Aluminium adjuvants in vaccines and potential health effects: systematic review

AbstractObjectiveTo systematically review and critically appraise human evidence on potential health effects of aluminium adjuvanted vaccines.DesignSystematic review following PRISMA (preferred reporting items for systematic review and meta-analysis) 2020 guidelines.Data sourcesSix databases and trial registries were searched from inception to 3 March 2023 then updated to 27 November 2025. Reference lists of eligible studies were also screened.Eligibility criteria for selecting studiesHuman studies assessing health outcomes after aluminium adjuvanted vaccination, including randomised controlled trials, cohort studies, case series, and ecological studies.

Investigational vaccines, case reports, and review articles were excluded.Data extraction and synthesisTwo reviewers screened studies (with AI assistance for the 2023-25 update), extracted data, and assessed risk of bias (using RoB 2.0, ROBINS-I, or an adapted tool for case series). Certainty of evidence was rated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).ResultsThe review included 59 studies (37 case series, 11 randomised controlled trials, nine cohort studies, two ecological studies).