Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination

Grijalva, Carlos G.; Zhu, Yuwei; Williams, Derek J.; Self, Wesley H.; Ampofo, Krow; Pavia, Andrew T.; Stockmann, Chris; McCullers, Jonathan A.; Arnold, Sandra R.; Wunderink, Richard G.; Anderson, Evan J.; Lindstrom, Stephen; Fry, Alicia M.; Foppa, Ivo; Finelli, Lyn; Bramley, Anna M.; Jain, Seema; Griffin, Marie R.; Edwards, Kathryn M.

doi:10.1001/jama.2015.12160

Cited by 83 publications

(62 citation statements)

References 37 publications

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“…Despite representing about one third of hospitalizations during the 2013–14 season, a smaller percentage of cases within this age group were vaccinated. Interestingly, in this age group, we observed that influenza vaccination was associated with a lower prevalence of pneumonia compared to the unvaccinated group, which has been described elsewhere [29, 30]. However, when adjusted for all other characteristics, this association was no longer significant.…”

Section: Discussionsupporting

confidence: 77%

Influenza Vaccination Modifies Disease Severity Among Community-dwelling Adults Hospitalized With Influenza

Arriola

Garg

Anderson

et al. 2017

Clinical Infectious Diseases

147

108

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Background We investigated the effect of influenza vaccination on disease severity in adults hospitalized with laboratory-confirmed influenza during 2013–14, a season in which vaccine viruses were antigenically similar to those circulating. Methods We analyzed data from the 2013–14 influenza season and used propensity score matching to account for the probability of vaccination within age strata (18–49, 50–64, and ≥65 years). Death, intensive care unit (ICU) admission, and hospital and ICU lengths of stay (LOS) were outcome measures for severity. Multivariable logistic regression and competing risk models were used to compare disease severity between vaccinated and unvaccinated patients, adjusting for timing of antiviral treatment and time from illness onset to hospitalization. Results Influenza vaccination was associated with a reduction in the odds of in-hospital death among patients aged 18–49 years (adjusted odds ratios [aOR] = 0.21; 95% confidence interval [CI], 0.05 to 0.97), 50–64 years (aOR = 0.48; 95% CI, 0.24 to 0.97), and ≥65 years (aOR = 0.39; 95% CI, 0.17 to 0.66). Vaccination also reduced ICU admission among patients aged 18–49 years (aOR = 0.63; 95% CI, 0.42 to 0.93) and ≥65 years (aOR = 0.63; 95% CI, 0.48 to 0.81), and shortened ICU LOS among those 50–64 years (adjusted relative hazards [aRH] = 1.36; 95% CI, 1.06 to 1.74) and ≥65 years (aRH = 1.34; 95% CI, 1.06 to 1.73), and hospital LOS among 50–64 years (aRH = 1.13; 95% CI, 1.02 to 1.26) and ≥65 years (aRH = 1.24; 95% CI, 1.13 to 1.37). Conclusions Influenza vaccination during 2013–14 influenza season attenuated adverse outcome among adults that were hospitalized with laboratory-confirmed influenza.

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Section: Discussionsupporting

confidence: 77%

Influenza Vaccination Modifies Disease Severity Among Community-dwelling Adults Hospitalized With Influenza

Arriola

Garg

Anderson

et al. 2017

Clinical Infectious Diseases

147

108

View full text Add to dashboard Cite

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“…7,29,41-44 Four studies examined virus interference from pooled estimates over more than one influenza season: one of these studies recruited children in hospitals in Australia, 42 one recruited children from hospitals in Hong Kong, 7 one recruited hospitalized pneumonia patients of all ages in the United States 43 and one included children and older adults seeking ambulatory care or admitted to hospitals in the US. 41 Consistently, no effect of virus interference was detected according to pooled estimates across several influenza seasons in these studies.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Virus Interference in a Test-negative Study of Influenza Vaccine Effectiveness

et al. 2017

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Background The observational test-negative study design is used to estimate vaccine effectiveness against influenza virus infection. An important assumption of the test-negative design is that vaccination does not affect the risk of infection with another virus. If such virus interference occurred, detection of other respiratory viruses would be more common among influenza vaccine recipients and vaccine effectiveness estimates could differ. We evaluated the potential for virus interference using data from the Influenza Incidence Surveillance Project. Methods From 2010 to 2013, outpatients presenting to clinics in 13 US jurisdictions with acute respiratory infections were tested for influenza and other respiratory viruses. We investigated whether virus interference might affect vaccine effectiveness estimates by first evaluating the sensitivity of estimates using alternative control groups that include or exclude patients with other respiratory virus detections by age group and early/middle/late stage of influenza seasons. Second, we evaluated the association between influenza vaccination receipt and other respiratory virus detection among influenza test negative patients. Results Influenza was detected in 3,743/10,650 patients (35%), and overall vaccine effectiveness was 47% (95% CI: 42%, 52%). Estimates using each control group were consistent overall or when stratified by age groups, and there were no differences among early, middle, or late phase during influenza season. We found no associations between detection of other respiratory viruses and receipt of influenza vaccination. Conclusions In this 3-year test-negative design study in an outpatient setting in the United States, we found no evidence of virus interference or impact on influenza vaccine effectiveness estimation.

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“…All these findings suggest the need for a higher rate of vaccination in young adults, especially those with underlying medical conditions. A recent study of hospitalized influenza pneumonia patients during two seasons (2010–2012) found an estimated vaccine effectiveness of 56.7%, and higher for influenza A(H1N1) (59.5%) than A(H3N2) (45.1) [41]. However, according to Eurosurveillance data, the influenza vaccine effectiveness (VE) for the season 2013/2014 in Spain was of 35% [33% for A (H1N1) and 28% for A (H3N2)], a lower percentage in comparison with previous years.…”

Section: Discussionmentioning

confidence: 99%

Seasonal Influenza A H1N1pdm09 Virus and Severe Outcomes: A Reason for Broader Vaccination in Non-Elderly, At-Risk People

et al. 2016

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BackgroundRecent pandemics of influenza A H1N1pdm09 virus have caused severe illness, especially in young people. Very few studies on influenza A H1N1pdm09 in post-pandemic periods exist, and there is no information on the severity of both seasonal influenza A(H1N1) and A(H3N2) from the same season, adjusting for potential confounders, including vaccine.Methods and ResultsWe performed a retrospective observational study of adults hospitalized during the 2014 season with influenza A(H1N1) or A(H3N2). All patients underwent the same diagnostic and therapeutic protocol in a single hospital, including early Oseltamivir therapy. We included 234 patients: 146 (62.4%) influenza A(H1N1) and 88 (37.6%) A(H3N2). A(H1N1) patients were younger (p<0.01), developed more pneumonia (p<0.01), respiratory complications (p = 0.015), ARDS (p = 0.047), and septic shock (p = 0.049), were more frequently admitted to the ICU (p = 0.022), required IMV (p = 0.049), and were less frequently vaccinated (p = 0.008). After adjusting for age, comorbidities, time from onset of illness, and vaccine status, influenza A(H1N1) (OR, 2.525), coinfection (OR, 2.821), and no vaccination (OR, 3.086) were independent risk factors for severe disease.ConclusionsHospitalized patients with influenza A(H1N1) were more than twice as likely to have severe influenza. They were younger and most had not received the vaccine. Our findings suggest that seasonal influenza A(H1N1) maintains some features of pandemic viruses, and recommend wider use of vaccination in younger adult high-risk patients.

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Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination

Cited by 83 publications

References 37 publications

Influenza Vaccination Modifies Disease Severity Among Community-dwelling Adults Hospitalized With Influenza

Influenza Vaccination Modifies Disease Severity Among Community-dwelling Adults Hospitalized With Influenza

Assessment of Virus Interference in a Test-negative Study of Influenza Vaccine Effectiveness

Seasonal Influenza A H1N1pdm09 Virus and Severe Outcomes: A Reason for Broader Vaccination in Non-Elderly, At-Risk People

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