elderly individuals, influenza, Cochrane Collaboration, pneumonia, hospital admission, Influenza vaccination, University of Calgary, influenza and pneumonia, effectiveness assessment, vaccine coverage, hospital admissions, the vaccines, vaccine efficacy, vaccines, John Wiley & Sons, Reviews, Servizio di Igiene e Sanita' Pubblica, Roma, Italy, influenza vaccines, Daniela Rivetti, Cochrane Database of Systematic Reviews, Health Department, Cochrane Central Register of Controlled Trials, Italy, Public Health Department, Cochrane Vaccines, Reviews Ltd, Asti
Vaccines for preventing influenza in the elderly (Review) Rivetti D, Jefferson T, Thomas RE, Rudin M, Rivetti A, Di Pietrantonj C, Demicheli V This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration
and published in The Cochrane Library 2009, Issue 4 http://www.thecochranelibrary.com Vaccines for preventing influenza in the elderly (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons
[Intervention Review] Vaccines for preventing influenza in the elderly Daniela Rivetti1, Tom Jefferson2, Roger E Thomas3, Melanie Rudin4, Alessandro Rivetti5, Carlo Di Pietrantonj5, Vittorio Demicheli6 1Public Health Department
, Servizio di Igiene e Sanita' Pubblica, ASL 19 Asti, Asti, Italy. 2Vaccines Field, The Cochrane Collaboration, Roma, Italy. 3Department of Medicine, University of Calgary, Calgary, Canada. 4Health Reviews Ltd, Roma, Italy. 5Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Azienda Sanitaria Locale ASL AL, Alessandria, Italy. 6Health Councillorship - Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Regione Piemonte - Azienda Sanitaria Locale ASL AL, Torino, Italy Contact address: Daniela Rivetti, Public Health Department, Servizio di Igiene e Sanita' Pubblica, ASL 19 Asti, Via Conte Verde, 125, Asti, 14100, Italy. [email protected]
(Editorial group: Cochrane Acute respiratory infection
s Group.) Cochrane Database
of Systematic Reviews, Issue 4, 2009 (Status in this issue: Unchanged) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD004876.pub2 This version first published online: 19 July 2006 in Issue 3, 2006. Last assessed as up-to-date: 4 May 2006. (Help document - Dates and Statuses explained) This record should be cited as: Rivetti D, Jefferson T, Thomas RE, Rudin M, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004876. DOI: 10.1002/14651858.CD004876.pub2. ABSTRACT Background Influenza vaccination of elderly individuals is recommended worldwide and has been targeted toward the elderly and those at serious risk of complications. Objectives Our aim was to review the evidence of efficacy, effectiveness and safety of Influenza vaccine
s in individuals aged 65 years or older. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infection (ARI) Group's specialized register, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effectiveness, (2006, issue 1); MEDLINE (January 1966 to March Week 3 2006); EMBASE (Dialog 1974 to 1979; SilverPlatter 1980 to December 2005); Biological Abstracts (SilverPlatter 1969 to December 2004); and Science Citation Index (Web of Science 1974 to December 2004). Selection criteria We considered randomised, quasi-randomised, cohort and case-control studies assessing efficacy against influenza (laboratory-confirmed cases) or effectiveness against influenza-like illness (ILI) or safety. Any influenza vaccine given independently, in any dose, preparation or time schedule, compared with placebo or with no intervention was considered. data collection
and analysis We grouped reports first according to the setting of the study (community or long-term care facilities) and then by level of viral circulation and vaccine matching. We further stratified by co-administration of pneumococcal polysaccharide vaccine (PPV) and by different types of influenza vaccines. We analysed the following outcomes: influenza, influenza-like illness, hospital admissions, complications and deaths. Vaccines for preventing influenza in the elderly (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Main results Sixty-four studies were included in the efficacy / effectiveness assessment, resulting in 96 data sets
. In homes for elderly individuals (with good vaccine match and high viral circulation) the effectiveness of vaccines against ILI was 23% (6% to 36%) and non-significant against influenza (RR 1.04: 95% CI 0.43 to 2.51). We found no correlation between vaccine coverage and ILI attack rate. Well matched vaccines prevented pneumonia (VE 46%; 30% to 58%), hospital admission (VE 45%; 16% to 64%) and deaths from influenza or pneumonia (VE 42%, 17% to 59%). In elderly individuals living in the community, vaccines were not significantly effective against influenza (RR 0.19; 95% CI 0.02 to 2.01), ILI (RR 1.05: 95% CI 0.58 to 1.89), or pneumonia (RR 0.88; 95% CI 0.64 to 1.20). Well matched vaccines prevented hospital admission for influenza and pneumonia (VE 26%; 12% to 38%) and all-cause mortality (VE 42%; 24% to 55%). After adjustment for confounders, vaccine performance was improved for admissions to hospital for influenza or pneumonia (VE* 27%; 21% to 33%), respiratory disease
s (VE* 22%; 15% to 28%) and cardiac disease (VE* 24%; 18% to 30%); and for all-cause mortality (VE* 47%; 39% to 54%). The public health safety profiles of the vaccines appear to be acceptable. Authors' conclusions In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants. PLAIN LANGUAGE SUMMARY The review looked at whether vaccines prevented seasonal influenza and its complications in people aged 65 or older Influenza vaccination of elderly individuals is recommended worldwide as people aged 65 and older are at highest risk for complications, hospitalisations and deaths from influenza. The review looked at evidence from experimental and non-experimental studies carried out over 40 years of influenza vaccination. Seventy-one studies were included and were grouped first according to study design
and then to setting (community or long-term care facilities). The results of the review are mostly based on non-experimental (observational) studies, which are at greater risk of bias, as not many good quality trials were available. Trivalent inactivated are the most commonly used influenza vaccines. Best effectiveness of current vaccines in preventing clinical illness and its complications was seen in long-term care facilities (for example nursing homes) where vaccines prevented about 45% of pneumonia cases, hospital admissions and influenza-related deaths. This compared to about 25% vaccine efficacy in preventing hospitalisation from influenza or respiratory illness in open community settings. The public health safety profile of the vaccines appears to be acceptable. Vaccines for preventing influenza in the elderly (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
D Rivetti, T Jefferson, R Thomas