A systematic review of immunogenicity and safety of influenza subunit vaccines and split vaccines

Abstract

Background: Vaccination remains the most effective preventive measure against influenza. Current flu vaccines include split-virus, subunit, and live-attenuated vaccines. Comparing adjuvanted and non-adjuvanted subunit vaccines and split-virus formulations is essential to evaluate their immunogenicity (through geometric mean titers [GMTs] and seroprotection rates) and safety (adverse event rates). Aim: The aim of this study was to analyze the immunogenicity and safety of adjuvanted subunit vaccines, non-adjuvanted subunit vaccines, and split vaccines. Methods: A systematic search of the PubMed, Cochrane, and EMBASE databases was conducted, supplemented by manual searches. After two reviewers independently screened the articles, extracted the data, and assessed the quality, a meta-analysis was conducted with Stata 16.0 software. Results: Twenty-four studies were ultimately included in the analysis. The systematic review found that adjuvanted subunit influenza vaccines (IV), non-adjuvanted IV, and split IV all provided good protection. Based on the seroconversion rate and GMTs levels, adjuvanted subunit IV was overall superior to non-adjuvanted split IV. However, adjuvanted subunit IV had lower safety compared to non-adjuvanted IV and split IV. Non-adjuvanted IV displayed similar seroprotection rates to adjuvanted subunit IV, providing sufficient protection. Conclusion: Adjuvanted subunit IV offers better immunogenicity but has a higher incidence of adverse reactions. For individuals with impaired immune systems, it is recommended to use adjuvanted subunit IV for better protection. However, for the majority of the population, non-adjuvanted subunit IV is recommended to achieve sufficient seroprotection rates and better safety. Relevance for patients: The systematic review is helpful for guiding better vaccination strategies and improves public health outcomes.

Keywords

Influenza / Adjuvant / Subunit vaccines / Split vaccines / Immunogenicity / Safety

Funding

This work was supported by the Fengcheng Talents Plan, a part of the 113 Biomedical Special Grant of Taizhou, China.

Conflict of interest

All authors declare that they have no conflicts of interest.

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