Impact of influenza vaccination in patients with chronic liver disease

  • Härmälä S & al.
  • BMJ Open
  • 6 Sep 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • This study suggests that in patients with chronic liver disease, the influenza vaccine may not protect against all-cause mortality.
  • However, it triggers an effective antibody response and may reduce the risk for all-cause hospitalisation.

Why this matters

  • Patients with liver disease are frequently admitted to hospitals with infection often the trigger.
  • Although influenza vaccination can effectively prevent infection in healthy and elderly, it is often perceived less beneficial in patients with liver disease.

Study design

  • Meta-analysis included 12 studies identified after a search on MEDLINE, EMBASE, PubMed and CENTRAL databases.
  • Outcome: all-cause hospitalisation and mortality, cause-specific hospitalisation and mortality and serological vaccine response.
  • Funding: UK Biotechnology and Biological Sciences Research Council.

Key results

  • Vaccination was associated with a reduction in the risk for hospital admission in patients with viral liver disease with a drop from 205/1000 to 149/1000 patients (risk difference [RD], −0.06; 95% CI, −0.07 to −0.04).
  • The risk for hospitalisation was lower in patients vaccinated with hepatitis B virus vs unvaccinated patients (risk ratio [RR], 0.73; 95% CI, 0.66-0.80).
  • Vaccinated vs unvaccinated patients had no less risk for death during:
    • influenza season (pooled random effects RR, 0.80 [95% CI, 0.43-1.50]; RD, −0.001 [95% CI, −0.01 to 0.01]; I2=33.00%; P=0.23); and
    • entire year (pooled random effects RR, 0.41 [95% CI, 0.11-1.52]; RD, −0.06 [95% CI, −0.08 to 0.04]; I2=94.00%).
  • No effect against all-cause or cause-specific mortality or cause-specific hospitalisation was observed.


  • Publication bias.
  • Inclusion of non-randomised studies.