Clinical endpoints to inform vaccine policy: A systematic review of outcome measures from pediatric influenza vaccine efficacy trials. Issue 32 (30th July 2022)

• Record Type: Journal Article
• Authors: Braunfeld, Jordan B.; Carson, Heather N.; Williams, Sarah R.; Schwartz, Lauren M.; Neuzil, Kathleen M.; Ortiz, Justin R.
• Is Part Of: Vaccine. Volume 40:Issue 32(2022)
• Page Start: 4339
• Page End: 4347
• Publication Date: 2022-07-30
• Subjects: Influenza -- Vaccine -- Paediatrics -- WHO -- Low-income country -- Middle-income country; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2022.06.028
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Influenza vaccines are not widely used in resource-limited settings. Clinical endpoints in vaccine efficacy trials in children are highly variable. Vaccine trials were not designed to measure severe illness outcomes. Broad vaccine implementation will require focus on clinically relevant outcomes. Abstract: Introduction: We conducted a systematic review of pediatric influenza vaccine efficacy trials to assess clinical outcome measures and whether the trials defined important public health endpoints. Material and methods: We systematically identified phase 3 or 4 influenza vaccine randomized controlled trials among children ≤18 years of age with laboratory-confirmed influenza outcomes since 1980. We recorded countries, age groups, vaccine formulations, specimen collection criteria, laboratory diagnostics, primary and secondary outcome measures, and funders, and we determined income category for study countries. We used descriptive statistics to summarize study characteristics. We analyzed the studies overall and a subset of studies conducted in at least one low- and middle-income country (LMIC). Results: From 6455 potentially relevant articles, we identified 41 eligible studies. Twenty-one studies (51%) were conducted in at least one LMIC, while the remaining studies (49%) were conducted in high-income countries only. Thirty-one studies (76%) included children younger than six years. We found 40 different primary outcome measures among the 41 eligible studies. Thirty-three studies (80%) reported standardized symptoms or findings which defined a primary outcome or triggered specimen collection. One study defined a primary outcome which captured more severe illness; however, cases were mostly due to high body temperature without other severity criteria. Of the 21 studies from at least one LMIC, 15 (71%) were published since 2010 and 17 (81%) enrolled children younger than six years. Eighteen (86%) studies from at least one LMIC reported standardized symptoms or findings which defined a primary outcome or triggered specimen collection. Conclusions: Among pediatric influenza vaccine efficacy trials, primary outcome measures and clinical specimen collection criteria were highly variable and, with one exception, focused on capturing any influenza illness. As most LMICs do not have influenza vaccination programs, our study highlights a potential data limitation affecting policy and implementation decisions in these settings.