Does Influenza Vaccination Modify Influenza Severity? Data on Older Adults Hospitalized With Influenza During the 2012−2013 Season in the United States

Arriola, Carmen Sofia; Anderson, Evan J.; Baumbach, Joan; Bennett, Nancy M.; Bohm, Susan; Hill, Mary; Lindegren, Mary Lou; Lung, Krista; Meek, James; Mermel, Elizabeth; Miller, Lisa; Monroe, Maya; Morin, Craig; Oni, Oluwakemi; Reingold, Arthur; Schaffner, William; Thomas, Ann; Zansky, Shelley; Finelli, Lyn; Chaves, Sandra S.

doi:10.1093/infdis/jiv200

Cited by 60 publications

(44 citation statements)

References 48 publications

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“…Our findings are consistent with the view that inactivated influenza vaccines provide moderate protection against infection but do not provide any additional protection against severe disease requiring hospitalization if breakthrough infection (vaccine failure) occurs [27,28]. …”

Section: Discussionsupporting

confidence: 90%

Influenza vaccine effectiveness by test-negative design – Comparison of inpatient and outpatient settings

Feng

Cowling

Sullivan

2016

Vaccine

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Background Observational studies of influenza vaccine effectiveness (VE) are increasingly using the test-negative design. Studies are typically based in outpatient or inpatient settings, but these two approaches are rarely compared directly. The aim of our study was to assess whether influenza VE estimates differ between inpatient and outpatient settings. Methods We searched the literature from Medline, PubMed and Web of Science using a combination of keywords to identify published studies of influenza VE using the test-negative design. Studies assessing any type of influenza vaccine among any population in any setting were considered, while interim studies or re-analyses were excluded. Retrieved articles were reviewed, screened and categorized based on study setting, location and influenza season. We searched for parallel studies in inpatient and outpatient settings that were done in the same influenza season, in the same location, and in the same or similar age groups. For each of the pairs identified, we estimated the difference in VE estimates between settings, and we tested whether the average difference was significant using a paired t-test. Results In total 25 pairs of estimates were identified that permitted comparisons between VE estimates in inpatient and outpatient study settings. Within pairs, the prevalence of influenza was generally higher among patients enrolled in the outpatient studies, while influenza vaccination coverage among the test-negative control groups was generally higher in the inpatient studies. There was no heterogeneity in the paired differences in VE, and the pooled difference in VE between inpatient and outpatient studies was −2% (95% confidence interval: −12%, 10%). Conclusions We found no differences in VE estimates between inpatient and outpatient settings by studies using the test-negative design. Further research involving direct comparisons of VE estimates from the two settings in the same populations and years would be valuable.

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Section: Discussionsupporting

confidence: 90%

Influenza vaccine effectiveness by test-negative design – Comparison of inpatient and outpatient settings

Feng

Cowling

Sullivan

2016

Vaccine

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“…We had previously assessed the effect of influenza vaccination on disease severity among adults aged 50 years and older during the 2012–13 season using a similar analytical approach [5]. In that study, we did not find a substantial effect of vaccination on clinical outcomes (we only found a modest effect of vaccination on ICU LOS in the 50–64 year olds).…”

Section: Discussionmentioning

confidence: 82%

“…However, some studies have suggested that influenza vaccination could modify the severity of illness among vaccinated patients who subsequently develop influenza virus infection [5–8]. Evidence for vaccine modification of influenza-associated disease severity could be an important argument toward improving influenza vaccination coverage in various groups of the population.…”

mentioning

confidence: 99%

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

Arriola

Garg

Anderson

et al. 2017

Clinical Infectious Diseases

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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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“…However, several studies have reported influenza vaccine effectiveness in reducing illness severity, including reducing severe illness in persons aged > 65 years [39], and reducing in-hospital mortality and ICU admissions for those aged 18-49 years and > 65 years compared to unvaccinated individuals [40]. One study reported that duration of ICU hospitalization was reduced a half-day in patients aged 50-64 years who had received influenza vaccination compared with unvaccinated patients [41]. A study across all age groups in Spain reported influenza VE of 58% in reducing the risk of severe influenza requiring hospitalization [42].…”

Section: Prevention and Vaccinationmentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses. Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.

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Does Influenza Vaccination Modify Influenza Severity? Data on Older Adults Hospitalized With Influenza During the 2012−2013 Season in the United States

Abstract: Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed.

Cited by 60 publications

References 48 publications

Influenza vaccine effectiveness by test-negative design – Comparison of inpatient and outpatient settings

Influenza vaccine effectiveness by test-negative design – Comparison of inpatient and outpatient settings

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

Influenza virus-related critical illness: prevention, diagnosis, treatment

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