Abstract
Seasonal influenza is the leading infectious disease in terms of its health and socioeconomic impact. Annual immunization is the most efficient way to reduce this burden. Several correlates of influenza vaccine-induced protection are commonly used, owing to their ready availability and cheapness. Influenza vaccine-induced immunogenicity is a function of host-, virus- and vaccine-related factors. Host-related factors constitute the most heterogeneous group. The objective of this study was to analyze the available systematic evidence on the host factors able to modify influenza vaccine-induced immunogenicity. An umbrella review approach was undertaken. A total of 28 systematic reviews/meta-analyses were analyzed—these covered the following domains: intravenous drug use, psychological stress, acute and chronic physical exercise, genetic polymorphisms, use of pre-/pro-/symbiotics, previous Bacillus Calmette–Guérin vaccination, diabetes mellitus, vitamin D supplementation/deficiency, latent cytomegalovirus infection and various forms of immunosuppression. In order to present effect sizes on the same scale, all possible meta-analyses were re-performed and cumulative evidence synthesis ranking was carried out. The meta-analysis was conducted separately on each health condition category and virus (sub)type. A total of 97 pooled estimates were used in order to construct an evidence-based stakeholder-friendly map. The principal public health implications are discussed.
Highlights
Influenza is the world’s leading annually occurring infectious disease and places an enormous burden on public health [1]
We examined the available systematic evidence on the relationship between several host-related factors and influenza vaccines (IVs)-induced immunogenicity; the analysis was made from both the qualitative and quantitative points of view
systematic reviews (SRs)/SRMAs on the same/similar topics and performed by different research groups using different systematic approaches may confound the decision-making of the principal stakeholders, including, for example, clinicians, reimbursement agencies and the pharmaceuticals industry
Summary
Influenza is the world’s leading annually occurring infectious disease and places an enormous burden on public health [1]. Annual influenza vaccination is the main public health intervention able to reduce the burden of disease [1,3]. The World Health Organization’s (WHO) most recent position paper [1] has recognized some priority target groups for annual influenza vaccination, including pregnant women, children aged 6 months to 5 years, the elderly, subjects with specific chronic conditions, healthcare workers and international travellers. In most countries of the WHO European Region, for example, vaccination is recommended for the elderly, people with underlying risk conditions, institutionalized populations, healthcare workers and (in fewer countries) children and pregnant women [7], while in the United States (US), it is universally recommended (for all subjects aged 6 months and above) [8]
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