Background

A lower conversion vaccination rate and a more rapid decline in antibody titers over time in dialysis patients raise concerns about the effectiveness of pneumococcal vaccination (PV) in this population, which has not been systematically reviewed.

Methods

We searched PubMed, Cochrane Library, Embase and three Chinese databases from inception until February 29th, 2020 for interventional, cohort and case–control studies evaluating PV alone or combined with influenza vaccination (IV) on outcomes (all-cause mortality, pneumonia, cardiovascular events, antibody response and safety). Independent reviewers completed citation screening, data extraction, risk assessment, meta-analysis, and GRADE rating of the quality of evidence.

Results

Five cohort studies and one quasirandomized control trial enrolling 394,299 dialysis patients with high to moderate quality were included. Compared with unvaccinated individuals, those receiving PV had lower risk of all-cause mortality [Adjusted relative risk (RR) 0.73, 95% CI 0.67–0.79, I² = 31.1%, GRADE low certainty] and cardiovascular events (adjusted RR 0.80, 95% CI 0.69–0.93, I² = 47.2%, GRADE low certainty) without serious adverse effect reported. Compared with no vaccination, lower all-cause mortality was observed in those receiving PV combined with IV (Adjusted RR 0.71, 95%CI 0.67–0.75, I² = 63.3%), PV alone (Adjusted RR 0.86, 95% CI 0.78–0.94,I² = 0%], and IV alone (Adjusted RR 0.76, 95% CI 0.73–0.79, I² = 0%]. There was no difference between pneumococcal vaccinated patients vs non-vaccinated patients with respect to pneumonia. Immune response to pneumococcal conjugate vaccine-13 was weaker in polysaccharide pneumococcal vaccine-23-pre-vaccinated compared with vaccine-naive patients.

Conclusions

The use of pneumococcal vaccine especially combined with influenza vaccination is associated with lower risks of all-cause mortality but may be affected by residual confounding/healthy vaccinee bias.

中文翻译：

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肺炎球菌疫苗在透析患者中​​单独使用或与流感疫苗结合使用的有效性和安全性：系统评价和荟萃分析

背景

透析患者中​​较低的转化疫苗接种率和抗体滴度随时间的快速下降引起了人们对该肺炎球菌疫苗接种（PV）有效性的担忧，但尚未对此进行系统的审查。

方法

从开始到2020年2月29日，我们在PubMed，Cochrane图书馆，Embase和三个中文数据库中进行了干预，队列研究和病例对照研究，评估了单独使用PV或联合流感疫苗接种（IV）对结局（全因死亡率，肺炎，心血管疾病）的干预作用事件，抗体反应和安全性）。独立审稿人完成了引文筛选，数据提取，风险评估，荟萃分析以及证据质量的GRADE评级。

结果

纳入了五项队列研究和一项准随机对照试验，该试验招募了394,299名具有高至中等质量的透析患者。与未接种疫苗的个体相比，接受PV的个体的全因死亡率风险较低[校正后相对风险（RR）0.73，95％CI 0.67-0.79，I ²  = 31.1％，GRADE低确定性]和心血管事件（校正后RR 0.80， 95％CI 0.69–0.93，I ²  = 47.2％，GRADE低确定性），未报告严重不良反应。与未接种疫苗相比，接受PV联合IV的患者（调整后的RR 0.71，95％CI 0.67-0.75，I ²  = 63.3％），仅接受PV的患者（调整后的RR 0.86，95％CI 0.78- 0.94，我² = 0％]和单独使用IV（校正后的RR 0.76，95％CI 0.73–0.79，I ²  = 0％）。接种肺炎球菌的患者与未接种肺炎的患者之间无差异。对肺炎球菌结合物的免疫反应与未接种疫苗的患者相比，在预先接种疫苗的多糖肺炎球菌疫苗23中，疫苗13较弱。

结论

肺炎球菌疫苗的使用，尤其是结合流感疫苗的接种，可降低全因死亡率，但可能会受到残留混杂因素/健康的疫苗接种者偏见的影响。