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Sex differences in adverse events following seasonal influenza vaccines: a meta-analysis of randomised controlled trials
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  • Published on: 4 January 2024
    Sex and age differences in adverse events following seasonal influenza vaccines: comment on the article by Kiely et al.
    • Ya-Hui Lin, Professor 1. College of Nursing, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan
    • Other Contributors:
      • Tsung-Yuan Yang, Cardiology
      • Gwo-Ping Jong, Cardiology

    The article by Kiely et al., which reported a higher risk of injection site reactions in women than men for both younger and older participants, is interesting. The risk of systemic reactions was also higher following influenza vaccination in women than in men, irrespective of age and vaccine type.1 These findings are a valuable addition to the literature. However, we have two concerning issues for the authors.
    First, there is underreporting, which occurs in any adverse events following vaccine or drug studies based on spontaneous reporting.2 Underreporting is a problem in adverse events studies following vaccination using self-reported data. This may lead to a bias away from the null value, and they are susceptible to response bias, social desirability bias, and misclassification.3 Therefore, with underreporting, the conclusions may not be rigorous.
    Second concern is the possibility of age and sex differences in adverse events following seasonal influenza vaccination. Previous studies have shown that elderly women have higher humoral responses against influenza than elderly men, but not young women compared with young men.4,5 Some authors have also reported sex and age differences in influenza vaccination. Elderly women typically suffered more frequently from local and systemic side effects because antibody induction is usually higher elderly women than in elderly men after vaccination. Consequently, the sex-related difference observed would not be the true di...

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    Conflict of Interest:
    None declared.