PMID- 35360146
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220402
IS  - 2589-5370 (Electronic)
IS  - 2589-5370 (Linking)
VI  - 46
DP  - 2022 Apr
TI  - Comparative efficacy and safety of vaccines to prevent seasonal influenza: A 
      systematic review and network meta-analysis.
PG  - 101331
LID - 10.1016/j.eclinm.2022.101331 [doi]
LID - 101331
AB  - BACKGROUND: Influenza is one of the most common respiratory viral infections 
      worldwide. Numerous vaccines are used to prevent influenza. Their selection 
      should be informed by the best available evidence. We aimed to estimate the 
      comparative efficacy and safety of seasonal influenza vaccines in children, 
      adults and the elderly. METHODS: We conducted a systematic review and network 
      meta-analysis (NMA). We searched the Cochrane Library Central Register of 
      Controlled Trials, MEDLINE and EMBASE databases, and websites of regulatory 
      agencies, through December 15th, 2020. We included placebo- or no 
      vaccination-controlled, and head-to-head randomized clinical trials (RCTs). Pairs 
      of reviewers independently screened the studies, abstracted the data, and 
      appraised the risk of bias in accordance to the Cochrane Handbook for Systematic 
      Reviews of Interventions. The primary outcome was laboratory-confirmed influenza. 
      We also synthesized data for hospitalization, mortality, influenza-like illness 
      (ILI), pneumonia or lower respiratory-tract disease, systemic and local adverse 
      events (AEs). We estimated summary risk ratios (RR) using pairwise and NMA with 
      random effects. This study is registered with PROSPERO, number CRD42018091895. 
      FINDINGS: We identified 13,439 citations. A total of 231 RCTs were included after 
      screening: 11 studies did not provide useful data for the analysis; 220 RCTs 
      [100,677 children (< 18 years) and 329,127 adults (18-60 years) and elderly (>/= 61 
      years)] were included in the NMA. In adults and the elderly, all vaccines, except 
      the trivalent inactivated intradermal vaccine (3-IIV ID), were more effective 
      than placebo in reducing the risk of laboratory-confirmed influenza, with a RR 
      between 0.33 (95% credible interval [CrI] 0.21-0.55) for trivalent inactivated 
      high-dose (3-IIV HD) and 0.56 (95% CrI 0.41-0.74) for trivalent live-attenuated 
      vaccine (3-LAIV). In adults and the elderly, compared with trivalent inactivated 
      vaccine (3-IIV), no significant differences were found for any, except 3-LAIV, 
      which was less efficacious [RR 1.41 (95% CrI 1.04-1.88)]. In children, compared 
      with placebo, RR ranged between 0.13 (95% CrI 0.03-0.51) for trivalent 
      inactivated vaccine adjuvanted with MF59/AS03 and 0.55 (95% CrI 0.36-0.83) for 
      trivalent inactivated vaccine. Compared with 3-IIV, 3-LAIV and trivalent 
      inactivated adjuvanted with MF59/AS03 were more efficacious [RR 0.52 (95% CrI 
      0.32-0.82) and RR 0.23 (95% CrI 0.06-0.87)] in reducing laboratory-confirmed 
      influenza. With regard to safety, higher systemic AEs rates after vaccination 
      with 3-IIV, 3-IIV HD, 3-IIV ID, 3-IIV MF59/AS03-adj, quadrivalent inactivated 
      (4-IIV), quadrivalent adjuvanted (4-IIV MF59/AS03-adj), quadrivalent recombinant 
      (4-RIV), 3-LAIV or quadrivalent live attenuated (4-LAIV) vaccines were noted in 
      adults and the elderly [RR 1.5 (95% CrI 1.18-1.89) to 1.15 (95% CrI 1.06-1.23)] 
      compared with placebo. In children, the systemic AEs rate after vaccination was 
      not significantly higher than placebo. INTERPRETATION: All vaccines cumulatively 
      achieved major reductions in the incidence of laboratory-confirmed influenza in 
      children, adults, and the elderly. While the live-attenuated was more efficacious 
      than the inactivated vaccine in children, many vaccine types can be used in 
      adults and the elderly. FUNDING: The directorate general of welfare, Lombardy 
      region.
CI  - (c) 2022 The Author(s).
FAU - Minozzi, Silvia
AU  - Minozzi S
AD  - Department of Epidemiology, Lazio regional health Service, Rome, Italy.
FAU - Lytras, Theodore
AU  - Lytras T
AD  - School of Medicine, European University Cyprus, Nicosia, Cyprus.
FAU - Gianola, Silvia
AU  - Gianola S
AD  - IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy.
FAU - Gonzalez-Lorenzo, Marien
AU  - Gonzalez-Lorenzo M
AD  - Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche 
      Mario Negri IRCCS, Milan, Italy.
FAU - Castellini, Greta
AU  - Castellini G
AD  - IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy.
FAU - Galli, Cristina
AU  - Galli C
AD  - Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
FAU - Cereda, Danilo
AU  - Cereda D
AD  - Directorate General for Health, Lombardy Region, Milan, Italy.
FAU - Bonovas, Stefanos
AU  - Bonovas S
AD  - Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas 
      University, Milan, Italy.
FAU - Pariani, Elena
AU  - Pariani E
AD  - Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
FAU - Moja, Lorenzo
AU  - Moja L
AD  - Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
LA  - eng
PT  - Journal Article
DEP - 20220325
PL  - England
TA  - EClinicalMedicine
JT  - EClinicalMedicine
JID - 101733727
PMC - PMC8961170
OTO - NOTNLM
OT  - 3-IIV HD, trivalent inactivated high-dose influenza vaccine
OT  - 3-IIV ID, trivalent inactivated intradermal influenza vaccine
OT  - 3-IIV MF59/AS03-adj, trivalent inactivated influenza vaccine adjuvanted with 
      MF59/AS03
OT  - 3-IIV vir/lip-adj, trivalent inactivated influenza vaccine adjuvanted with 
      virosome/liposome
OT  - 3-IIV, trivalent inactivated influenza vaccine
OT  - 3-LAIV, trivalent live-attenuated influenza vaccine
OT  - 3-RIV, trivalent recombinant influenza vaccine
OT  - 4-IIV HD, quadrivalent inactivated high-dose influenza vaccine
OT  - 4-IIV ID, quadrivalent inactivated intradermal influenza vaccine
OT  - 4-IIV MF59/AS03-adj, quadrivalent inactivated influenza vaccine adjuvanted with 
      MF59/AS03
OT  - 4-IIV vir/lip-adj, quadrivalent inactivated influenza vaccine adjuvanted with 
      virosome/liposome
OT  - 4-IIV, quadrivalent inactivated influenza vaccine
OT  - 4-LAIV, quadrivalent live-attenuated influenza vaccine
OT  - 4-RIV, quadrivalent recombinant influenza vaccine
OT  - AE, adverse event
OT  - CI, confidence interval
OT  - CrI, credible interval
OT  - IIV, inactivated influenza vaccine
OT  - ILI, influenza-like illness
OT  - Influenza
OT  - LAIV, live-attenuated influenza vaccine
OT  - NMA, network meta-analysis
OT  - Network meta-analysis
OT  - RCT, randomized controlled trial
OT  - RIV, recombinant influenza vaccine
OT  - RR, risk ratio
OT  - SUCRA, surface under the cumulative ranking curve
OT  - Systematic review
OT  - Vaccines
COIS- EP declares support for attending meeting and travel by Sanofi and Seqirus and, 
      participation in Advisory Board of Sanofi. CG declares participation in Advisory 
      Board of Sanofi. SM, TL, SG, MGL, GC, DC, SB and LM declare no competing 
      interests.
EDAT- 2022/04/02 06:00
MHDA- 2022/04/02 06:01
PMCR- 2022/03/25
CRDT- 2022/04/01 05:17
PHST- 2021/12/15 00:00 [received]
PHST- 2022/02/02 00:00 [revised]
PHST- 2022/02/16 00:00 [accepted]
PHST- 2022/04/01 05:17 [entrez]
PHST- 2022/04/02 06:00 [pubmed]
PHST- 2022/04/02 06:01 [medline]
PHST- 2022/03/25 00:00 [pmc-release]
AID - S2589-5370(22)00061-X [pii]
AID - 101331 [pii]
AID - 10.1016/j.eclinm.2022.101331 [doi]
PST - epublish
SO  - EClinicalMedicine. 2022 Mar 25;46:101331. doi: 10.1016/j.eclinm.2022.101331. 
      eCollection 2022 Apr.