Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Issue 4 (23rd January 2017)

• Record Type: Journal Article
• Authors: Domnich, Alexander; Arata, Lucia; Amicizia, Daniela; Puig-Barberà, Joan; Gasparini, Roberto; Panatto, Donatella
• Is Part Of: Vaccine. Volume 35:Issue 4(2017)
• Page Start: 513
• Page End: 520
• Publication Date: 2017-01-23
• Subjects: Influenza vaccine -- MF59-adjuvanted vaccine -- Elderly -- Influenza vaccine effectiveness -- Meta-analysis; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2016.12.011
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Traditional inactivated flu vaccines are often poorly immunogenic in the elderly. Adjuvantation with MF59 may increase vaccine effectiveness among seniors. The aim was to assess MF59-vaccine effectiveness in preventing influenza-related outcomes. Our review suggests that MF59-adjuvanted vaccine is highly effective in the elderly. Field effectiveness of MF59-adjuvanted vaccine is superior to unadjuvanted vaccines. Abstract: Background: In the elderly, traditional influenza inactivated vaccines are often only modestly immunogenic, owing to immunosenescence. Given that adjuvantation is a means of enhancing the immune response, the trivalent inactivated vaccine adjuvanted with MF59 (MF59-TIV) was specifically designed to overcome this problem. Considering that, for ethical reasons, the absolute effectiveness of an influenza vaccine in the elderly cannot be demonstrated in placebo-controlled studies, the present study aimed to assess the effectiveness of MF59-TIV in preventing influenza-related outcomes in the elderly. Methods: We conducted a systematic review of observational studies aimed at evaluating the effectiveness of MF59-TIV against influenza-related outcomes. Results of single studies were pooled whenever possible. Results: Of the 1993 papers screened, 11 (6 case-control, 3 cohort and 2 prospective case-control) studies were identified. Hospitalization due to pneumonia/influenza and laboratory-confirmed influenza were reported in more than one study, while other outcomes (influenza-like illness, cardio- and cerebrovascular accidents) were investigated only by one study each. Pooled analysis of four case-control studies showed an adjusted MF59-TIV effectiveness of 51% (95% CI: 39–61%) against hospitalizations for pneumonia/influenza among community-dwelling seniors. Pooled results of the adjusted vaccine effectiveness against laboratory-confirmed influenza were also high (60.1%), although the 95% CI passed through zero (−1.3 to 84.3%). Other single community-based studies showed very high effectiveness of MF59-TIV in preventing hospitalizations for acute coronary [87% (95% CI: 35–97%)] and cerebrovascular [93% (95% CI: 52–99%)] events. MF59-TIV proved highly effective [94% (95% CI: 47–100%] in reducing influenza-like illness among institutionalized elderly. Furthermore, MF59-TIV displayed greater efficacy than non-adjuvanted vaccines in preventing hospitalizations due to pneumonia/influenza [adjusted risk ratio 0.75 (95% CI: 0.57–0.98)] and laboratory-confirmed influenza [adjusted odds ratio 0.37 (0.14–0.96)]. Conclusions: Our results suggest that MF59-TIV is effective in reducing several influenza-related outcomes among the elderly, especially hospitalizations due to influenza-related complications.