Influenza Vaccine Effectiveness in Mainland China: A Systematic Review and Meta-Analysis.

Xiaokun Yang,Zhibin Peng,Hongting Zhao,Jiandong Zheng,Zhongjie Li,Aiqin Zhu,Luzhao Feng,Zhili Li,Yu Li,Zijian Feng,Mengjie Geng,Minrui Ren,Zhijie An,Ying Qin

doi:10.3390/vaccines9020079

Abstract

Influenza endangers human health but can be prevented in part by vaccination. Assessing influenza vaccine effectiveness (VE) provides scientific evidence for developing influenza vaccination policy. We conducted a systematic review and meta-analysis of studies that evaluated influenza VE in mainland China. We searched six relevant databases as of 30 August 2019 to identify studies and used Review Manager 5.3 software to analyze the included studies. The Newcastle–Ottawa scale was used to assess the risk of publication bias. We identified 1408 publications, and after removing duplicates and screening full texts, we included 21 studies in the analyses. Studies were conducted in Beijing, Guangzhou, Suzhou, and Zhejiang province from the 2010/11 influenza season through the 2017/18 influenza season. Overall influenza VE for laboratory confirmed influenza was 36% (95% CI: 25–46%). In the subgroup analysis, VE was 45% (95% CI: 18–64%) for children 6–35 months who received one dose of influenza vaccine, and 57% (95% CI: 50–64%) who received two doses. VE was 47% (95% CI: 39–54%) for children 6 months to 8 years, and 18% (95% CI: 0–33%) for adults ≥60 years. For inpatients, VE was 21% (95% CI: −11–44%). We conclude that influenza vaccines that were used in mainland China had a moderate effectiveness, with VE being higher among children than the elderly. Influenza VE should be continuously monitored in mainland China to provide evidence for policy making and improving uptake of the influenza vaccine.

Highlights

Influenza is an acute respiratory infectious disease that causes a large burden of disease globally
With the exception of a few cities where local government subsidize influenza vaccination programs, influenza vaccination has not been introduced in a national, government-funded program for people in mainland China, nor is the influenza vaccine included in health insurance
To be eligible for this systematic review and meta-analysis a study had to meet the following criteria: (1) the study setting was in mainland China; (2) the study design was either a test-negative design (TND) case–control study, another type of case–control study, or a cohort study; (3) patients with influenza-like illness (ILI) or acute respiratory infection (ARI) had to have been tested by reverse transcription polymerase chain reaction(RT-PCR) for the influenza virus; (4) the study reported influenza vaccine effectiveness (VE); and (5) the study was a post-marketing influenza

Summary

Introduction

Influenza is an acute respiratory infectious disease that causes a large burden of disease globally. According to WHO estimates, 5 to 10% of adults and 20 to 30% of children will suffer from seasonal influenza infection every year, resulting in 3 to 5 million cases of severe illness and 290,000–650,000 deaths [1]. In each year of the 2010/2011 through 2014/2015 seasons, there was an estimated 65 to 190 million people infected and. With the exception of a few cities where local government subsidize influenza vaccination programs, influenza vaccination has not been introduced in a national, government-funded program for people in mainland China, nor is the influenza vaccine included in health insurance. Health and economic analyses of seasonal influenza vaccination may help local and national governments justify influenza vaccination programs. An essential component of the health and economic evaluation of vaccines is their effectiveness. Monitoring influenza VE can provide evidence for program and policy making

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