Evidence map›Paper›PMID 27737830›Full record

SynthesisBMJ (Clinical research ed.)2016

Non-specific immunological effects of selected routine childhood immunisations: systematic review.

Rama Kandasamy, Merryn Voysey, Fiona McQuaid, Karlijn de Nie, Rebecca Ryan, Olivia Orr, Ulrike Uhlig, Charles Sande, Daniel O'Connor, Andrew J Pollard

Open access · bronzeAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 2 pooled it
5.9field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

48 citing papers in PubMed, 2 syntheses or guidelines pooled it, 98 citations in OpenAlex.

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  16. Effects of SilirumAnimals : an open access journal from MDPI · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Rama KandasamyOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK rama.kandasamy@paediatrics.ox.ac.uk.
Merryn VoyseyOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
Fiona McQuaidOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Karlijn de NieOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Rebecca RyanOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Olivia OrrOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Ulrike UhligDepartment of Paediatrics, Children's Hospital Oxford, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK.
Charles SandeOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Daniel O'ConnorOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Andrew J PollardOxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK.
Churchill Hospital · GBOxford BioMedica (United Kingdom) · GBUniversity of Oxford · GBOxford University Hospitals NHS Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo identify and characterise non-specific immunological effects after routine childhood vaccines against BCG, measles, diphtheria, pertussis, and tetanus.

designSystematic review of randomised controlled trials, cohort studies, and case-control studies. DATA SOURCES: Embase, PubMed, Cochrane library, and Trip searched between 1947 and January 2014. Publications submitted by a panel of experts in the specialty were also included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All human studies reporting non-specific immunological effects after vaccination with standard childhood immunisations. Studies using recombinant vaccines, no vaccine at all, or reporting only vaccine specific outcomes were excluded. The primary aim was to systematically identify, assemble, and review all available studies and data on the possible non-specific or heterologous immunological effects of BCG; measles; mumps, measles, and rubella (MMR); diphtheria; tetanus; and pertussis vaccines.

resultsThe initial search yielded 11 168 references; 77 manuscripts met the inclusion criteria for data analysis. In most included studies (48%) BCG was the vaccine intervention. The final time point of outcome measurement was primarily performed (70%) between one and 12 months after vaccination. There was a high risk of bias in the included studies, with no single study rated low risk across all assessment criteria. A total of 143 different immunological variables were reported, which, in conjunction with differences in measurement units and summary statistics, created a high number of combinations thus precluding any meta-analysis. Studies that compared BCG vaccinated with unvaccinated groups showed a trend towards increased IFN-γ production in vitro in the vaccinated groups. Increases were also observed for IFN-γ measured after BCG vaccination in response to in vitro stimulation with microbial antigens from Candida albicans, tetanus toxoid, Staphylococcus aureas, lipopolysaccharide, and hepatitis B. Cohort studies of measles vaccination showed an increase in lymphoproliferation to microbial antigens from tetanus toxoid and C albicans Increases in immunogenicity to heterologous antigens were noted after diphtheria-tetanus (herpes simplex virus and polio antibody titres) and diphtheria-tetanus-pertussis (pneumococcus serotype 14 and polio neutralising responses) vaccination.

conclusionsThe papers reporting non-specific immunological effects had heterogeneous study designs and could not be conventionally meta-analysed, providing a low level of evidence quality. Some studies, such as BCG vaccine studies examining in vitro IFN-γ responses and measles vaccine studies examining lymphoproliferation to microbial antigen stimulation, showed a consistent direction of effect suggestive of non-specific immunological effects. The quality of the evidence, however, does not provide confidence in the nature, magnitude, or timing of non-specific immunological effects after vaccination with BCG, diphtheria, pertussis, tetanus, or measles containing vaccines nor the clinical importance of the findings.

Indexed as

BCG VaccineCase-Control StudiesChild, PreschoolCommunicable Disease ControlDiphtheriaDiphtheria-Tetanus-Pertussis VaccineFemaleHumansImmunizationInfantMaleMeaslesMeasles-Mumps-Rubella VaccineMeasles VaccineRandomized Controlled Trials as TopicTetanusBCG VaccineDiphtheria-Tetanus-Pertussis VaccineMeasles-Mumps-Rubella VaccineMeasles Vaccine

Identifiers

PMID27737830
PMCPMC5063033
OpenAlexW2530956777

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.