Efficacy, immunogenicity, and safety of available vaccines in children on biologics: A systematic review and meta-analysis

Chiara Gertosio; Amelia Licari; Annalisa De Silvestri; Chiara Rebuffi; Elena Chiappini; Gian Luigi Marseglia

doi:10.1016/j.vaccine.2022.03.041

Efficacy, immunogenicity, and safety of available vaccines in children on biologics: A systematic review and meta-analysis

Vaccine. 2022 Apr 26;40(19):2679-2695. doi: 10.1016/j.vaccine.2022.03.041. Epub 2022 Mar 31.

Authors

Chiara Gertosio¹, Amelia Licari², Annalisa De Silvestri³, Chiara Rebuffi⁴, Elena Chiappini⁵, Gian Luigi Marseglia¹

Affiliations

¹ Pediatric Clinic, Fondazione IRCSS-Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy.
² Pediatric Clinic, Fondazione IRCSS-Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy. Electronic address: amelia.licari@unipv.it.
³ Unit of Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
⁴ Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
⁵ Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, 50139 Florence, Italy.

PMID: 35370019
DOI: 10.1016/j.vaccine.2022.03.041

Abstract

Vaccinations are essential for preventing infectious diseases in children with chronic diseases as they have increased risk of infection from frequent use of biologics. Response to immunizations in this group is not well known.

Objective: A systematic review was performed to evaluate three primary outcomes: efficacy; immunogenicity; and safety of vaccines in children with chronic conditions treated with biologics.

Methods: The protocol for our systematic review and meta-analysis was registered and published with PROSPERO. We searched electronic bibliographic databases for studies published from 2009 to 2019, focusing on vaccinations in children with chronic conditions treated with biologics.

Results: We retrieved 532 records. Thirty-one full-text articles were selected, and 14 were included in the meta-analysis. No significant publication bias was found.

Efficacy: limited data are available regarding the efficacy of vaccination, as most studies have focused on immunogenicity as surrogate outcome for efficacy. Immunogenicity: patients receiving anti-TNF-alpha therapy had a statistically significant risk of poor seroconversion (p = 0.028) and seroprotection by the serotype B influenza vaccine [inflammatory bowel disease (IBD) p = 0.013; juvenile idiopathic arthritis (JIA) p = 0.004]. We found adequate responses with H1N1 and H3N2 serotypes. Few studies existed for pneumococcal, hepatitis A virus, hepatitis B virus, varicella-zoster virus, Measles Mumps Rubella virus, and multiple vaccine administration.

Safety: vaccine administration was not associated with serious side effects, but JIA patients on anti-TNF alpha therapy had a statistically significant risk of presenting with myalgia or arthralgia postinfluenza vaccine (p = 0.014).

Conclusions: More evidence concerning efficacy, immunogenicity, and safety of vaccinations is needed to guide physicians in the vaccine decision process for this pediatric population.

Keywords: Biological drugs; Chronic diseases; Efficacy; Immunogenicity; Safety; Vaccine.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Biological Products* / adverse effects
Child
Humans
Immunogenicity, Vaccine
Influenza A Virus, H1N1 Subtype*
Influenza A Virus, H3N2 Subtype
Measles-Mumps-Rubella Vaccine / adverse effects
Pneumococcal Vaccines
Tumor Necrosis Factor Inhibitors

Substances

Biological Products
Measles-Mumps-Rubella Vaccine
Pneumococcal Vaccines
Tumor Necrosis Factor Inhibitors