The Effect of Monovalent Influenza Vaccine on the Risk of Hospitalization and All-Cause Mortality According to the Re-sults of Randomized Clinical Trials: A Systematic Review and Meta-Analysis
Abstract
Background: In recent years, various studies have been conducted to investigate the role of the influenza vaccine in reducing the risk of hospitalization and mortality; however, the results of these studies are clearly contradictory. Accordingly, we aimed to investigate the effect of monovalent flu vaccines on the risk of hospitalization and all-cause mortality.
Methods: This study was a systematic review and meta-analysis of Randomized Clinical Trial (RCT) studies published in databases (Web of Science (ISI), Scopus, PubMed, Cochrane, Science Direct, Google Scholar) from 1980 to Dec 2022. All analyzes were performed by Stata15 statistical software and the significance level in this study was considered 0.05.
Results: In the initial search, 375 articles were retrieved which, considering the study criteria, finally 8 RCT were included in the meta-analysis of the effects of monovalent Flu vaccine on the risk of hospitalization, and 10 RCT on the risk of all-cause mortality. Based on the results of meta-analysis, the overall Odds Ratio (OR) of hospitalization is equal to 0.71 (95% CI: 0.56-0.90; P <0.001) and the overall OR of all-cause mortality is equal to 0.82 (95% CI: 0.68-0.98; P=0.033). There was no publication bias in the study of the effect of monovalent flu vaccine on the risk of hospitalization and all-cause mortality
Conclusion: Getting the flu vaccine can reduce the risk of hospitalization by 29% and the risk of overall death by 18%. Therefore, it may be promising to receive this vaccine as a preventive intervention for deaths and hospitalizations.
1. Clark NM, Lynch JP, 3rd (2011). Influenza: epidemiology, clinical features, therapy, and prevention. Semin Respir Crit Care Med, 32:373-392.
2. Lagacé-Wiens PR, Rubinstein E, Gumel A (2010). Influenza epidemiology--past, present, and future. Crit Care Med, 38(4 Suppl):e1-9.
3. Eden JS, Tanaka MM, Boni MF, et al (2013). Recombination within the pandemic norovirus GII.4 lineage. J Virol,87:6270-6282.
4. Kilbourne ED (2006). Influenza pandemics of the 20th century. Emerg Infect Dis,12:9-14.
5. Pakzad R, Mohammadian-Hafshejani A, Khosravi B, et al (2016). The incidence and mortality of esophageal cancer and their relationship to development in Asia. Ann Transl Med,4:29.
6. Lee KR, Bae JH, Hwang IC, et al (2017). Effect of influenza vaccination on risk of stroke: a systematic review and meta-analysis. Neuroepidemiology,48:103-110.
7. Mohammadian M, Allah Bakeshei K, Mohammadian-Hafshejani A (2020). International epidemiology of liver cancer: geographical distribution, secular trends and predicting the future. J Prev Med Hyg,61:E259-E289.
8. Pakzad R, Khani Y, Pakzad I, et al (2016). Spatial Analysis of Stomach Cancer Incidence in Iran. Asian Pac J Cancer Prev,17(S3):27-32.
9. Pakzad R, Moudi A, Pournamdar Z, et al (2016). Spatial Analysis of Colorectal Cancer in Iran. Asian Pac J Cancer Prev,17(S3):53-58.
10. Rafiemanesh H, Maleki F, Mohammadian-Hafshejani A, et al (2016). The Trend in Histological Changes and the Incidence of Esophagus Cancer in Iran (2003-2008). Int J Prev Med,7:31.
11. Salehiniya H, Ghobadi Dashdebi S, Rafiemanesh H, et al (2016). Time Trend Analysis of Cancer Incidence in Caspian Sea, 2004 - 2009: A Population-based Cancer Registries Study (northern Iran). Caspian J Intern Med, 7:25-30.
12. Hertzman L, Hayes M (1985). Will the elderly really bankrupt us with increased health care costs? Can J Public Health,76:373-377.
13. Mohammadian M, Soroush A, Mohammadian-Hafshejani A, et al (2016). Incidence and Mortality of Liver Cancer and Their Relationship with Development in Asia. Asian Pac J Cancer Prev,17:2041-2047.
14. Rafiemanesh H, Mehtarpoor M, Mohammadian-Hafshejani A, et al (2015). Cancer epidemiology and trends in Sistan and Baluchestan province, Iran. Med J Islam Repub Iran, 29:254.
15. Russell M, Ardalan A (2007). Aging and future health care costs: a warning for the country's health system. Iran J Ageing,4:300-305.
16. Chen CM, Chen HJ, Chen Ws, et al (2018). Clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis. Int J Rheum Dis, 21:1246-1253.
17. Mulpuru S, Li L, Ye L, et al (2019). Effectiveness of influenza vaccination on hospitalizations and risk factors for severe outcomes in hospitalized patients with COPD. Chest, 155:69-78.
18. Wang I-K, Lin C-L, Lin P-C, et al (2016). Seasonal influenza vaccination is associated with reduced morbidity and mortality in peritoneal dialysis patients. Nephrol Dial Transplant, 31:269-274.
19. Anderson ML, Dobkin C, Gorry D (2020). The effect of influenza vaccination for the elderly on hospitalization and mortality: an observational study with a regression discontinuity design. Ann Intern Med,172:445-452.
20. Gilca R, Skowronski DM, Douville-Fradet M, et al (2015). Mid-season estimates of influenza vaccine effectiveness against influenza A (H3N2) hospitalization in the elderly in Quebec, Canada, January 2015. PLoS One,10:e0132195.
21. Kaselitz TB, Martin ET, Power LE, et al (2019). Impact of vaccination on morbidity and mortality in adults hospitalized with influenza A, 2014–2015. Infect Dis Clin Pract,27:328-333.
22. Yokomichi H, Kurihara S, Yokoyama T, et al (2014). The pandemic influenza A (H1N1) 2009 vaccine does not increase the mortality rate of idiopathic interstitial pneumonia: a matched case-control study. PLoS One, 9:e88927.
23. Song JY, Noh JY, Lee JS, et al (2018). Effectiveness of influenza and pneumococcal polysaccharide vaccines against influenza-related outcomes including pneumonia and acute exacerbation of cardiopulmonary diseases: Analysis by dominant viral subtype and vaccine matching. PLoS One,13:e0207918.
24. Zhang D, Zhang Y, Wang Q, et al (2019). The effectiveness of influenza vaccination in preventing hospitalizations in elderly in Beijing, 2016–18. Vaccine, 37:1853-1858.
25. Pebody R, Zhao H, Whitaker H, et al (2020). Effectiveness of influenza vaccine in children in preventing influenza associated hospitalisation, 2018/19, England. Vaccine, 38:158-164.
26. Jadad AR, Moore RA, Carroll D, et al (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials,17:1-12.
27. Altman DG, Schulz KF, Moher D, et al (2001). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med,134:663-694.
28. . Loeb M. Influenza vaccine to prevent adverse vascular events - IVVE. Presented at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, April 3, 2022.
29. Govaert TM, Thijs C, Masurel N, et al (1994). The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA, 272:1661-1665.
30. Gurfinkel EP, Leon de la Fuente R, Mendiz O, et al (2004). Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study. Eur Heart J, 25:25-31.
31. Ciszewski A, Bilinska ZT, Brydak LB, et al (2008). Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J, 29:1350-1358.
32. De Villiers PJ, Steele AD, Hiemstra LA, et al (2009). Efficacy and safety of a live attenuated influenza vaccine in adults 60 years of age and older. Vaccine,28:228-234.
33. Keshtkar-Jahromi M, Vakili H, Rahnavardi M (2009). The efficacy of influenza vaccination in reducing cardiovascular events in patients with coronary artery diseases: IVCAD study. Clin Microbiol Infect, 15:S395-396.
34. Phrommintikul A, Kuanprasert S, Wongcharoen W, et al (2011). Influenza vaccination reduces cardiovascular events in patients with acute coronary syndrome. Eur Heart J,32:1730-1735.
35. Fröbert O, Götberg M, Erlinge D, et al (2021). Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation,144:1476-1484.
36. Langley JM, Risi G, Caldwell M, et al (2011). Dose-sparing H5N1 A/Indonesia/05/2005 pre-pandemic influenza vaccine in adults and elderly adults: a phase III, placebo-controlled, randomized study. J Infect Dis, 203:1729-1738.
37. Verhees RAF, Thijs C, Ambergen T, et al (2019). Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality. PLoS One, 14:e0216983.
38. Liu I-F, Huang C-C, Chan W-L, et al (2012). Effects of annual influenza vaccination on mortality and hospitalization in elderly patients with ischemic heart disease: a nationwide population-based study. Prev Med, 54:431-433.
39. Wang I-K, Lin C-L, Chang Y-C, et al (2013). Effectiveness of influenza vaccination in elderly diabetic patients: a retrospective cohort study. Vaccine,31:718-724.
40. Puig-Barberà J, Díez-Domingo J, Varea ÁB, et al (2007). Effectiveness of MF59™-adjuvanted subunit influenza vaccine in preventing hospitalisations for cardiovascular disease, cerebrovascular disease and pneumonia in the elderly. Vaccine,25:7313-7321.
41. Örtqvist Å, Granath F, Askling J, et al (2007). Influenza vaccination and mortality: prospective cohort study of the elderly in a large geographical area. Eur Respir J,30:414-422.
42. Nichol KL, Nordin J, Mullooly J, et al (2003). Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med,348:1322-1332.
43. Hara M, Sakamoto T, Tanaka K (2006). Effectiveness of influenza vaccination in preventing influenza-like illness among community-dwelling elderly: population-based cohort study in Japan. Vaccine, 24:5546-5551.
44. Hung IF, Leung AY, Chu DW, et al (2010). Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clin Infect Dis,51:1007-1016.
2. Lagacé-Wiens PR, Rubinstein E, Gumel A (2010). Influenza epidemiology--past, present, and future. Crit Care Med, 38(4 Suppl):e1-9.
3. Eden JS, Tanaka MM, Boni MF, et al (2013). Recombination within the pandemic norovirus GII.4 lineage. J Virol,87:6270-6282.
4. Kilbourne ED (2006). Influenza pandemics of the 20th century. Emerg Infect Dis,12:9-14.
5. Pakzad R, Mohammadian-Hafshejani A, Khosravi B, et al (2016). The incidence and mortality of esophageal cancer and their relationship to development in Asia. Ann Transl Med,4:29.
6. Lee KR, Bae JH, Hwang IC, et al (2017). Effect of influenza vaccination on risk of stroke: a systematic review and meta-analysis. Neuroepidemiology,48:103-110.
7. Mohammadian M, Allah Bakeshei K, Mohammadian-Hafshejani A (2020). International epidemiology of liver cancer: geographical distribution, secular trends and predicting the future. J Prev Med Hyg,61:E259-E289.
8. Pakzad R, Khani Y, Pakzad I, et al (2016). Spatial Analysis of Stomach Cancer Incidence in Iran. Asian Pac J Cancer Prev,17(S3):27-32.
9. Pakzad R, Moudi A, Pournamdar Z, et al (2016). Spatial Analysis of Colorectal Cancer in Iran. Asian Pac J Cancer Prev,17(S3):53-58.
10. Rafiemanesh H, Maleki F, Mohammadian-Hafshejani A, et al (2016). The Trend in Histological Changes and the Incidence of Esophagus Cancer in Iran (2003-2008). Int J Prev Med,7:31.
11. Salehiniya H, Ghobadi Dashdebi S, Rafiemanesh H, et al (2016). Time Trend Analysis of Cancer Incidence in Caspian Sea, 2004 - 2009: A Population-based Cancer Registries Study (northern Iran). Caspian J Intern Med, 7:25-30.
12. Hertzman L, Hayes M (1985). Will the elderly really bankrupt us with increased health care costs? Can J Public Health,76:373-377.
13. Mohammadian M, Soroush A, Mohammadian-Hafshejani A, et al (2016). Incidence and Mortality of Liver Cancer and Their Relationship with Development in Asia. Asian Pac J Cancer Prev,17:2041-2047.
14. Rafiemanesh H, Mehtarpoor M, Mohammadian-Hafshejani A, et al (2015). Cancer epidemiology and trends in Sistan and Baluchestan province, Iran. Med J Islam Repub Iran, 29:254.
15. Russell M, Ardalan A (2007). Aging and future health care costs: a warning for the country's health system. Iran J Ageing,4:300-305.
16. Chen CM, Chen HJ, Chen Ws, et al (2018). Clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis. Int J Rheum Dis, 21:1246-1253.
17. Mulpuru S, Li L, Ye L, et al (2019). Effectiveness of influenza vaccination on hospitalizations and risk factors for severe outcomes in hospitalized patients with COPD. Chest, 155:69-78.
18. Wang I-K, Lin C-L, Lin P-C, et al (2016). Seasonal influenza vaccination is associated with reduced morbidity and mortality in peritoneal dialysis patients. Nephrol Dial Transplant, 31:269-274.
19. Anderson ML, Dobkin C, Gorry D (2020). The effect of influenza vaccination for the elderly on hospitalization and mortality: an observational study with a regression discontinuity design. Ann Intern Med,172:445-452.
20. Gilca R, Skowronski DM, Douville-Fradet M, et al (2015). Mid-season estimates of influenza vaccine effectiveness against influenza A (H3N2) hospitalization in the elderly in Quebec, Canada, January 2015. PLoS One,10:e0132195.
21. Kaselitz TB, Martin ET, Power LE, et al (2019). Impact of vaccination on morbidity and mortality in adults hospitalized with influenza A, 2014–2015. Infect Dis Clin Pract,27:328-333.
22. Yokomichi H, Kurihara S, Yokoyama T, et al (2014). The pandemic influenza A (H1N1) 2009 vaccine does not increase the mortality rate of idiopathic interstitial pneumonia: a matched case-control study. PLoS One, 9:e88927.
23. Song JY, Noh JY, Lee JS, et al (2018). Effectiveness of influenza and pneumococcal polysaccharide vaccines against influenza-related outcomes including pneumonia and acute exacerbation of cardiopulmonary diseases: Analysis by dominant viral subtype and vaccine matching. PLoS One,13:e0207918.
24. Zhang D, Zhang Y, Wang Q, et al (2019). The effectiveness of influenza vaccination in preventing hospitalizations in elderly in Beijing, 2016–18. Vaccine, 37:1853-1858.
25. Pebody R, Zhao H, Whitaker H, et al (2020). Effectiveness of influenza vaccine in children in preventing influenza associated hospitalisation, 2018/19, England. Vaccine, 38:158-164.
26. Jadad AR, Moore RA, Carroll D, et al (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials,17:1-12.
27. Altman DG, Schulz KF, Moher D, et al (2001). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med,134:663-694.
28. . Loeb M. Influenza vaccine to prevent adverse vascular events - IVVE. Presented at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, April 3, 2022.
29. Govaert TM, Thijs C, Masurel N, et al (1994). The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA, 272:1661-1665.
30. Gurfinkel EP, Leon de la Fuente R, Mendiz O, et al (2004). Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study. Eur Heart J, 25:25-31.
31. Ciszewski A, Bilinska ZT, Brydak LB, et al (2008). Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J, 29:1350-1358.
32. De Villiers PJ, Steele AD, Hiemstra LA, et al (2009). Efficacy and safety of a live attenuated influenza vaccine in adults 60 years of age and older. Vaccine,28:228-234.
33. Keshtkar-Jahromi M, Vakili H, Rahnavardi M (2009). The efficacy of influenza vaccination in reducing cardiovascular events in patients with coronary artery diseases: IVCAD study. Clin Microbiol Infect, 15:S395-396.
34. Phrommintikul A, Kuanprasert S, Wongcharoen W, et al (2011). Influenza vaccination reduces cardiovascular events in patients with acute coronary syndrome. Eur Heart J,32:1730-1735.
35. Fröbert O, Götberg M, Erlinge D, et al (2021). Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation,144:1476-1484.
36. Langley JM, Risi G, Caldwell M, et al (2011). Dose-sparing H5N1 A/Indonesia/05/2005 pre-pandemic influenza vaccine in adults and elderly adults: a phase III, placebo-controlled, randomized study. J Infect Dis, 203:1729-1738.
37. Verhees RAF, Thijs C, Ambergen T, et al (2019). Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality. PLoS One, 14:e0216983.
38. Liu I-F, Huang C-C, Chan W-L, et al (2012). Effects of annual influenza vaccination on mortality and hospitalization in elderly patients with ischemic heart disease: a nationwide population-based study. Prev Med, 54:431-433.
39. Wang I-K, Lin C-L, Chang Y-C, et al (2013). Effectiveness of influenza vaccination in elderly diabetic patients: a retrospective cohort study. Vaccine,31:718-724.
40. Puig-Barberà J, Díez-Domingo J, Varea ÁB, et al (2007). Effectiveness of MF59™-adjuvanted subunit influenza vaccine in preventing hospitalisations for cardiovascular disease, cerebrovascular disease and pneumonia in the elderly. Vaccine,25:7313-7321.
41. Örtqvist Å, Granath F, Askling J, et al (2007). Influenza vaccination and mortality: prospective cohort study of the elderly in a large geographical area. Eur Respir J,30:414-422.
42. Nichol KL, Nordin J, Mullooly J, et al (2003). Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med,348:1322-1332.
43. Hara M, Sakamoto T, Tanaka K (2006). Effectiveness of influenza vaccination in preventing influenza-like illness among community-dwelling elderly: population-based cohort study in Japan. Vaccine, 24:5546-5551.
44. Hung IF, Leung AY, Chu DW, et al (2010). Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clin Infect Dis,51:1007-1016.
| Files | ||
| Issue | Vol 52 No 5 (2023) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i5.12709 | |
| Keywords | ||
| Influenza vaccine Hospitalization All-cause mortality Meta-analysis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Rezaei-Tavabe N, Kheiri S, Mousavi MS, Mohammadian-Hafshejani A. The Effect of Monovalent Influenza Vaccine on the Risk of Hospitalization and All-Cause Mortality According to the Re-sults of Randomized Clinical Trials: A Systematic Review and Meta-Analysis. Iran J Public Health. 2023;52(5):924-936.
