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Article: Vaccines for prophylaxis of viral infections in patients with hematological malignancies.

TitleVaccines for prophylaxis of viral infections in patients with hematological malignancies.
Authors
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
Citation
Cochrane Database Of Systematic Reviews (Online), 2011, v. 3, p. CD006505 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/135327
ISSN
2013 Impact Factor: 5.939
2013 SCImago Journal Rankings: 1.142
ISI Accession Number ID
Funding AgencyGrant Number
University of Hong Kong, Hong Kong
Cochrane Hematological Malignancies Group
Funding Information:

Internal sources

 

Author Affiliations
  1. The University of Hong Kong
DC FieldValueLanguage
dc.contributor.authorCheuk, DKen_HK
dc.contributor.authorChiang, AKen_HK
dc.contributor.authorLee, TLen_HK
dc.contributor.authorChan, GCen_HK
dc.contributor.authorHa, SYen_HK
dc.date.accessioned2011-07-27T01:33:37Z-
dc.date.available2011-07-27T01:33:37Z-
dc.date.issued2011en_HK
dc.identifier.citationCochrane Database Of Systematic Reviews (Online), 2011, v. 3, p. CD006505en_HK
dc.identifier.issn1469-493Xen_HK
dc.identifier.urihttp://hdl.handle.net/10722/135327-
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.en_HK
dc.languageengen_US
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.htmlen_HK
dc.relation.ispartofCochrane database of systematic reviews (Online)en_HK
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.en_HK
dc.typeArticleen_HK
dc.identifier.emailChiang, AK:chiangak@hkucc.hku.hken_HK
dc.identifier.emailChan, GC:gcfchan@hkucc.hku.hken_HK
dc.identifier.authorityChiang, AK=rp00403en_HK
dc.identifier.authorityChan, GC=rp00431en_HK
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1002/14651858.CD006505.pub2-
dc.identifier.pmid21412895en_HK
dc.identifier.scopuseid_2-s2.0-79953292676en_HK
dc.identifier.hkuros186803en_US
dc.identifier.hkuros200686-
dc.identifier.volume3en_HK
dc.identifier.issue3, article no. CD006505-
dc.identifier.spageCD006505en_HK
dc.identifier.epageCD006505en_HK
dc.identifier.isiWOS:000288457900012-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridCheuk, DK=8705936100en_HK
dc.identifier.scopusauthoridChiang, AK=7101623534en_HK
dc.identifier.scopusauthoridLee, TL=37066172400en_HK
dc.identifier.scopusauthoridChan, GC=16160154400en_HK
dc.identifier.scopusauthoridHa, SY=7202501115en_HK

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