Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Chang, Yeun‐Chung; Huang, Yu‐Tung; Chen, Long-Sheng; Tung, Ho-Jui; Huang, Kuang‐Hua; Ernawaty, Ernawaty; Wu, Szu‐Yuan

doi:10.3390/vaccines8010140

Cited by 4 publications

(6 citation statements)

References 32 publications

(39 reference statements)

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“…Several studies have assessed the effectiveness of the influenza vaccine in preventing influenza illness and hospital admissions [ 8 , 9 , 10 , 11 ]. Additional recent studies have confirmed a reduction in all-cause mortality as well as influenza-related hospitalizations in elderly vaccinated individuals [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 94%

Impact of Influenza Vaccination on Mortality in the Oldest Old: A Propensity Score-Matched Cohort Study

et al. 2020

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Influenza remains a major cause of illness and death in geriatric populations. While the influenza vaccine has successfully reduced morbidity and mortality, its effectiveness is suspected to decrease with age. The aim of this study was to assess the impact of influenza vaccination on all-cause mortality in very old ambulatory subjects. We conducted a prospective cohort study from 1 July 2016 to 31 June 2017 in a large unselected ambulatory population aged over 80 years. We compared all-cause mortality in vaccinated versus unvaccinated subjects after propensity-score matching, to control for age, sex and comorbidities. Among the 9149 patients included, with mean age 86 years, 4380 (47.9%) were vaccinated against influenza. In total, 5253 (57.4%) had at least one chronic disease. The most commonly vaccinated patients were those with chronic respiratory failure (76.3%) and the least commonly vaccinated were those suffering from Parkinson’s disease (28.5%). Overall, 2084 patients (22.8%) died during the study. After propensity score matching, the mortality was evaluated at 20.9% in the vaccinated group and 23.9% in the unvaccinated group (OR = 0.84 [0.75–0.93], p = 0.001). This decrease in mortality in the vaccinated group persisted whatever the age and Charlson Comorbidity index. In conclusion, nearly a half of this ambulatory elderly population received Influenza vaccine. After adjustment on comorbidities, influenza vaccination was associated with a significant decrease in all-cause mortality, even in the eldest multimorbid population. Improving immunization coverage in this frail older population is urgently needed.

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Section: Introductionmentioning

confidence: 94%

Impact of Influenza Vaccination on Mortality in the Oldest Old: A Propensity Score-Matched Cohort Study

et al. 2020

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“…The risk of bias assessment for cohort and case–control studies was done using the Newcastle-Ottawa scale. For cohort studies, most showed a low risk of bias ( 14 , 23 , 25 , 27 , 29 , 30 , 32 , 34 ) except for Liu et al ( 26 ) Nichol et al ( 20 ), Holodinsky et al ( 35 ) and Chang et al ( 31 ) showed a moderate risk of bias ( Supplementary Table S2 ). For case–control studies, most showed a moderate risk of bias ( 15–17 , 19 , 22 , 28 ), while ( 10 , 12 , 36 ) showed a low risk of bias, and Grau et al ( 21 ) showed a high risk ( Supplementary Table S3 ).…”

Section: Resultsmentioning

confidence: 99%

Influenza vaccine effect on risk of stroke occurrence: a systematic review and meta-analysis

Zahhar,

Salamatullah,

Almutairi

et al. 2024

Front. Neurol.

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BackgroundStroke is a significant global cause of mortality and long-term disability, potentially influenced by infections that heighten systemic inflammation and thrombotic events. The full impact of influenza vaccination on stroke remains uncertain. This systematic review and meta-analysis aimed to investigate the association between influenza immunization and stroke incidence.MethodsWe searched for randomized controlled trials (RCTs), case–control, and cohort studies published in PubMed/Medline, Cochrane-Central-Register-of-Controlled-Trials (CENTRAL), and Embase until 5 December 2022, and identified articles investigating the effect of influenza vaccine on stroke occurrence. All articles were screened by two independent reviewers. We performed a meta-analysis to investigate the risk of stroke occurrence in vaccinated vs. unvaccinated individuals. The random-effects model was used in all statistical analyses.ResultsAmong the 26 articles meeting our criteria, 10 were retrospective cohort studies, 9 were case–control studies, 3 were prospective cohort studies, 3 were RCTs and 1 case-series. Overall, the studies showed a significant decrease in the risk of stroke incidence/hospitalization among vaccinated patients (OR = 0.81, 95% CI [0.77–0.86], p = 0.00001). Furthermore, studies showed flu vaccine decreases the occurrence of mortality among stroke patients (OR = 0.50, 95% CI [0.37–0.68], p = 0.00001). Sub-group analysis revealed significant protective effect for patients with specific comorbidities including atrial fibrillation (OR = 0.68, 95% CI [0.57–0.81], p = 0.0001), diabetes (OR = 0.76, 95% CI [0.66–0.87], p = 0.0001), Chronic obstructive pulmonary disease (OR = 0.70, 95% CI [0.61–0.81], p = 0.00001), and hypertension (OR = 0.76, 95% CI [0.70–83], p = 0.00001).ConclusionThe current meta-analysis further supports prior findings that influenza vaccination reduces stroke risk, particularly in patients with comorbidities. Guidelines should promote vaccination for at-risk individuals.

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“…In Taiwan, a universal insurance scheme called the National Health Insurance (NHI) was launched in 1995, which is a single-payer national health insurance plan that covers >99.9% of the citizens of Taiwan [ 24 ]. Free influenza vaccination for elderly people aged ≥65 years has been implemented through the NHI program since 2001 [ 25 , 26 ]. Each year, starting from October 1, enrolled elderly people can visit any NHI-licensed clinic or hospital to receive free influenza vaccination [ 25 , 26 , 27 ] based on the Taiwan’s Annual Seasonal Influenza Mass Vaccination Program-Lessons for Pandemic Planning [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…Free influenza vaccination for elderly people aged ≥65 years has been implemented through the NHI program since 2001 [ 25 , 26 ]. Each year, starting from October 1, enrolled elderly people can visit any NHI-licensed clinic or hospital to receive free influenza vaccination [ 25 , 26 , 27 ] based on the Taiwan’s Annual Seasonal Influenza Mass Vaccination Program-Lessons for Pandemic Planning [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

“…The influenza season was defined based on the influenza-like illness (ILI) activity peak of the influenza-surveillance data from the Centers for Disease Control (CDC) in Taiwan [ 25 ]. From 2010 to 2016, the CDC surveillance system indicated that ILI activities were not similar every year; however, in general, it began to increase at the beginning of January and plateaued at the end of September [ 25 , 26 ]. Therefore, the influenza season in this study was defined as the period between January and September every year from 2010 to 2016.…”

Section: Methodsmentioning

confidence: 99%

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The Protective Effects of Influenza Vaccination in Elderly Patients with Breast Cancer in Taiwan: A Real-World Evidence-Based Study

Tung

Huang

et al. 2022

Vaccines

Self Cite

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In elderly patients with newly diagnosed breast cancer, clarity is lacking regarding the effects of influenza vaccines, particularly on clinical outcomes. This study conducted two nationwide, population-based, and propensity score-matched cohorts to estimate and compare the protective effects of influenza vaccine in elderly women and elderly patients with breast cancer. Data were derived from the National Health Insurance Research Database and Cancer Registry Database. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. Adjusted odds ratios (aORs) were used to estimate the relative risks, and stratified analyses in the breast cancer cohort were performed to further evaluate elderly breast cancer patients undergoing a variety of adjuvant therapies. The GEE analysis showed that the aORs of death and hospitalization, including for influenza and pneumonia, respiratory diseases, respiratory failure, and heart disease, did not significantly decrease in vaccinated elderly patients with newly diagnosed breast cancer. Conversely, the aORs of all influenza-related clinical outcomes were significantly decreased in elderly women. No protective effects of influenza vaccination were found in the elderly patients with a newly diagnosed breast cancer. More studies focusing on identifying strategies to improve the real-world effectiveness of influenza vaccination to the immunocompromised are needed. Our clinical outcomes will be valuable for future public health policy establishment and shared decision making for influenza vaccine use in elderly patients with newly diagnosed breast cancer. According to our findings, regular influenza vaccine administration for elderly patients with newly diagnosed breast cancer may be reconsidered, with potential contraindications for vaccination. On the other hand, implementing the vaccination of close contacts of patients with breast cancer may be a more important strategy for enhancing protection of those fragile patients.

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Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

Cited by 4 publications

References 32 publications

Impact of Influenza Vaccination on Mortality in the Oldest Old: A Propensity Score-Matched Cohort Study

Impact of Influenza Vaccination on Mortality in the Oldest Old: A Propensity Score-Matched Cohort Study

Influenza vaccine effect on risk of stroke occurrence: a systematic review and meta-analysis

The Protective Effects of Influenza Vaccination in Elderly Patients with Breast Cancer in Taiwan: A Real-World Evidence-Based Study

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