Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis
Summary from The Lancet Infectious Diseases 10/17/2014 PDF
No published meta-analyses have assessed efficacy and effectiveness of licensed influenza vaccines in the USA with sensitive and
highly specific diagnostic tests to confirm influenza.
We searched Medline for randomized controlled trials assessing a relative reduction in influenza risk of all circulating influenza
viruses during individual seasons after vaccination (efficacy) and observational studies meeting inclusion criteria (effectiveness).
Eligible articles were published between Jan 1, 1967, and Feb 15, 2011, and used RT-PCR or culture for confirmation of
influenza. We excluded some studies on the basis of study design and vaccine characteristics. We estimated random-effects
pooled efficacy for trivalent inactivated vaccine (TIV) and live attenuated influenza vaccine (LAIV) when data were available for
statistical analysis (eg, at least three studies that assessed comparable age groups).
We screened 5707 articles and identified 31 eligible studies (17 randomized controlled trials and 14 observational studies).
Efficacy of TIV was shown in eight (67%) of the 12 seasons analyzed in ten randomized controlled trials (pooled efficacy 59% [95%
CI 51—67] in adults aged 18—65 years). No such trials met inclusion criteria for children aged 2—17 years or adults aged 65 years
or older. Efficacy of LAIV was shown in nine (75%) of the 12 seasons analyzed in ten randomized controlled trials (pooled efficacy
83% [69—91]) in children aged 6 months to 7 years. No such trials met inclusion criteria for children aged 8—17 years. Vaccine
effectiveness was variable for seasonal influenza: six (35%) of 17 analyses in nine studies showed significant protection against
medically attended influenza in the outpatient or inpatient setting. Median monovalent pandemic H1N1 vaccine effectiveness in
five observational studies was 69% (range 60—93).
Influenza vaccines can provide moderate protection against virologically confirmed influenza, but such protection is greatly
reduced or absent in some seasons. Evidence for protection in adults aged 65 years or older is lacking. LAIVs consistently show
highest efficacy in young children (aged 6 months to 7 years). New vaccines with improved clinical efficacy and effectiveness
are needed to further reduce influenza-related morbidity and mortality.
Credits : Alfred P Sloan Foundation, Prof Michael T Osterholm PhD, Nicholas S Kelley PhD, Prof Alfred Sommer MD, Edward A Belongia MD