Article: Vaccines for prophylaxis of viral infections in patients with hematological malignancies.
| Title | Vaccines for prophylaxis of viral infections in patients with hematological malignancies. | ||||||
|---|---|---|---|---|---|---|---|
| Authors | Cheuk, DK1 Chiang, AK Lee, TL Chan, GC Ha, SY | ||||||
| Issue Date | 2011 | ||||||
| Publisher | John Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html | ||||||
| Citation | Cochrane Database Of Systematic Reviews (Online), 2011, v. 3, p. CD006505 [How to Cite?] DOI: http://dx.doi.org/10.1002/14651858.CD006505.pub2 | ||||||
| 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<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. | ||||||
| ISSN | 1469-493X 2011 Impact Factor: 5.715 2011 SCImago Journal Rankings: 0.174 | ||||||
| DOI | http://dx.doi.org/10.1002/14651858.CD006505.pub2 | ||||||
| ISI Accession Number ID | WOS:000288457900012
Funding Information: Internal sources |
| dc.contributor.author | Cheuk, DK | ||||||
|---|---|---|---|---|---|---|---|
| dc.contributor.author | Chiang, AK | ||||||
| dc.contributor.author | Lee, TL | ||||||
| dc.contributor.author | Chan, GC | ||||||
| dc.contributor.author | Ha, SY | ||||||
| dc.date.accessioned | 2011-07-27T01:33:37Z | ||||||
| dc.date.available | 2011-07-27T01:33:37Z | ||||||
| dc.date.issued | 2011 | ||||||
| dc.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<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.nature | published_or_final_version | ||||||
| dc.identifier.citation | Cochrane 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.doi | http://dx.doi.org/10.1002/14651858.CD006505.pub2 | ||||||
| dc.identifier.epage | CD006505 | ||||||
| dc.identifier.hkuros | 186803 | ||||||
| dc.identifier.hkuros | 200686 | ||||||
| dc.identifier.isi | WOS:000288457900012
Funding Information: Internal sources | ||||||
| dc.identifier.issn | 1469-493X 2011 Impact Factor: 5.715 2011 SCImago Journal Rankings: 0.174 | ||||||
| dc.identifier.issue | 3, article no. CD006505 | ||||||
| dc.identifier.pmid | 21412895 | ||||||
| dc.identifier.scopus | eid_2-s2.0-79953292676 | ||||||
| dc.identifier.spage | CD006505 | ||||||
| dc.identifier.uri | http://hdl.handle.net/10722/135327 | ||||||
| dc.identifier.volume | 3 | ||||||
| dc.language | eng | ||||||
| dc.publisher | John 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.place | United Kingdom | ||||||
| dc.relation.ispartof | Cochrane database of systematic reviews (Online) | ||||||
| dc.rights | Cochrane Database of Systematic Reviews. Copyright © John Wiley & Sons Ltd. | ||||||
| dc.rights | This 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.rights | Creative Commons: Attribution 3.0 Hong Kong License | ||||||
| dc.subject.mesh | Chickenpox Vaccine - therapeutic use | ||||||
| dc.subject.mesh | Hematologic Neoplasms - complications | ||||||
| dc.subject.mesh | Influenza Vaccines - therapeutic use | ||||||
| dc.subject.mesh | Poliovirus Vaccines - therapeutic use | ||||||
| dc.subject.mesh | Virus Diseases - prevention and control | ||||||
| dc.title | Vaccines for prophylaxis of viral infections in patients with hematological malignancies. | ||||||
| dc.type | Article |
Author Affiliations
- The University of Hong Kong