A systematic review of randomized clinical trials on quadrivalent influenza vaccines for adults

Abstract Background Vaccination is the most effective intervention to prevent influenza. Adults at risk of complications are among the targets of annual vaccination campaigns and can receive different types of quadrivalent influenza vaccines (QIV). To assess the immunogenicity of different QIVs we performed a systematic review of available randomized controlled trials (RCTs) with the aim of indirectly compare them through a network meta-analysis. Methods The systematic review was conducted in accordance with PRISMA-NMA guidelines. We systematically searched RCTs conducted in adults aged 18-64 years that assessed the immunogenicity, namely seroprotection and seroconversion rate (SPR and SCR), of any QIV compared to any comparator. The literature search was performed on three databases (Medline, Cochrane Library and Scopus) until March 30th, 2021. Results Twenty-four RCTs were included in the systematic review. A network meta-analysis was not possible: the assumption of transitivity was not satisfied. Therefore, we decided to combine data on immunogenicity and efficacy of each QIV through single meta-analyses in the presence of at least two studies. Live attenuated QIV showed the worst results in terms of both SCR and SPR. Standard dose egg based, low dose adjuvanted, cell based, recombinant and intradermal QIV showed similar SCR in respect to influenza strain A, whereas low dose adjuvanted QIV showed an overall better profile in respect to B lineages. Regarding SCR, the better results were issued by standard egg based, cell based, recombinant, and low dose adjuvanted QIVs. Conclusions Albeit an indirect comparison among different QIVs was not possible, the assessment of SCR and SPR provided an overview of their respective potentiality and criticality in adulthood. In particular attention should be paid to new generation influenza vaccines that can have an antigen sparing effect and to the collection of real world data to make comparison among different QIVs possible. Key messages • Available evidence does not allow to perform indirect comparison of the quadrivalent influenza vaccines for adults. • Some QIVs, including new generation ones, elicit a better antibody response.


Background:
Vaccination is the most effective intervention to prevent influenza. Adults at risk of complications are among the targets of annual vaccination campaigns and can receive different types of quadrivalent influenza vaccines (QIV). To assess the immunogenicity of different QIVs we performed a systematic review of available randomized controlled trials (RCTs) with the aim of indirectly compare them through a network metaanalysis.

Methods:
The systematic review was conducted in accordance with PRISMA-NMA guidelines. We systematically searched RCTs conducted in adults aged 18-64 years that assessed the immunogenicity, namely seroprotection and seroconversion rate (SPR and SCR), of any QIV compared to any comparator. The literature search was performed on three databases (Medline, Cochrane Library and Scopus) until March 30th, 2021.

Results:
Twenty-four RCTs were included in the systematic review. A network meta-analysis was not possible: the assumption of transitivity was not satisfied. Therefore, we decided to combine data on immunogenicity and efficacy of each QIV through single meta-analyses in the presence of at least two studies. Live attenuated QIV showed the worst results in terms of both SCR and SPR. Standard dose egg based, low dose adjuvanted, cell based, recombinant and intradermal QIV showed similar SCR in respect to influenza strain A, whereas low dose adjuvanted QIV showed an overall better profile in respect to B lineages. Regarding SCR, the better results were issued by standard egg based, cell based, recombinant, and low dose adjuvanted QIVs.

Conclusions:
Albeit an indirect comparison among different QIVs was not possible, the assessment of SCR and SPR provided an overview of their respective potentiality and criticality in adulthood. In particular attention should be paid to new generation influenza vaccines that can have an antigen sparing effect and to the collection of real world data to make comparison among different QIVs possible.

Key messages:
Available evidence does not allow to perform indirect comparison of the quadrivalent influenza vaccines for adults. Some QIVs, including new generation ones, elicit a better antibody response.
Many societal developments have an impact on health care in general and on child health care, in particular. Internationally challenges include an aging population, more cultural diversity and a rising prevalence of chronic diseases among children and adolescents, revealing potential risks for child health care. A strong focus must be placed on prevention strategies that are effective, sustainable and equitable. Planning and implementing prevention strategies may require shifts in the organization of care, such as the forging and strengthening of interdisciplinary and intersectoral partnerships within a country. A promising example of such partnerships is the collaboration of public health with paediatrics. Both professional groups acknowledge the call for greater integration since prevention strategies can only be achieved and sustained by working together. The objectives of this workshop are to: Provide a selective overview of three partnerships and plans for cooperation between public health and paediatrics.
To exchange experiences and possibilities with the audience to pave the way for further successful partnerships. In this workshop, we outline the partnership and plans for cooperation between public health and paediatrics in three European countries: Netherlands, Finland and Switzerland. In the first presentation, Danielle Jansen and Károly Illy will share the new vision towards the year 2030 of the Dutch Paediatric Society in which building blocks are presented to guarantee accessible, high-quality, timely and effective care for every child. One of the building blocks to be highlighted is the interprofessional collaboration between paediatricians and public health professionals. In the second presentation, Julia Dratva and Susanne Stronski from Switzerland will present a iii244 European Journal of Public Health, Volume 32 Supplement 3, 2022