Cochrane re-arranged: Support for policies to vaccinate elderly people against influenza
Cochrane re-arranged: Support for policies to vaccinate elderly people against influenza
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DOI：
10.1016/j.vaccine.2013.09.063
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发表时间：
2013-12-05
期刊：
影响因子：
5.5
通讯作者：
Osterhaus, Albert D. M. E.
中科院分区：
文献类型：
--
作者：
Beyer, Walter E. P.;McElhaney, Janet;Osterhaus, Albert D. M. E.
2010年科克伦综述关于老年人流感疫苗接种的有效性、有效性和安全性，Jefferson等人涵盖了四十年来的数十项临床研究，证实了疫苗的安全性，但没有发现疫苗有效性（VE）的令人信服的证据，因此挑战了正在进行的老年人疫苗接种工作。该科克伦综述分析和呈现数据的方式本身可能阻碍了将真实的疫苗益处与不可避免的“背景噪声”分开。根据不同的疫苗类型、研究设计、人群和结局病例定义，将数据排列在100多个独立的荟萃分析中，然后根据病毒循环和抗原匹配进一步细分。这样，一般疫苗效应就不能与大量的环境和操作非疫苗相关变异分开。此外，改变病毒循环和抗原漂移对VE的预期影响无法得到证实，我们根据生物学和概念框架重新安排了非常相同的数据，该框架基于整个“患者旅程”（暴露，感染，临床结果，观察）的基本事件顺序，并使用广泛的结果定义和简单的VE值频率分布。这种方法产生了有意义的预测VE对流感相关的致命性和非致命性并发症（平均类似于30%，离散度很大），典型的流感样疾病（类似于40%），确诊病毒感染的疾病（类似于50%），和生物疫苗对感染的有效性（类似于60%），在病毒循环的条件下。我们还可以证明，在没有病毒循环的情况下，VE平均值约为零，并且随着病毒循环的减少和抗原漂移的增加，VE值逐渐降低。我们认为这些发现是流感疫苗能够降低流感感染和流感风险的实质性证据。老年人相关疾病和死亡。(C)2013爱思唯尔有限公司保留所有权利。
The 2010 Cochrane review on efficacy, effectiveness and safety of influenza vaccination in the elderly by Jefferson et al. covering dozens of clinical studies over a period of four decades, confirmed vaccine safety, but found no convincing evidence for vaccine effectiveness (VE) against disease thus challenging the ongoing efforts to vaccinate the elderly.However, the Cochrane review analyzed and presented the data in a way that may itself have hampered the desired separation of real vaccine benefits from inevitable 'background noise'. The data are arranged in more than one hundred stand-alone meta-analyses, according to various vaccine types, study designs, populations, and outcome case definitions, and then further subdivided according to virus circulation and antigenic match. In this way, general vaccine effects could not be separated from an abundance of environmental and operational, non vaccine-related variation. Furthermore, expected impacts of changing virus circulation and antigenic drift on VE could not be demonstrated.We re-arranged the very same data according to a biological and conceptual framework based on the basic sequence of events throughout the 'patient journey' (exposure, infection, clinical outcome, observation) and using broad outcome definitions and simple frequency distributions of VE values. This approach produced meaningful predictions for VE against influenza-related fatal and non-fatal complications (average similar to 30% with large dispersion), typical influenza-like illness (similar to 40%), disease with confirmed virus infection (similar to 50%), and biological vaccine efficacy against infection (similar to 60%), under conditions of virus circulation. We could also demonstrate a VE average around zero in the absence of virus circulation, and decreasing VE values with decreasing virus circulation and increasing antigenic drift.We regard these findings as substantial evidence for the ability of influenza vaccine to reduce the risk of influenza infection and influenza-related disease and death in the elderly. (C) 2013 Elsevier Ltd. All rights reserved.