The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials

Tzu-Lin Yeh, Pei-Ching Shih, Shu-Jung Liu, Chao-Hsu Lin, Jui-Ming Liu, Wei-Te Lei, Chien-Yu Lin, Tzu-Lin Yeh, Pei-Ching Shih, Shu-Jung Liu, Chao-Hsu Lin, Jui-Ming Liu, Wei-Te Lei, Chien-Yu Lin

Abstract

Background: Influenza infection is a common disease with a huge disease burden. Influenza vaccination has been widely used, but concerns regarding vaccine efficacy exist, especially in the elderly. Probiotics are live microorganisms with immunomodulatory effects and may enhance the immune responses to influenza vaccination.

Methods: We conducted a systematic review and meta-analysis to determine the influence of prebiotics/probiotics/synbiotics supplementation on vaccine responses to influenza vaccination. Studies were systematically identified from electronic databases up to July 2017. Information regarding study population, influenza vaccination, components of supplements, and immune responses were extracted and analyzed. Twelve studies, investigating a total of 688 participants, were included in this review.

Results: Patients with prebiotics/probiotics supplements were found to have higher influenza hemagglutination inhibition antibody titers after vaccination (for A/H1N1, 42.89 vs 35.76, mean difference =7.14, 95% CI =2.73, 11.55, P=0.002; for A/H3N2, 105.4 vs 88.25, mean difference =17.19, 95% CI =3.39, 30.99, P=0.01; for B strain, 34.87 vs 30.73, mean difference =4.17, 95% CI =0.37, 7.96, P=0.03).

Conclusion: Supplementation with prebiotics or probiotics may enhance the influenza hemagglutination inhibition antibody titers in all A/H1N1, A/H3N2, and B strains (20%, 19.5%, and 13.6% increases, respectively). Concomitant prebiotics or probiotics supplementation with influenza vaccination may hold great promise for improving vaccine efficacy. However, high heterogeneity was observed and further studies are warranted.

Keywords: antibody titer; immune response; influenza; influenza vaccine; prebiotics; probiotics; synbiotics.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram showing the selection of articles for review. Abbreviations: CINAHL, Cumulative Index to Nursing and Allied Health; NTLTD, Networked Digital Library of Theses and Dissertations; RCT, randomized controlled trials.
Figure 2
Figure 2
Forest plot of the HI titers of A/H1N1 strain after influenza vaccination between the prebiotic or probiotic group, and the placebo group. Abbreviations: HI, hemagglutination inhibition; IV, inverse variance.
Figure 3
Figure 3
Forest plot of the HI titers of A/H3N2 strain after influenza vaccination between prebiotic or probiotic group, and placebo group. Abbreviations: HI, hemagglutination inhibition; IV, inverse variance.
Figure 4
Figure 4
Forest plot of the HI titers of B strain between prebiotic or probiotic group, and placebo group. Abbreviations: HI, hemagglutination inhibition; IV, inverse variance.
Figure 5
Figure 5
Forest plot of the incidence of adverse effect between prebiotic or probiotic group, and placebo group. Abbreviation: M–H, Mantel–Haenszel method.

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