{"title":"Effects of influenza vaccination on neurodegenerative and demyelinating disorders: a systematic review and meta-analysis.","authors":"Jiaxin Chen, Wenkai Zhou, Mengting Cen, Can Chen, Kexin Cao, Mengsha Chen, Rongrong Qu, Jiani Miao, Jiaxing Qi, Xiaoyue Wu, Huihui Zhang, Qianqian Feng, Anqi Dai, Jingtong Zhou, Nani Xu, Xiaowei Hu, Shigui Yang","doi":"10.1007/s00415-025-13238-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Previous studies have highlighted potential associations between influenza vaccination (IV) and neurological outcomes, particularly neurodegenerative disorders (NDs) and demyelinating disorders (DDs). However, the existing evidence remains inconclusive. Given the widespread global uptake of IV, even small potential effects may carry important public health implications. Therefore, a comprehensive synthesis of current evidence is essential to clarify these associations and inform evidence-based vaccination strategies.</p><p><strong>Objective: </strong>This study aimed to systematically examine the associations between IV and NDs as well as DDs.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Scopus, and Web of Science from database inception to November 30, 2024, to identify relevant studies. Studies meeting predefined were selected for analysis, followed by data extraction and quality assessment. Pooled odds ratio (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed by population characteristics and study features, and sensitivity analyses were conducted to test the robustness of results.</p><p><strong>Result: </strong>A total of 64 studies were included in the analysis (22 on NDs and 44 on DDs), comprising 5,679,964,431 participants were included. IV was associated with a reduced risk of NDs (OR = 0.85, 95% CI 0.75-0.98). Subgroup analyses showed a stronger protective effect against NDs among individuals with chronic comorbidities (OR = 0.66, 95% CI 0.63-0.69) and older adults (OR = 0.83, 95% CI 0.69-0.99), with the protective effect increasing with age. For DDs, IV was associated with an increased risk of DDs (OR = 1.61, 95% CI 1.22-2.12). Elevated risks were primarily observed in earlier studies (OR = 2.15, 95% CI 1.23-3.77) and in populations who received pandemic influenza vaccines (OR = 2.03, 95% CI 1.44-2.86). However, no statistically significant association between influenza vaccination and DDs was found in studies conducted after 2010 (OR = 1.13, 95% CI 0.90-1.41). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected.</p><p><strong>Conclusion: </strong>IV was associated with a reduced risk of NDs, particularly among older adults and individuals with chronic comorbidities. Although an increased risk of DDs was observed in earlier studies and among recipients of pandemic IV, no significant association was found in studies conducted over the past decade. Given the protective benefits of IV against both influenza itself and NDs in elderly individuals and those with chronic health conditions, expanding IV coverage in these vulnerable groups is strongly recommended.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 8","pages":"499"},"PeriodicalIF":4.8000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00415-025-13238-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Previous studies have highlighted potential associations between influenza vaccination (IV) and neurological outcomes, particularly neurodegenerative disorders (NDs) and demyelinating disorders (DDs). However, the existing evidence remains inconclusive. Given the widespread global uptake of IV, even small potential effects may carry important public health implications. Therefore, a comprehensive synthesis of current evidence is essential to clarify these associations and inform evidence-based vaccination strategies.
Objective: This study aimed to systematically examine the associations between IV and NDs as well as DDs.
Methods: We systematically searched PubMed, Embase, Scopus, and Web of Science from database inception to November 30, 2024, to identify relevant studies. Studies meeting predefined were selected for analysis, followed by data extraction and quality assessment. Pooled odds ratio (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed by population characteristics and study features, and sensitivity analyses were conducted to test the robustness of results.
Result: A total of 64 studies were included in the analysis (22 on NDs and 44 on DDs), comprising 5,679,964,431 participants were included. IV was associated with a reduced risk of NDs (OR = 0.85, 95% CI 0.75-0.98). Subgroup analyses showed a stronger protective effect against NDs among individuals with chronic comorbidities (OR = 0.66, 95% CI 0.63-0.69) and older adults (OR = 0.83, 95% CI 0.69-0.99), with the protective effect increasing with age. For DDs, IV was associated with an increased risk of DDs (OR = 1.61, 95% CI 1.22-2.12). Elevated risks were primarily observed in earlier studies (OR = 2.15, 95% CI 1.23-3.77) and in populations who received pandemic influenza vaccines (OR = 2.03, 95% CI 1.44-2.86). However, no statistically significant association between influenza vaccination and DDs was found in studies conducted after 2010 (OR = 1.13, 95% CI 0.90-1.41). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected.
Conclusion: IV was associated with a reduced risk of NDs, particularly among older adults and individuals with chronic comorbidities. Although an increased risk of DDs was observed in earlier studies and among recipients of pandemic IV, no significant association was found in studies conducted over the past decade. Given the protective benefits of IV against both influenza itself and NDs in elderly individuals and those with chronic health conditions, expanding IV coverage in these vulnerable groups is strongly recommended.
背景：先前的研究强调了流感疫苗接种（IV）与神经系统预后，特别是神经退行性疾病（NDs）和脱髓鞘疾病（dd）之间的潜在关联。然而，现有的证据仍然没有定论。鉴于静脉注射在全球的广泛使用，即使是很小的潜在影响也可能带来重要的公共卫生影响。因此，全面综合现有证据对于澄清这些关联并为基于证据的疫苗接种策略提供信息至关重要。目的：本研究旨在系统地探讨静脉注射与NDs和DDs之间的关系。方法：系统检索PubMed、Embase、Scopus、Web of Science自建库至2024年11月30日的相关研究。选择符合预定义的研究进行分析，然后进行数据提取和质量评估。采用随机效应模型计算合并优势比（ORs）和95%置信区间（ci）。根据群体特征和研究特征进行亚组分析，并进行敏感性分析以检验结果的稳健性。结果：共纳入64项研究（22项nd和44项dd），包括5,679,964,431名参与者。静脉注射与NDs风险降低相关（OR = 0.85, 95% CI 0.75-0.98）。亚组分析显示，慢性合并症患者（OR = 0.66, 95% CI 0.63-0.69）和老年人（OR = 0.83, 95% CI 0.69-0.99）对NDs有较强的保护作用，且保护作用随年龄增长而增强。对于DDs， IV与DDs风险增加相关（OR = 1.61, 95% CI 1.22-2.12）。在早期研究中（OR = 2.15, 95% CI 1.23-3.77）和接种大流行性流感疫苗的人群中（OR = 2.03, 95% CI 1.44-2.86）主要观察到风险升高。然而，在2010年之后进行的研究中，没有发现流感疫苗接种和ddds之间有统计学意义的关联（OR = 1.13, 95% CI 0.90-1.41）。敏感性分析证实了这些发现的稳健性，没有发现明显的发表偏倚。结论：静脉注射与NDs风险降低有关，特别是在老年人和慢性合并症患者中。虽然在早期研究和第四次大流行的接受者中观察到腹泻风险增加，但在过去十年进行的研究中未发现显著关联。鉴于静脉注射对流感本身以及老年人和慢性病患者的非传染性疾病具有保护作用，强烈建议扩大这些弱势群体的静脉注射覆盖率。
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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