Efficacy of influenza vaccine in the elderly in welfare nursing homes: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic

Deguchi, Yasuo; Y, Takasugi; Tatara, Kozo

doi:10.1099/0022-1317-49-6-553

Cited by 28 publications

(16 citation statements)

References 10 publications

(12 reference statements)

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“…Vaccinated patients were significantly less likely to be infected with influenza (Table 2). This finding corroborates the results of previous studies (6,8,(10)(11)(12)24). Since the effect of influenza vaccination on infection was evaluated after controlling for the effects of variables such as patient age, gender, and ADL category, the net impact of vaccination was highly positive.…”

Section: Discussionsupporting

confidence: 81%

“…In studies evaluating parameters of vaccine efficacy, such as morbidity (6,7), mortality (6,7), hospitalization rate (8)(9)(10), and side-effects (6), influenza vaccination of elderly subjects was reported to be effective (6,7,(9)(10)(11)(12)(13). Furthermore, several studies showed no significant differences between healthy and frail elderly patients with respect to the induction of antibody responses following influenza vaccination (10,12,13).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Influenza Vaccine among Elderly Patients by Physical Activity Status

Hara

Hagihara

Ikematu

et al. 2002

Environ. Health Prev. Med.

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Objective: Although many studies have shown the usefulness of influenza vaccine in elderly in-patients, the efficacy of vaccination with regard to the daily physical activities of patients has not been fully evaluated. To address this issue, we correlated the use of medical resources with vaccination status in patients categorized according to their daily activity levels.Methods: The subjects comprised 237 in-patients at or above 51 years of age, who were hospitalized in the long-term care unit of a Japanese hospital between January and March, 1999. The vaccination status and medical resources use (i.e., oral antibiotics, injected antibiotics, blood cell count, chest X-ray) of each patient were recorded, and the patients were assigned to three subgroups, based on daily life activity scores.Results: Vaccinated in-patients in the 'bed-bound' category required fewer medical resources, i.e., oral antibiotics (-2.29 days, P<0.05), injected antibiotics (-5.02 days, P<0.001), blood cell counts (-4.66 times, P<0.001), and chest X-rays (-4.31 times, P<0.001), compared with unvaccinated in-patients. There were no significant differences in treatment parameters between vaccinated and unvaccinated patients in the 'partly limited' or 'no limitation' categories.Conclusions: It is suggested that influenza vaccination significantly reduces the need for medical treatment only among those in-patients who are the least physically active. Further studies are required to replicate these findings, and to elucidate the underlying reasons for this reduction.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Efficacy of Influenza Vaccine among Elderly Patients by Physical Activity Status

Hara

Hagihara

Ikematu

et al. 2002

Environ. Health Prev. Med.

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“…There are also data indicating that the absolute risk reduction is 2-5 times higher among high-risk persons than among healthy elderly persons [281]. A protective efficacy against influenza, pneumonia, and death of the same magnitude has also been demonstrated in the nursing home setting [282][283][284]. There is some evidence that influenza vaccination of healthcare personnel may reduce mortality of elderly people in long-term hospitals, although no difference in the proportion of elderly persons positive for influenza was seen [285,286].…”

Section: Prevention By Vaccinationmentioning

confidence: 89%

Guidelines for the management of adult lower respiratory tract infections

Woodhead¹

2005

European Respiratory Journal

678

555

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“…Influenza virus infections caused by both A and B strains continue to be a cause of morbidity and mortality, particularly for patients who are elderly or otherwise immunocompromised (2,9).…”

mentioning

confidence: 99%

Pharmacodynamic Evaluation of RWJ-270201, a Novel Neuraminidase Inhibitor, in a Lethal Murine Model of Influenza Predicts Efficacy for Once-Daily Dosing

Drusano

Preston

Smee

et al. 2001

Antimicrob Agents Chemother

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We examined RWJ-270201 in a lethal model of influenza in BALB/c mice. The aim was to delineate the pharmacodynamically linked variable for the drug. Challenge was performed with influenza virus A/Shongdong/09/93 (H3N2). Treatment was administered by gavage. Five doses (1 to 10 mg/kg of body weight) and three schedules (every 24, 12, and 8 h) were evaluated with 10 mice per group. There were 39 placebo-treated mice. Drug exposure was evaluated for infected mice. Exposures were calculated after population modeling of all the plasma concentration-time data simulataneously using the NPEM3 program. Evaluation of dose and schedule with Kaplan-Meier analysis and Cox proportional hazards modeling demonstrated that schedule offered no explanatory power relative to dose alone. Evaluation of peak concentration, trough concentration, and area under the concentration-time curve (AUC) by the same methods revealed that AUC was the dynamically linked variable. Again, schedule offered no further explanatory power when included in the model with AUC. This indicates that AUC is the linked variable and that the anti-influenza effect of RWJ-270201 is independent of schedule. We conclude that once-daily dosing of RWJ-270201 should be evaluated in clinical trials of influenza therapy.Influenza virus infections caused by both A and B strains continue to be a cause of morbidity and mortality, particularly for patients who are elderly or otherwise immunocompromised (2, 9).The viral neuraminidase is a logical target for antiviral chemotherapy, as it is readily accessible and is a necessary site for ongoing spread of viral infection. In addition, this enzyme is appealing as a target for chemotherapy because it would be expected to affect clinical outcome, even after infection initiation, because of its ability to interrupt viral spread. Further, it differs from older agents like amantadine and rimantadine in having a lower probability of viral emergence of resistance (7).RWJ-270201 is a new, potent member of the neuraminidase inhibitor class of influenza antivirals. Other members of this class currently available to the physician have been well reviewed (1). Previous studies with mice have demonstrated a pharmacokinetic profile that produced sufficient exposure to conclude that this agent would be useful for the therapy of influenza infection (data on file, R. W. Johnson Pharmaceutical Research Institute, Raritan, N.J.).Experience with other classes of anti-infectives has demonstrated that animal model experiments that delineate which pharmacodynamic variable (peak concentration/50% inhibitory concentration [IC 50 The ability to delineate which aspect of the concentrationtime curve affects outcome is extremely valuable, as it allows the choice of the proper dosing schedule and facilitates the setting of a therapeutic goal. For these reasons, we decided to investigate RWJ-270201 in a lethal murine model of influenza infection and attempt to delineate the pharmacodynamic variable most closely linked to outcome. MATERIALS AND METHODS Virus....

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Efficacy of influenza vaccine in the elderly in welfare nursing homes: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic

Cited by 28 publications

References 10 publications

Efficacy of Influenza Vaccine among Elderly Patients by Physical Activity Status

Efficacy of Influenza Vaccine among Elderly Patients by Physical Activity Status

Guidelines for the management of adult lower respiratory tract infections

Pharmacodynamic Evaluation of RWJ-270201, a Novel Neuraminidase Inhibitor, in a Lethal Murine Model of Influenza Predicts Efficacy for Once-Daily Dosing

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