Immune thrombocytopenic purpura after influenza vaccine administration; a systematic review and meta-analysis

Mohamed Elsaid; Arvind Nune; Aml M Brakat; Ayush Anand; Mahmoud Alashwah; Ahmed Maher; Nitu Lama; Criselle Angeline C Peñamante

doi:10.1186/s40794-023-00206-9

Immune thrombocytopenic purpura after influenza vaccine administration; a systematic review and meta-analysis

Trop Dis Travel Med Vaccines. 2023 Nov 25;9(1):22. doi: 10.1186/s40794-023-00206-9.

Authors

Mohamed Elsaid^{1

2}, Arvind Nune³, Aml M Brakat^{4

5}, Ayush Anand^{6

5}, Mahmoud Alashwah^{7

5}, Ahmed Maher^{8

5}, Nitu Lama^{9

5}, Criselle Angeline C Peñamante^{10

11

5}

Affiliations

¹ Faculty of Medicine, Misr University for Science and Technology, 6th of October, Giza, Egypt. mohamed65295@student.must.edu.eg.
² Medical Research Platform, Giza, Egypt. mohamed65295@student.must.edu.eg.
³ Department of Rheumatology and General Medicine, Southport and Ormskirk Hospital NHS Trust, Southport, UK.
⁴ Faculty of Medicine, Zagazig University, Ash Sharqia Governorate, Egypt.
⁵ Medical Research Platform, Giza, Egypt.
⁶ B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
⁷ Faculty of Medicine, Cairo University, Cairo, Egypt.
⁸ Faculty of Medicine, Al-Azhar University, New-Damietta, Egypt.
⁹ Dr. M. V. Shetty College of Physiotherapy, Rajiv Gandhi University of Health Sciences, Mangaluru, India.
¹⁰ Department of Clinical Epidemiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
¹¹ Department of Psychology, College of Science, University of Santo Tomas, Manila, Philippines.

Abstract

Background: The American Society of Haematology defines immune thrombocytopenic purpura (ITP) as a common hematologic disorder characterized by a transient or long-term decrease in platelet counts (< 100 × 109/L.), purpura, and haemorrhagic episodes caused by antiplatelet autoantibodies, with the exclusion of other clinical conditions. We aimed to systematically determine the incidence of ITP in adults and children following influenza vaccination, the duration between vaccination and the occurrence of ITP, and to identify predictors of ITP after the vaccine.

Methods: We searched PubMed, Cochrane Library, Google Scholar, Web of Science, Scopus, and Science Direct. We included primary studies that assessed the occurrence of immune thrombocytopenia in individuals who had received any influenza vaccine (primary or booster dose), regardless of the dosage, preparation, time of administration, or age of the participants. We excluded studies that were (a) Narrative, scoping, and umbrella reviews ;(b) studies with no accessible full text, abstract-only studies, or (c) Overlapping or unreliable data. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) tool. We categorized studies for qualitative analysis based on study design. Descriptive statistics were used to summarize quantitative data, including the incidence of ITP after influenza vaccination.

Results: Out of 729 articles retrieved from the database search, we included 24 studies. All patients identified and included in this systematic review presented with immune thrombocytopenia, determined by their platelet count. The period between vaccination and the occurrence of ITP ranged from (2:35 days). The mean duration was 13.5 days. The analysis revealed a statistically significant incidence rate ratio (IRR) = 1.85,95% CI [1.03-3.32] of ITP occurrence after 42 days.

Conclusions: Influenza-associated ITP is uncommon, self-limiting, non-life-threatening, and curable. None of the patients reported having severe adverse events or death. Further studies are required to confirm the exact incidence of the ITP to better understand the pathophysiology of ITP development post-influenza vaccination.

Keywords: Immune thrombocytopenia (ITP); Influenza vaccine; Meta-analysis.; Platelets; Systematic review.

Publication types

Review