High Clinical Burden of Influenza Disease in Adults Aged ≥ 65 Years: Can We Do Better? A Systematic Literature Review

Introduction: Adults aged ≥65 years contribute a large proportion of influenza-related hospitalizations and deaths due to increased risk of complications, which result in high medical costs and reduced health-related quality of life (HRQoL). Although seasonal influenza vaccines are recommended for older adults, the effectiveness of current vaccines is dependent on several factors including strain matching and recipient demographic factors. Objective: This systemic literature review aimed to explore the economic and humanistic burden of influenza in adults aged ≥65 years. Methods: An electronic database search was conducted to identify studies assessing the economic and humanistic burden of influenza, including influenza symptoms that impact the HRQoL and patient related outcomes in adults aged ≥65 years. Studies were to be published in English and conducted in Germany, France, Spain, and Italy, United Kingdom, United States, Canada, China, Japan, Brazil, Saudi Arabia, and South Africa. Results: Twenty-five studies reported on the economic and humanistic burden of influenza in adults aged ≥65 years. Higher direct costs were reported for people at increased-risk of influenza-related complications compared to those at low-risk. Lower influenza-related total costs were found in those vaccinated with adjuvanted inactivated trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD). Older age was associated with an increased occurrence and longer duration of certain influenza symptoms. Despite the limited data identified for, results show that influenza exerts a high humanistic and economic burden. in older adults. Further research is required to confirm findings and to identify the unmet needs of current vaccines.

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“…]65 years. The findings of the clinical burden SLR have been previously reported (24). Here, we report the humanistic and economic findings.…”

Section: Introductionsupporting

confidence: 56%

“…Influenza symptom studies were included to identify those that assess the impact of influenza on the HRQoL. The remaining studies reported on clinical burden and results have been reported elsewhere (24).…”

Section: Summary Of Resultsmentioning

confidence: 99%

Room for improvement in current influenza vaccines? A systematic literature review on the humanistic and economic burden of influenza in older (≥65 years old) adults

Langer

Welch

Moran

et al. 2023

Preprint

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“…Moreover, multimorbidity is associated with increased hospitalization rates or mortality in people ≥65 of age. 4,5 National vaccination uptake rates (VURs) are about 35% among elderly and patients with chronic diseases 6 and thus far below the WHO recommended target of 75%. 7,8 Vaccination rates in Switzerland are in the middle range for Europe.…”

Section: Introductionmentioning

confidence: 99%

“…The increased risk in these groups is driven by many factors, for example, the decline in immune function and a reduced vaccine effectiveness. Moreover, multimorbidity is associated with increased hospitalization rates or mortality in people ≥65 of age 4,5 . National vaccination uptake rates (VURs) are about 35% among elderly and patients with chronic diseases 6 and thus far below the WHO recommended target of 75% 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Influenza vaccination uptake among at‐risk patients in Switzerland—The potential of national claims data for surveillance

Plate,

Bagnoud,

Rosemann

et al. 2023

Influenza Resp Viruses

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BackgroundSwiss national surveillance of influenza vaccination uptake rates (VURs) relies on self‐reported vaccination status. The aim of this study was to determine VURs among at‐risk patients, namely, patients ≥65 of age and adult patients with chronic diseases, using claims data, instead of self‐reported measures, to investigate factors of vaccine uptake, and to assess different methodological approaches to conduct vaccination surveillance.MethodsIn this retrospective cross‐sectional analysis, we determined VURs in three influenza seasons (2015/2016–2017/2018). Medication, diagnosis, or medical services claims were used as triggers to identify patients. For the calculation of VURs in patients with chronic diseases, we identified those by triggers in the given season only (Model 1) and in the given and previous seasons (Model 2). Regression analysis was used to identify factors associated with vaccination status.ResultsData from 214,668 individual patients were analyzed. VURs over all seasons ranged from 18.4% to 19.8%. Most patients with chronic diseases were identified with the medication trigger, and we found no clinical significant differences in VURs comparing both models. Having a chronic disease, age, male gender, and regular health care provider visits were associated with increased odds of being vaccinated.ConclusionsVURs were below the recommended thresholds, and our analysis highlighted the need for efforts to increase VURs. We assessed the identification of chronic diseases by medication claims and the calculation of VURs based on data of the given season only as an effective approach to conduct vaccination surveillance. Claims data‐based surveillance may complete the national surveillance.

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“…These vaccines are particularly important for persons aged 65 years and older who are disproportionately affected by severe influenza. (1, 2) Several influenza vaccines were approved for the 2022–2023 influenza season, with three preferentially recommended by the Centers for Disease Control and Prevention for people aged 65 years and older: Fluzone High-Dose Quadrivalent inactivated, Flublok Quadrivalent recombinant, and Fluad Quadrivalent adjuvanted vaccines. (1) As of February 2023, vaccination coverage for the 2022–2023 influenza season among Medicare Fee-For-Service beneficiaries 65 years and older was 53.7% representing the highest influenza vaccination rate among individuals above 18 years of age.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Potential Adverse Events Following the 2022–2023 Seasonal Influenza Vaccines Among U.S. Adults Aged 65 Years and Older

Shi,

Gruber,

Ondari

et al. 2023

Preprint

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Background While safety of influenza vaccines is well-established, some studies have suggested potential associations between influenza vaccines and certain adverse events (AEs). This study examined the safety of the 2022 to 2023 influenza vaccines among U.S. adults 65 years and older. Methods A self-controlled case series compared incidence rates of anaphylaxis, encephalitis/encephalomyelitis, Guillain Barre-Syndrome (GBS), and transverse myelitis following 2022 to 2023 seasonal influenza vaccinations (i.e., any, high-dose or adjuvanted) in risk and control intervals among Medicare beneficiaries 65 years and older. We used conditional Poisson regression to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) adjusted for event-dependent observation time, seasonality, and outcome misclassification. For AEs with any statistically significant associations, we stratified results by concomitant vaccination status. Results Among 12.7 million vaccine recipients, we observed 76 anaphylaxis, 276 encephalitis/encephalomyelitis, 134 GBS and 75 transverse myelitis cases. Only rates of anaphylaxis were elevated in risk compared to control intervals. With all adjustments, an elevated, but non-statistically significant, anaphylaxis rate was observed following any (IRR: 2.40, 95% CI: 0.96 to 6.03), high-dose (IRR: 2.31, 95% CI: 0.67 to 7.91), and adjuvanted (IRR: 3.28, 95% CI: 0.71 to 15.08) influenza vaccination; anaphylaxis IRRs were 2.54 (95% CI: 0.49 to 13.05) and 1.64 (95% CI: 0.38 to 7.05) for those with and without concomitant vaccination, respectively. Conclusions Rates of encephalitis/encephalomyelitis, GBS, or transverse myelitis were not elevated following 2022 to 2023 seasonal influenza vaccinations among U.S. adults 65 years and older. There was an increased rate of anaphylaxis following influenza vaccination that may have been influenced by concomitant vaccination.

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High Clinical Burden of Influenza Disease in Adults Aged ≥ 65 Years: Can We Do Better? A Systematic Literature Review

Cited by 30 publications

References 89 publications

Room for improvement in current influenza vaccines? A systematic literature review on the humanistic and economic burden of influenza in older (≥65 years old) adults

Room for improvement in current influenza vaccines? A systematic literature review on the humanistic and economic burden of influenza in older (≥65 years old) adults

Influenza vaccination uptake among at‐risk patients in Switzerland—The potential of national claims data for surveillance

Assessment of Potential Adverse Events Following the 2022–2023 Seasonal Influenza Vaccines Among U.S. Adults Aged 65 Years and Older

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