Abstract

BackgroundVaccination against influenza is recommended in patients with end-stage renal disease (ESRD). However, so far, no systematic review has summarized the available evidence on the effectiveness and safety of influenza vaccination in this patient group.MethodsWe conducted a systematic review and meta-analysis and assessed the quality of evidence using the GRADE methodology. We searched MEDLINE, EMBASE, Cochrane Library databases, ClinicalTrials.gov, and reference lists for studies on efficacy, effectiveness, and/or safety of seasonal influenza vaccination in patients with ESRD receiving dialysis. All reported clinical outcomes were considered, including all-cause mortality, cardiac death, infectious death, all-cause hospitalization, hospitalization due to influenza or pneumonia, hospitalization due to bacteremia, viremia, or septicemia, hospitalization due to respiratory infection, ICU admission, and influenza-like illness.ResultsFive observational studies and no randomized-controlled trial were identified. In four studies, risk of bias was high regarding all reported outcomes. Strong residual confounding was likely to be present in one study reporting on three outcomes, as indicated by significant protective effects of vaccination outside influenza seasons. Therefore, the statistically significant protective effects on all-cause mortality (vaccine effectiveness (VE), 32%; 95% CI, 24–39%), cardiac death (VE, 16%; 95% CI, 1–29%), hospitalization due to influenza or pneumonia (VE, 14%; 95% CI, 7–20%), ICU admission (VE, 81%; 95% CI, 63–86%), and influenza-like illness (VE, 12%; 95% CI, 10–14%) have to be taken with caution. According to GRADE, the quality of the body of evidence was considered very low for all outcomes. No study reported on laboratory-confirmed influenza virus infections or on safety endpoints.ConclusionsEvidence on the protective effects of influenza vaccination in patients with ESRD is limited and of very low quality. Since VE estimates in the available literature are prone to unmeasured confounding, studies using randomization or quasi-experimental designs are needed to determine the extent by which vaccination prevents influenza and related clinical outcomes in this at-risk population. However, given the high rates of health-endangering events in these patients, even a low VE can be considered as sufficient to recommend annual influenza vaccination.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0244-9) contains supplementary material, which is available to authorized users.

Highlights

  • Vaccination against influenza is recommended in patients with end-stage renal disease (ESRD)

  • Selection of studies and study characteristics We identified, in the initial search, 1,541 records in electronic databases (Figure 1) and included a total of five studies in this review after applying the inclusion and exclusion criteria

  • Significant protective effects of influenza vaccination were observed for the outcomes hospitalization due to influenza or pneumonia and ICU admission

Read more

Summary

Introduction

Vaccination against influenza is recommended in patients with end-stage renal disease (ESRD). Patients with ESRD have an impaired innate and adaptive immune system, including defects in complement activation and B- and T-cell function [4,5,6]. This functional abnormality contributes to higher incidences and severe courses of infectious diseases [7,8]. To reduce influenza disease burden among these patients, the World Health Organization and many national immunization technical advisory groups recommend annual vaccination against seasonal influenza [10,11,12,13]

Methods
Results
Discussion
Conclusion
Full Text
Paper version not known

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.