title: Immunogenicity and Safety of Influenza Vaccination in Systemic Lupus Erythematosus Patients Compared with Healthy Controls: A Meta-Analysis.
abstract: OBJECTIVE
  To assess the immunogenicity and safety of influenza vaccine in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Relevant articles were retrieved from electronic databases. Seroprotection rate, seroconversion rate and factors that increase antibody geometric mean titer (GMT) were used as indices to measure the immunogenicity. The safety of vaccine was assessed through monitoring adverse events, which included side effects and SLE exacerbations. We performed a meta-analysis of influenza vaccine seroprotection, seroconversion and adverse effects. SLE exacerbation after vaccination was comprehensively described. We used the Committee for Proprietary Medicinal Products (CPMP) guidelines to determine whether influenza can induce adequate immunogenicity in patients with SLE.
  
  
  RESULTS
  Eighteen studies with 1966 subjects met the inclusion criteria. At least 565 of the subjects were patients with low-to-moderate SLE Disease Activity Index (SLEDAI) score or stable SLE disease. Compared with the general population, seroprotection rate in SLE patients was significantly decreased in patients with H1N1 [odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.27-0.50] and H3N2 vaccination (OR = 0.48, 95% CI: 0.24-0.93), but not influenza B vaccination (OR = 0.55, 95% CI: 0.24-1.25). Seroconversion rate also significantly decreased in patients with H1N1 (OR = 0.39, 95% CI: 0.27-0.57) and influenza B (OR = 0.47, 95% CI: 0.29-0.76) vaccination, but not H3N2 vaccination (OR = 0.62, 95% CI: 0.21-1.79). However, the immunogenicity of influenza vaccine in SLE patients almost reached that of the CPMP guidelines. The OR for side effects (patients versus healthy controls) was 3.24 (95% CI: 0.62-16.76). Among 1966 patients with SLE, 32 experienced mild exacerbation of SLE and five had serious side effects for other reasons.
  
  
  CONCLUSIONS
  Influenza vaccine has moderate effect on protecting patients with SLE. The side effects of influenza vaccine are not serious and are manageable. With consideration of a higher risk of SLE exacerbation and a more severe course of infection among SLE patients, influenza vaccination should be promoted among SLE patients with a low-to-moderate SLEDAI score or stable disease.
authors: Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China.
authors: Zhengfa
authors: Z
authors: Liao
authors: Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China.
authors: Hao
authors: H
authors: Tang
authors: Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China.
authors: Xiaojia
authors: X
authors: Xu
authors: Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China.
authors: Yaping
authors: Y
authors: Liang
authors: School Clinic, Guangdong Medical University, Dongguan, China.
authors: Yongzhen
authors: Y
authors: Xiong
authors: Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China.
authors: Jindong
authors: J
authors: Ni
mesh_terms: D000914:Antibodies, Viral / Q000276:immunology; D018450:Disease Progression; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000009:adverse effects* / Q000276:immunology*; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000453:epidemiology; D016017:Odds Ratio; D017594:Publication Bias; D014611:Vaccination
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines