE、EMBASE、科克伦图书馆和纳入随机临床试验（RCT）的参考文献识别RCT。纳入了报告接种匹配和不匹配流感病毒株抗原的健康受试者中实验室确认流感的RCT。两名独立评审员筛选引文/全文文章、摘要数据，并评估偏倚风险。冲突通过讨论解决。进行了随机效应荟萃分析。使用以下公式计算VE：（1-相对风险× 100%）。我们纳入了34项RCT，提供了47个流感季节和94，821名参与者的数据。减毒活流感疫苗（LAIV）在6至36个月的儿童中显示出对不匹配（6项RCT，VE 54%，95%置信区间（CI）28%至71%）和匹配（7项RCT，VE 83%，95% CI 75%至88%）流感毒株的显著保护作用。在6至36个月的儿童中，观察到不匹配的甲型流感病毒（5项RCT，VE 75%，95% CI 41%至90%）和不匹配的乙型流感病毒（5项RCT，VE 42%，95% CI 22%至56%）估计值的点估计值之间存在差异。三价灭活疫苗（TIV）还对成人中的错配（9项RCT，VE 52%，95% CI 37%至63%）和匹配（8项RCT，VE 65%，95% CI 54%至73%）流感病毒株提供了显著保护。在成人中，观察到不匹配的甲型流感病毒（5项RCT，VE 64%，95% CI 23%至82%）和不匹配的乙型流感病毒（8项RCT，VE 52%，95% CI 19%至72%）估计值的点估计值之间存在数值差异。所有荟萃分析的统计异质性均较低（I2 <50%），儿童中的LAIV荟萃分析除外（I2 = 79%）。TIV和LAIV疫苗可提供针对不匹配的循环毒株的交叉保护。匹配与非匹配菌株的VE点估计值不同，CI重叠。
Influenza vaccines are most effective when the antigens in the vaccine match those of circulating strains. However, antigens contained in the vaccines do not always match circulating strains. In the present work we aimed to examine the vaccine efficacy (VE) afforded by influenza vaccines when they are not well matched to circulating strains. We identified randomized clinical trials (RCTs) through MEDLINE, EMBASE, the Cochrane Library, and references of included RCTs. RCTs reporting laboratory-confirmed influenza among healthy participants vaccinated with antigens of matching and non-matching influenza strains were included. Two independent reviewers screened citations/full-text articles, abstracted data, and appraised risk of bias. Conflicts were resolved by discussion. A random effects meta-analysis was conducted. VE was calculated using the following formula: (1 - relative risk × 100%). We included 34 RCTs, providing data on 47 influenza seasons and 94,821 participants. The live-attenuated influenza vaccine (LAIV) showed significant protection against mismatched (six RCTs, VE 54%, 95% confidence interval (CI) 28% to 71%) and matched (seven RCTs, VE 83%, 95% CI 75% to 88%) influenza strains among children aged 6 to 36 months. Differences were observed between the point estimates for mismatched influenza A (five RCTs, VE 75%, 95% CI 41% to 90%) and mismatched influenza B (five RCTs, VE 42%, 95% CI 22% to 56%) estimates among children aged 6 to 36 months. The trivalent inactivated vaccine (TIV) also afforded significant protection against mismatched (nine RCTs, VE 52%, 95% CI 37% to 63%) and matched (eight RCTs, VE 65%, 95% CI 54% to 73%) influenza strains among adults. Numerical differences were observed between the point estimates for mismatched influenza A (five RCTs, VE 64%, 95% CI 23% to 82%) and mismatched influenza B (eight RCTs, VE 52%, 95% CI 19% to 72%) estimates among adults. Statistical heterogeneity was low (I2 <50%) across all meta-analyses, except for the LAIV meta-analyses among children (I2 = 79%). The TIV and LAIV vaccines can provide cross protection against non-matching circulating strains. The point estimates for VE were different for matching versus non-matching strains, with overlapping CIs.
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影响因子：
4.4
作者：
WHO Writing Group;Ampofo WK;Baylor N;Cobey S;Cox NJ;Daves S;Edwards S;Ferguson N;Grohmann G;Hay A;Katz J;Kullabutr K;Lambert L;Levandowski R;Mishra AC;Monto A;Siqueira M;Tashiro M;Waddell AL;Wairagkar N;Wood J;Zambon M;Zhang W
通讯作者：
Zhang W
影响因子：
168.9
作者：
Barrett, P. Noel;Berezuk, Gregory;Ehrlich, Hartmut J.
通讯作者：
Ehrlich, Hartmut J.
影响因子：
5.1
作者：
Belshe, RB;Gruber, WC;Wolff, M
通讯作者：
Wolff, M
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
120.7
作者：
Bridges, CB;Thompson, WW;Fukuda, K
通讯作者：
Fukuda, K