Influenza vaccination in XXXX with @entity454 : systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness, and safety.

@entity1 @entity778 @entity295 @entity646 @entity55 @entity6831 @entity683 @entity1729 @entity204 @entity2259 @entity454
BACKGROUND: Vaccination against @entity683 is recommended in @entity1 with @entity454 ( @entity454 ). However, so far, no systematic review has summarized the available evidence on the effectiveness and safety of @entity683 vaccination in this @entity1 group. METHODS: We conducted a systematic review and meta-analysis and assessed the quality of evidence using the GRADE methodology. We searched MEDLINE, EMBASE, Cochrane Library databases, ClinicalTrials.gov, and reference lists for studies on efficacy, effectiveness, and/or safety of seasonal @entity683 vaccination in @entity1 with @entity454 receiving dialysis. All reported clinical outcomes were considered, including all-cause mortality, @entity204 , @entity204 , all-cause hospitalization, hospitalization due to @entity55 , hospitalization due to @entity2259 , @entity646 , or @entity295 , hospitalization due to @entity1729 , ICU admission, and @entity683 . RESULTS: Five observational studies and no randomized-controlled trial were identified. In four studies, risk of bias was high regarding all reported outcomes. Strong residual confounding was likely to be present in one study reporting on three outcomes, as indicated by significant protective effects of vaccination outside @entity683 seasons. Therefore, the statistically significant protective effects on all-cause mortality ( @entity6831 ( @entity6831 ), 32%; 95% CI, 24-39%), @entity204 ( @entity6831 , 16%; 95% CI, 1-29%), hospitalization due to @entity55 ( @entity6831 , 14%; 95% CI, 7-20%), ICU admission ( @entity6831 , 81%; 95% CI, 63-86%), and @entity683 ( @entity6831 , 12%; 95% CI, 10-14%) have to be taken with caution. According to GRADE, the quality of the body of evidence was considered very low for all outcomes. No study reported on laboratory-confirmed @entity778 or on safety endpoints. CONCLUSIONS: Evidence on the protective effects of @entity683 vaccination in @entity1 with @entity454 is limited and of very low quality. Since @entity6831 estimates in the available literature are prone to unmeasured confounding, studies using randomization or quasi-experimental designs are needed to determine the extent by which vaccination prevents @entity683 and related clinical outcomes in this at-risk population. However, given the high rates of health-endangering events in these @entity1 , even a low @entity6831 can be considered as sufficient to recommend annual @entity683 vaccination.
