"Efficacy, immunogenicity and safety of COVID-19 vaccines in older adults: a systematic review and meta-analysis"

作者全名："Li, Zejun; Liu, Shouhuan; Li, Fengming; Li, Yifeng; Li, Yilin; Peng, Pu; Li, Sai; He, Li; Liu, Tieqiao"

作者地址："[Li, Zejun; Peng, Pu; He, Li; Liu, Tieqiao] Cent South Univ, Xiangya Hosp 2, Natl Clin Res Ctr Mental Disorders, Dept Psychiat, Changsha, Peoples R China; [Liu, Shouhuan] Kunming Med Univ, Affiliated Hosp 1, Dept Psychiat, Kunming, Peoples R China; [Li, Fengming] Chongqing Med Univ, Childrens Hosp, Key Lab Child Dev & Disorders, Minist Educ, Chongqing, Peoples R China; [Li, Yifeng; Li, Yilin; Li, Sai] Chongqing Med Univ, Coll Pediat, Chongqing, Peoples R China"

通信作者："He, L; Liu, TQ (通讯作者)，Cent South Univ, Xiangya Hosp 2, Natl Clin Res Ctr Mental Disorders, Dept Psychiat, Changsha, Peoples R China."

来源：FRONTIERS IN IMMUNOLOGY

ESI学科分类：IMMUNOLOGY

WOS号：WOS:000861588500001

JCR分区：Q1

影响因子：7.3

年份：2022

卷号：13

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：COVID-19 vaccines; efficacy; immunogenicity; safety; older adults; randomized controlled trials (RCTs); meta-analysis

摘要："Background: Older adults are more susceptible to severe health outcomes for coronavirus disease 2019 (COVID-19). Universal vaccination has become a trend, but there are still doubts and research gaps regarding the COVID-19 vaccination in the elderly. This study aimed to investigate the efficacy, immunogenicity, and safety of COVID-19 vaccines in older people aged > 55 years and their influencing factors. Methods: Randomized controlled trials from inception to April 9, 2022, were systematically searched in PubMed, EMBASE, the Cochrane Library, and Web of Science. We estimated summary relative risk (RR), rates, or standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects meta-analysis. This study was registered with PROSPERO (CRD42022314456). Results: Of the 32 eligible studies, 9, 21, and 25 were analyzed for efficacy, immunogenicity, and safety, respectively. In older adults, vaccination was efficacious against COVID-19 (79.49%, 95% CI: 60.55-89.34), with excellent seroconversion rate (92.64%, 95% CI: 86.77-96.91) and geometric mean titer (GMT) (SMD 3.56, 95% CI: 2.80-4.31) of neutralizing antibodies, and provided a significant protection rate against severe disease (87.01%, 50.80-96.57). Subgroup and meta-regression analyses consistently found vaccine types and the number of doses to be primary influencing factors for efficacy and immunogenicity. Specifically, mRNA vaccines showed the best efficacy (90.72%, 95% CI: 86.82-93.46), consistent with its highest seroconversion rate (98.52%, 95% CI: 93.45-99.98) and GMT (SMD 6.20, 95% CI: 2.02-10.39). Compared to the control groups, vaccination significantly increased the incidence of total adverse events (AEs) (RR 1.59, 95% CI: 1.38-1.83), including most local and systemic AEs, such as pain, fever, chill, etc. For inactivated and DNA vaccines, the incidence of any AEs was similar between vaccination and control groups (p > 0.1), while mRNA vaccines had the highest risk of most AEs (RR range from 1.74 to 7.22). Conclusion: COVID-19 vaccines showed acceptable efficacy, immunogenicity and safety in older people, especially providing a high protection rate against severe disease. The mRNA vaccine was the most efficacious, but it is worth surveillance for some AEs it caused. Increased booster coverage in older adults is warranted, and additional studies are urgently required for longer follow-up periods and variant strains."

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