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Article: Vaccines for prophylaxis of viral infections in patients with hematological malignancies.
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TitleVaccines for prophylaxis of viral infections in patients with hematological malignancies.
 
AuthorsCheuk, DK1
Chiang, AK
Lee, TL
Chan, GC
Ha, SY
 
Issue Date2011
 
PublisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html
 
CitationCochrane Database Of Systematic Reviews (Online), 2011, v. 3, p. CD006505 [How to Cite?]
DOI: http://dx.doi.org/10.1002/14651858.CD006505.pub2
 
AbstractViral infections cause significant morbidity and mortality in patients with hematological malignancies. It remains uncertain whether viral vaccinations in these patients are supported by good evidence. We aimed to determine the effectiveness and safety of viral vaccines in patients with hematological malignancies. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL (June 2010), reference lists of relevant papers, abstracts from scientific meetings and contacted vaccine manufacturers. Randomized controlled trials (RCTs) evaluating viral vaccines in patients with hematological malignancies were included. Relative risk (RR) was used for binary data and mean difference (MD) for continuous data. Primary outcome was incidence of infection. Secondary outcomes were mortality, incidence of complications and severe viral infection, hospitalization, immune response and adverse effects. Fixed-effect model was used in meta-analyses. Eight RCTs were included, with 305 patients in the intervention groups and 288 in the control groups. They evaluated heat-inactivated varicella zoster virus (VZV) vaccine (two trials), influenza vaccines (five trials) and inactivated poliovirus vaccine (IPV) (one trial). Seven trials had high and one trial had moderate risk of bias.VZV vaccine might reduce herpes zoster compared to no vaccine (RR 0.54, 95% CI 0.3 to 1.0, P=0.05), but not statistically significant. Vaccination also demonstrated efficacy in immune response but frequently caused local adverse effects. One trial reported severity score of zoster, which favored vaccination (MD 2.6, 95% CI 0.94 to 4.26, P=0.002).Two RCTs compared inactivated influenza vaccine with no vaccine and reported lower risk of lower respiratory infections (RR 0.39, 95% CI 0.19 to 0.78, P=0.008) and hospitalization (RR 0.17, 95% CI 0.09 to 0.31, P<0.00001) in vaccine recipients. However, vaccine recipients more frequently experienced irritability and local adverse effects. There was no significant difference in seroconversion between one and two doses of influenza vaccine (one trial), or between recombinant and standard influenza vaccine (one trial), or influenza vaccine given with or without re-induction chemotherapy (one trial).The IPV trial comparing vaccination starting at 6 versus 18 months after stem cell transplant (SCT) found no significant difference in seroconversion. Inactivated VZV vaccine might reduce zoster severity in adult SCT recipients. Inactivated influenza vaccine might reduce respiratory infections and hospitalization in adults with multiple myeloma or children with leukemia or lymphoma. However, the quality of evidence is low. Local adverse effects occur frequently. Further high-quality RCTs are needed.
 
ISSN1469-493X
2013 Impact Factor: 5.939
2013 SCImago Journal Rankings: 1.142
 
DOIhttp://dx.doi.org/10.1002/14651858.CD006505.pub2
 
ISI Accession Number IDWOS:000288457900012
Funding AgencyGrant Number
University of Hong Kong, Hong Kong
Cochrane Hematological Malignancies Group
Funding Information:

Internal sources

 
DC FieldValue
dc.contributor.authorCheuk, DK
 
dc.contributor.authorChiang, AK
 
dc.contributor.authorLee, TL
 
dc.contributor.authorChan, GC
 
dc.contributor.authorHa, SY
 
dc.date.accessioned2011-07-27T01:33:37Z
 
dc.date.available2011-07-27T01:33:37Z
 
dc.date.issued2011
 
dc.description.abstractViral infections cause significant morbidity and mortality in patients with hematological malignancies. It remains uncertain whether viral vaccinations in these patients are supported by good evidence. We aimed to determine the effectiveness and safety of viral vaccines in patients with hematological malignancies. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL (June 2010), reference lists of relevant papers, abstracts from scientific meetings and contacted vaccine manufacturers. Randomized controlled trials (RCTs) evaluating viral vaccines in patients with hematological malignancies were included. Relative risk (RR) was used for binary data and mean difference (MD) for continuous data. Primary outcome was incidence of infection. Secondary outcomes were mortality, incidence of complications and severe viral infection, hospitalization, immune response and adverse effects. Fixed-effect model was used in meta-analyses. Eight RCTs were included, with 305 patients in the intervention groups and 288 in the control groups. They evaluated heat-inactivated varicella zoster virus (VZV) vaccine (two trials), influenza vaccines (five trials) and inactivated poliovirus vaccine (IPV) (one trial). Seven trials had high and one trial had moderate risk of bias.VZV vaccine might reduce herpes zoster compared to no vaccine (RR 0.54, 95% CI 0.3 to 1.0, P=0.05), but not statistically significant. Vaccination also demonstrated efficacy in immune response but frequently caused local adverse effects. One trial reported severity score of zoster, which favored vaccination (MD 2.6, 95% CI 0.94 to 4.26, P=0.002).Two RCTs compared inactivated influenza vaccine with no vaccine and reported lower risk of lower respiratory infections (RR 0.39, 95% CI 0.19 to 0.78, P=0.008) and hospitalization (RR 0.17, 95% CI 0.09 to 0.31, P<0.00001) in vaccine recipients. However, vaccine recipients more frequently experienced irritability and local adverse effects. There was no significant difference in seroconversion between one and two doses of influenza vaccine (one trial), or between recombinant and standard influenza vaccine (one trial), or influenza vaccine given with or without re-induction chemotherapy (one trial).The IPV trial comparing vaccination starting at 6 versus 18 months after stem cell transplant (SCT) found no significant difference in seroconversion. Inactivated VZV vaccine might reduce zoster severity in adult SCT recipients. Inactivated influenza vaccine might reduce respiratory infections and hospitalization in adults with multiple myeloma or children with leukemia or lymphoma. However, the quality of evidence is low. Local adverse effects occur frequently. Further high-quality RCTs are needed.
 
dc.description.naturepublished_or_final_version
 
dc.identifier.citationCochrane Database Of Systematic Reviews (Online), 2011, v. 3, p. CD006505 [How to Cite?]
DOI: http://dx.doi.org/10.1002/14651858.CD006505.pub2
 
dc.identifier.doihttp://dx.doi.org/10.1002/14651858.CD006505.pub2
 
dc.identifier.epageCD006505
 
dc.identifier.hkuros186803
 
dc.identifier.hkuros200686
 
dc.identifier.isiWOS:000288457900012
Funding AgencyGrant Number
University of Hong Kong, Hong Kong
Cochrane Hematological Malignancies Group
Funding Information:

Internal sources

 
dc.identifier.issn1469-493X
2013 Impact Factor: 5.939
2013 SCImago Journal Rankings: 1.142
 
dc.identifier.issue3, article no. CD006505
 
dc.identifier.pmid21412895
 
dc.identifier.scopuseid_2-s2.0-79953292676
 
dc.identifier.spageCD006505
 
dc.identifier.urihttp://hdl.handle.net/10722/135327
 
dc.identifier.volume3
 
dc.languageeng
 
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofCochrane database of systematic reviews (Online)
 
dc.rightsCochrane Database of Systematic Reviews. Copyright © John Wiley & Sons Ltd.
 
dc.rightsThis review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD006505. DOI: http://dx.doi.org/10.1002/14651858.CD006505.pub2). Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshChickenpox Vaccine - therapeutic use
 
dc.subject.meshHematologic Neoplasms - complications
 
dc.subject.meshInfluenza Vaccines - therapeutic use
 
dc.subject.meshPoliovirus Vaccines - therapeutic use
 
dc.subject.meshVirus Diseases - prevention and control
 
dc.titleVaccines for prophylaxis of viral infections in patients with hematological malignancies.
 
dc.typeArticle
 
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<contributor.author>Chiang, AK</contributor.author>
<contributor.author>Lee, TL</contributor.author>
<contributor.author>Chan, GC</contributor.author>
<contributor.author>Ha, SY</contributor.author>
<date.accessioned>2011-07-27T01:33:37Z</date.accessioned>
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<description.abstract>Viral infections cause significant morbidity and mortality in patients with hematological malignancies. It remains uncertain whether viral vaccinations in these patients are supported by good evidence. We aimed to determine the effectiveness and safety of viral vaccines in patients with hematological malignancies. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL (June 2010), reference lists of relevant papers, abstracts from scientific meetings and contacted vaccine manufacturers. Randomized controlled trials (RCTs) evaluating viral vaccines in patients with hematological malignancies were included. Relative risk (RR) was used for binary data and mean difference (MD) for continuous data. Primary outcome was incidence of infection. Secondary outcomes were mortality, incidence of complications and severe viral infection, hospitalization, immune response and adverse effects. Fixed-effect model was used in meta-analyses. Eight RCTs were included, with 305 patients in the intervention groups and 288 in the control groups. They evaluated heat-inactivated varicella zoster virus (VZV) vaccine (two trials), influenza vaccines (five trials) and inactivated poliovirus vaccine (IPV) (one trial). Seven trials had high and one trial had moderate risk of bias.VZV vaccine might reduce herpes zoster compared to no vaccine (RR 0.54, 95% CI 0.3 to 1.0, P=0.05), but not statistically significant. Vaccination also demonstrated efficacy in immune response but frequently caused local adverse effects. One trial reported severity score of zoster, which favored vaccination (MD 2.6, 95% CI 0.94 to 4.26, P=0.002).Two RCTs compared inactivated influenza vaccine with no vaccine and reported lower risk of lower respiratory infections (RR 0.39, 95% CI 0.19 to 0.78, P=0.008) and hospitalization (RR 0.17, 95% CI 0.09 to 0.31, P&lt;0.00001) in vaccine recipients. However, vaccine recipients more frequently experienced irritability and local adverse effects. There was no significant difference in seroconversion between one and two doses of influenza vaccine (one trial), or between recombinant and standard influenza vaccine (one trial), or influenza vaccine given with or without re-induction chemotherapy (one trial).The IPV trial comparing vaccination starting at 6 versus 18 months after stem cell transplant (SCT) found no significant difference in seroconversion. Inactivated VZV vaccine might reduce zoster severity in adult SCT recipients. Inactivated influenza vaccine might reduce respiratory infections and hospitalization in adults with multiple myeloma or children with leukemia or lymphoma. However, the quality of evidence is low. Local adverse effects occur frequently. Further high-quality RCTs are needed.</description.abstract>
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<subject.mesh>Chickenpox Vaccine - therapeutic use</subject.mesh>
<subject.mesh>Hematologic Neoplasms - complications</subject.mesh>
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Author Affiliations
  1. The University of Hong Kong