Influenza Vaccination to Reduce Cardiovascular Morbidity and Mortality in Patients With COVID-19

Behrouzi, Bahar; Campoverde, Maria Viviana Araujo; Liang, Kyle; Talbot, H. Keipp; Bogoch, Isaac I.; McGeer, Allison; Fröbert, Ole; Loeb, Mark; Vardeny, Orly; Solomon, Scott D.; Udell, Jacob A.

doi:10.1016/j.jacc.2020.08.028

Cited by 65 publications

(80 citation statements)

References 122 publications

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“…Virus-specific treatment is also essential. Treatments targeting viral replication, which includes antiviral therapies like remdesivir, passive antibody therapies like monoclonal antibodies, and antibodies elicited from previous infection or vaccination (82)(83)(84), are effective in the disease process and could be more effective in the initial stage of the disease (85,86). In addition, given the complexity and heterogeneity of immune response among individuals, though it is conceptionally reasonable, it may be practically challenging to use the immune modulator without a clear picture of the basal level and response among individuals.…”

Section: Resultsmentioning

confidence: 99%

Cellular Immune Response to COVID-19 and Potential Immune Modulators

Zhou

2021

Front. Immunol.

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Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Droplets and contacts serve as the main route of transmission of SARS-CoV-2. The characteristic of the disease is rather heterogeneous, ranging from no symptoms to critical illness. The factors associated with the outcome of COVID-19 have not been completely characterized to date. Inspired by previous studies on the relevance of infectious diseases, viral and host factors related to clinical outcomes have been identified. The severity of COVID-19 is mainly related to host factors, especially cellular immune responses in patients. Patients with mild COVID-19 and improved patients with severe COVID-19 exhibit a normal immune response to effectively eliminate the virus. The immune response in patients with fatal severe COVID-19 includes three stages: normal or hypofunction, hyperactivation, and anergy. Eventually, the patients were unable to resist viral infection and died. Based on our understanding of the kinetics of immune responses during COVID-19, we suggest that type I interferon (IFN) could be administered to patients with severe COVID-19 in the hypofunctional stage, intravenous immunoglobulin (IVIG) and glucocorticoid therapy could be administered in the immune hyperactivation stage. In addition, low molecular weight heparin (LMWH) anticoagulation therapy and anti-infective therapy with antibiotics are recommended in the hyperactivation stage.

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Section: Resultsmentioning

confidence: 99%

Cellular Immune Response to COVID-19 and Potential Immune Modulators

Zhou

2021

Front. Immunol.

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“…Increasing number of literatures has been demonstrating that influenza virus infection may trigger non-neutralizing antibodies responses which also binds to pathogens as diverse as HIV-1, herpes simplex virus and Ebola [ 22 – 28 ]. Some other researches showed that influenza vaccination could reduce cardiovascular morbidity and mortality in patients with COVID-19 [ 29 ] Therefore, some potential mechanisms including active immunity or passive immunity may involve in the virus immunity for exhibition its protective effects. In this study, influenza virus IgM positive showed as a protective effector in severe COVID-19 patients associated with better prognosis and higher cumulative survivor rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcome of influenza virus infection among adults hospitalized with severe COVID-19: a retrospective cohort study from Wuhan, China

Tong

et al. 2021

BMC Infect Dis

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Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that rapidly spreads worldwide and co-infection of COVID-19 and influenza may occur in some cases. We aimed to describe clinical features and outcomes of severe COVID-19 patients with co-infection of influenza virus. Methods Retrospective cohort study was performed and a total of 140 patients with severe COVID-19 were enrolled in designated wards of Sino-French New City Branch of Tongji Hospital between Feb 8th and March 15th in Wuhan city, Hubei province, China. The demographic, clinical features, laboratory indices, treatment and outcomes of these patients were collected. Results Of 140 severe COVID-19 hospitalized patients, including 73 patients (52.14%) with median age 62 years were influenza virus IgM-positive and 67 patients (47.86%) with median age 66 years were influenza virus IgM-negative. 76 (54.4%) of severe COVID-19 patients were males. Chronic comorbidities consisting mainly of hypertension (45.3%), diabetes (15.8%), chronic respiratory disease (7.2%), cardiovascular disease (5.8%), malignancy (4.3%) and chronic kidney disease (2.2%). Clinical features, including fever (≥38 °C), chill, cough, chest pain, dyspnea, diarrhea and fatigue or myalgia were collected. Fatigue or myalgia was less found in COVID-19 patients with IgM-positive (33.3% vs 50/7%, P = 0.0375). Higher proportion of prolonged activated partial thromboplastin time (APTT) > 42 s was observed in COVID-19 patients with influenza virus IgM-negative (43.8% vs 23.6%, P = 0.0127). Severe COVID-19 Patients with influenza virus IgM positive have a higher cumulative survivor rate than that of patients with influenza virus IgM negative (Log-rank P = 0.0308). Considering age is a potential confounding variable, difference in age was adjusted between different influenza virus IgM status groups, the HR was 0.29 (95% CI, 0.081–1.100). Similarly, difference in gender was adjusted as above, the HR was 0.262 (95% CI, 0.072–0.952) in the COX regression model. Conclusions Influenza virus IgM positive may be associated with decreasing in-hospital death.

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“…Influenza vaccination has been recommended as the primary prevention method for influenza infection in >65-year-olds since the 1960s, [102][103][104][105] and not only prevents influenza infection but plays a key role in prevention of secondary events and complications, including cardiovascular morbidity and mortality. 106,107 Vaccination of healthcare professionals (HCPs) may also be important in protecting elderly patients from viral infections and complications and has been a consideration during the COVID-19 pandemic. However, the true impact on both influenza and SARS-CoV-2-related infection is yet to be demonstrated conclusively.…”

Section: Influenza Vaccinationmentioning

confidence: 99%

Respiratory viral infections in the elderly

Watson

Wilkinson

2021

Ther Adv Respir Dis

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With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13–31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential. The reviews of this paper are available via the supplemental material section.

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Influenza Vaccination to Reduce Cardiovascular Morbidity and Mortality in Patients With COVID-19

Cited by 65 publications

References 122 publications

Cellular Immune Response to COVID-19 and Potential Immune Modulators

Cellular Immune Response to COVID-19 and Potential Immune Modulators

Clinical characteristics and outcome of influenza virus infection among adults hospitalized with severe COVID-19: a retrospective cohort study from Wuhan, China

Respiratory viral infections in the elderly

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