Journal of Infectious Diseases
Volume 206 Issue 8 October 15, 2012
Editor’s choice: Influenza Vaccination for Immunocompromised Patients: Systematic Review and Meta-analysis by Etiology
J Infect Dis. (2012) 206(8): 1250-1259 doi:10.1093/infdis/jis487
Charles R. Beck, Bruce C. McKenzie, Ahmed B. Hashim, Rebecca C. Harris,
University of Nottingham Influenza and the ImmunoCompromised (UNIIC) Study Group, and Jonathan S. Nguyen-Van-Tam
Many national guidelines recommend annual influenza vaccination of immunocompromised patients, although the decision to vaccinate is usually at clinical discretion. We conducted a systematic review and meta-analyses to assess the evidence for influenza vaccination in this group, and we report our results by etiology. Meta-analyses showed significantly lower odds of influenza-like illness after vaccination in patients with human immunodeficiency virus (HIV) infection, patients with cancer, and transplant recipients and of laboratory-confirmed influenza in HIV-positive patients, compared with patients receiving placebo or no vaccination. Pooled odds of seroconversion and seroprotection were typically lower in HIV-positive patients, patients with cancer, and transplant recipients, compared with immunocompetent controls. Vaccination was generally well tolerated, with variation in mild adverse events between etiological groups. Limited evidence of a transient increase in viremia and a decrease in the percentage of CD4+ cells in HIV-positive patients was found although not accompanied by worsening of clinical symptoms. Clinical judgment remains important when discussing the benefits and safety profile with immunocompromised patients.