Yellow fever vaccine safety in immunocompromised individuals: a systematic review and meta-analysis
Yellow fever vaccine safety in immunocompromised individuals: a systematic review and meta-analysis
Data
2023
Autores
Lagos, Letícia Wigg de Araújo
Abreu, Ariane de Jesus Lopes de
Caetano, Rosângela
Braga, José Ueleres
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Travel Medicine
Resumo
Background: Yellow fever (YF) is an arbovirus with variable severity, including severe forms with high mor-
tality. The vaccination is the most effective measure to protect against the disease. Non-serious and serious
adverse events have been described in immunocompromised individuals, but previous studies have failed to
demonstrate this association. This systematic review assessed the risk of adverse events after YF vaccination in
immunocompromised individuals compared with its use in non-immunocompromised individuals.
Methods: A search was conducted in the MEDLINE, LILACS, EMBASE, SCOPUS, DARE, Toxiline, Web of Science
and grey literature databases for publications until February 2021. Randomized and quasi-randomized clinical
trials and observational studies that included immunocompromised participants (individuals with HIV infection,
organ transplants, with cancer, who used immunosuppressive drugs for rheumatologic diseases and those on
immunosuppressive therapy for other diseases) were selected. The methodological quality of observational or
non-randomized studies was assessed by the ROBINS-I tool. Two meta-analyses were performed, proportion and
risk factor analyses, to identify the summary measure of relative risk (RR) in the studies that had variables suitable
for combination.
Results: Twenty-five studies were included, most with risk of bias classified as critical. Thirteen studies had
enough data to carry out the proposed meta-analyses. Seven studies without a comparator group had their
results aggregated in the proportion meta-analysis, identifying an 8.5% [95% confidence interval (CI) 0.07–21.8]
risk of immunocompromised individuals presenting adverse events after vaccination. Six cohort studies were
combined, with an RR of 1.00 (95% CI 0.78–1.29). Subgroup analysis was performed according to the aetiology
of immunosuppression and was also unable to identify an increased risk of adverse events following vaccination.
Conclusions: It is not possible to affirm that immunocompromised individuals, regardless of aetiology, have a higher
risk of adverse events after receiving the YF vaccine.
Description
Palavras-chave
immunocompromised, systematic review, adverse events, yellow fever vaccine, Yellow fever
Citação
Wigg de Araújo Lagos L, de Jesus Lopes de Abreu A, Caetano R, Braga JU. Yellow fever vaccine safety in immunocompromised individuals: a systematic review and meta-analysis. J Travel Med. 2023 Apr 5;30(2):taac095. doi: 10.1093/jtm/taac095.