Summary
Background
No published meta-analyses have assessed efficacy and effectiveness of licensed influenza
vaccines in the USA with sensitive and highly specific diagnostic tests to confirm
influenza.
Methods
We searched Medline for randomised controlled trials assessing a relative reduction
in influenza risk of all circulating influenza viruses during individual seasons after
vaccination (efficacy) and observational studies meeting inclusion criteria (effectiveness).
Eligible articles were published between Jan 1, 1967, and Feb 15, 2011, and used RT-PCR
or culture for confirmation of influenza. We excluded some studies on the basis of
study design and vaccine characteristics. We estimated random-effects pooled efficacy
for trivalent inactivated vaccine (TIV) and live attenuated influenza vaccine (LAIV)
when data were available for statistical analysis (eg, at least three studies that
assessed comparable age groups).
Findings
We screened 5707 articles and identified 31 eligible studies (17 randomised controlled
trials and 14 observational studies). Efficacy of TIV was shown in eight (67%) of
the 12 seasons analysed in ten randomised controlled trials (pooled efficacy 59% [95%
CI 51–67] in adults aged 18–65 years). No such trials met inclusion criteria for children
aged 2–17 years or adults aged 65 years or older. Efficacy of LAIV was shown in nine
(75%) of the 12 seasons analysed in ten randomised controlled trials (pooled efficacy
83% [69–91]) in children aged 6 months to 7 years. No such trials met inclusion criteria
for children aged 8–17 years. Vaccine effectiveness was variable for seasonal influenza:
six (35%) of 17 analyses in nine studies showed significant protection against medically
attended influenza in the outpatient or inpatient setting. Median monovalent pandemic
H1N1 vaccine effectiveness in five observational studies was 69% (range 60–93).
Interpretation
Influenza vaccines can provide moderate protection against virologically confirmed
influenza, but such protection is greatly reduced or absent in some seasons. Evidence
for protection in adults aged 65 years or older is lacking. LAIVs consistently show
highest efficacy in young children (aged 6 months to 7 years). New vaccines with improved
clinical efficacy and effectiveness are needed to further reduce influenza-related
morbidity and mortality.
Funding
Alfred P Sloan Foundation.
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Publication History
Published: October 26, 2011
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