Abstract
BackgroundThe primary influenza prevention strategy is focused on annual vaccination according to the categories identified in the various countries as being at greatest risk of complications. Many studies were conducted in order to demonstrate that intradermal (ID) vaccine formulation represents a promising alternative to conventional intramuscular (IM) formulation, especially in subjects with an impaired immune system. However, there is no consensus whether the efficacy and safety of ID is equivalent to IM in these subjects. Therefore, we performed a meta-analysis of Randomized Controlled Trials (RCT) to compare the immunogenicity and safety of ID and IM influenza vaccines in subjects with a depleted immune system.MethodsWe conducted a search strategy of medical literature published until November 2014 in order to identify RCTs that evaluated the immunogenicity and safety of ID compared with IM influenza vaccines in immunocompromized patients.ResultsWe identified a total of 269 citations through research in electronic databases and scanning reference lists. Of these, 6 articles were included in the meta-analysis, for a total of 673 subjects. The seroprotection rate induced by the ID vaccine is comparable to that elicited by the IM vaccine. The overall RR was 1.00 (95 % CI = 0.91 -1.10) for A/H1N1 strain, 1.00 (95 % CI = 0.90-1.12) for A/H3N2 and 0.99 (95 % CI = 0.84 -1.16) for B strain. No significant differences in the occurrence of systemic reactions were detected (17.7 % in the ID group vs 18.2 % in the IM group) with a pooled RR = 1.00 (95 % CI = 0.67 -1.51), whereas ID administration caused significantly more injection site reactions with a mean frequency of 46 % in the ID group compared to 22 % in the IM group, with a pooled RR = 1.89 (95 % CI = 1.40 -2.57).ConclusionsThe ID influenza vaccine has shown a similar immunogenicity and safety to the IM influenza vaccine in immunocompromized patients, and it may be a valid option to increase compliance to influenza vaccination in these populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1161-z) contains supplementary material, which is available to authorized users.
Highlights
The primary influenza prevention strategy is focused on annual vaccination according to the categories identified in the various countries as being at greatest risk of complications
Among the several strategies investigated to increase the immunogenicity of influenza vaccine, researchers have focused attention on ID formulation that appears a valid alternative to IM route because this mode of delivery may be advantageous in terms of immunogenicity, dose sparing, greater acceptability among the patients and lower risk of accidental puncture for healthcare workers, because needle-free injection devices can evoke less pain and stress in patients and avoid unsafe injection practices, in line with the World Health Organization (WHO) objectives [3, 4]
Many studies have been conducted in order to demonstrate that the ID influenza vaccine represents a promising alternative to the IM formulation, especially in subjects with a limited vaccination response caused by an impairment of the immune defenses as a result of many different mechanisms, such as treatment with immunosuppressive drugs or Human Immunodeficiency Virus (HIV) infection [5,6,7]
Summary
The primary influenza prevention strategy is focused on annual vaccination according to the categories identified in the various countries as being at greatest risk of complications. We performed a meta-analysis of Randomized Controlled Trials (RCT) to compare the immunogenicity and safety of ID and IM influenza vaccines in subjects with a depleted immune system. The primary influenza prevention strategy is focused on annual vaccination according to the categories identified as being at greatest risk of complications. Many studies have been conducted in order to demonstrate that the ID influenza vaccine represents a promising alternative to the IM formulation, especially in subjects with a limited vaccination response caused by an impairment of the immune defenses as a result of many different mechanisms, such as treatment with immunosuppressive drugs or HIV infection [5,6,7]. We performed a meta-analysis of Randomized Controlled Trials (RCT) to compare the immunogenicity and safety of ID and IM influenza vaccine in immunocompromized subjects
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