1
|
Gravagna K, Wolfson C, Basta NE. Influenza vaccine coverage and factors associated with non-vaccination among caregiving and care-receiving adults in the Canadian Longitudinal Study on Aging (CLSA). BMC Public Health 2024; 24:924. [PMID: 38553696 PMCID: PMC10981287 DOI: 10.1186/s12889-024-18372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Influenza vaccination is recommended for those at increased risk of influenza complications and their household contacts to help reduce influenza exposure. Adults who require care often experience health issues that could increase the risk of severe influenza and have close contact with caregivers. Assessing influenza vaccination prevalence in caregivers and care recipients can provide important information about uptake. OBJECTIVES We aimed to (1) estimate influenza non-vaccination prevalence and (2) assess factors associated with non-vaccination among caregivers aged ≥ 45 years and among care recipients aged ≥ 65 years. METHODS We conducted an analysis of cross-sectional data from the Canadian Longitudinal Study on Aging collected 2015-2018. We estimated non-vaccination prevalence and reported adjusted odds ratios with 95% confidence intervals from logistic regression models to identify factors associated with non-vaccination among caregivers and care recipients. RESULTS Of the 23,500 CLSA participants who reported providing care, 41.4% (95% CI: 40.8%, 42.0%) reported not receiving influenza vaccine in the previous 12 months. Among the 5,559 participants who reported receiving professional or non-professional care, 24.8% (95% CI: 23.7%, 26.0%) reported not receiving influenza vaccine during the same period. For both groups, the odds of non-vaccination were higher for those who had not visited a family doctor in the past year, were daily smokers, and those who identified as non-white. DISCUSSION Identifying groups at high risk of severe influenza and their close contacts can inform public health efforts to reduce the risk of influenza. Our results suggest sub-optimal influenza vaccination uptake among caregivers and care recipients. Efforts are needed to increase influenza vaccination and highlight the direct and indirect benefits for caregiver-care recipient pairs. CONCLUSION The proportions of both caregivers and care recipients who had not been vaccinated for influenza was high, despite the benefits of vaccination. Influenza vaccination campaigns could target undervaccinated, high-risk groups to increase coverage.
Collapse
Affiliation(s)
- Katie Gravagna
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| |
Collapse
|
2
|
Pott H, J LeBlanc J, S ElSherif M, Hatchette TF, McNeil SA, Andrew MK. Clinical features and outcomes of influenza and RSV coinfections: a report from Canadian immunization research network serious outcomes surveillance network. BMC Infect Dis 2024; 24:147. [PMID: 38291361 PMCID: PMC10826021 DOI: 10.1186/s12879-024-09033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Influenza and RSV coinfections are not commonly seen but are concerning as they can lead to serious illness and adverse clinical outcomes among vulnerable populations. Here we describe the clinical features and outcomes of influenza and RSV coinfections in hospitalized adults. METHODS A cohort study was performed with pooled active surveillance in hospitalized adults ≥ 50 years from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) during the 2012/13, 2013/14, and 2014/15 influenza seasons. Descriptive statistics summarized the characteristics of influenza/RSV coinfections. Kaplan-Meier estimated the probability of survival over the first 30 days of hospitalization. RESULTS Over three influenza seasons, we identified 33 cases of RSV and influenza coinfection, accounting for 2.39 cases per 1,000 hospitalizations of patients with acute respiratory illnesses. Adults aged 50 + years commonly reported cough (81.8%), shortness of breath (66.7%), sputum production (45.5%), weakness (33.3%), fever (27.3%), and nasal congestion (24.2%) as constitutional and lower respiratory tract infection symptoms. The mortality rate was substantial (12.1%), and age, comorbidity burden, and frailty were associated with a higher risk for adverse clinical outcomes. CONCLUSIONS Older adults are at higher risk for complications from influenza and RSV coinfections, especially those over 65 with a high comorbidity burden and frailty.
Collapse
Affiliation(s)
- Henrique Pott
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada.
- Department of Medicine, Universidade Federal de São Carlos, Rod. Washington Luis, km 235. São Carlos, São Carlos, 13656-905, Brazil.
| | - Jason J LeBlanc
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - May S ElSherif
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
| |
Collapse
|
3
|
Pott H, Andrew MK, Shaffelburg Z, Nichols MK, Ye L, ElSherif M, Hatchette TF, LeBlanc J, Ambrose A, Boivin G, Bowie W, Johnstone J, Katz K, Lagacé-Wiens P, Loeb M, McCarthy A, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. Vaccine Effectiveness of non-adjuvanted and adjuvanted trivalent inactivated influenza vaccines in the prevention of influenza-related hospitalization in older adults: A pooled analysis from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN). Vaccine 2023; 41:6359-6365. [PMID: 37696717 DOI: 10.1016/j.vaccine.2023.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Influenza vaccines prevent influenza-related morbidity and mortality; however, suboptimal vaccine effectiveness (VE) of non-adjuvanted trivalent inactivated influenza vaccine (naTIV) or quadrivalent formulations in older adults prompted the use of enhanced products such as adjuvanted TIV (aTIV). Here, the VE of aTIV is compared to naTIV for preventing influenza-associated hospitalization among older adults. METHODS A test-negative design study was used with pooled data from the 2012 to 2015 influenza seasons. An inverse probability of treatment (IPT)-weighted logistic regression estimated the Odds Ratio (OR) for laboratory-confirmed influenza-associated hospitalization. VE was calculated as (1-OR)*100% with accompanying 95% confidence intervals (CI). RESULTS Of 7,101 adults aged ≥ 65, 3,364 received naTIV and 526 received aTIV. The overall VE against influenza hospitalization was 45.9% (95% CI: 40.2%-51.1%) for naTIV and 53.5% (42.8%-62.3%) for aTIV. No statistically significant differences in VE were found between aTIV and naTIV by age group or influenza season, though a trend favoring aTIV over naTIV was noted. Frailty may have impacted VE in aTIV recipients compared to those receiving naTIV, according to an exploratory analysis; VE adjusted by frailty was 59.1% (49.6%-66.8%) for aTIV and 44.8% (39.1%-50.0%) for naTIV. The overall relative VE of aTIV to naTIV against laboratory-confirmed influenza hospital admission was 25% (OR 0.75; 0.61-0.92), demonstrating statistically significant benefit favoring aTIV. CONCLUSIONS Adjusting for frailty, aTIV showed statistically significantly better protection than naTIV against influenza-associated hospitalizations in older adults. In future studies, it is important to consider frailty as a significant confounder of VE.
Collapse
Affiliation(s)
- Henrique Pott
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Melissa K Andrew
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Zachary Shaffelburg
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Michaela K Nichols
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Public Health Agency of Canada, Halifax, Canada
| | - Lingyun Ye
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - May ElSherif
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Jason LeBlanc
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Pathology, Dalhousie University, Halifax, Canada
| | - Ardith Ambrose
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Guy Boivin
- CHU de Québec-Université Laval, Québec, Québec
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andre Poirier
- Centre Intégré Universitaire de santé et services sociaux, Quebec, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Grant Stiver
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | | | | | - Shelly A McNeil
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada.
| |
Collapse
|
4
|
Andrew MK, Pott H, Staadegaard L, Paget J, Chaves SS, Ortiz JR, McCauley J, Bresee J, Nunes MC, Baumeister E, Raboni SM, Giamberardino HIG, McNeil SA, Gomez D, Zhang T, Vanhems P, Koul PA, Coulibaly D, Otieno NA, Dbaibo G, Almeida MLG, Laguna-Torres VA, Drăgănescu AC, Burtseva E, Sominina A, Danilenko D, Medić S, Diez-Domingo J, Lina B. Age Differences in Comorbidities, Presenting Symptoms, and Outcomes of Influenza Illness Requiring Hospitalization: A Worldwide Perspective From the Global Influenza Hospital Surveillance Network. Open Forum Infect Dis 2023; 10:ofad244. [PMID: 37383245 PMCID: PMC10296081 DOI: 10.1093/ofid/ofad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 06/30/2023] Open
Abstract
Background The Global Influenza Hospital Surveillance Network (GIHSN) was established in 2012 to conduct coordinated worldwide influenza surveillance. In this study, we describe underlying comorbidities, symptoms, and outcomes in patients hospitalized with influenza. Methods Between November 2018 and October 2019, GIHSN included 19 sites in 18 countries using a standardized surveillance protocol. Influenza infection was laboratory-confirmed with reverse-transcription polymerase chain reaction. A multivariate logistic regression model was utilized to analyze the extent to which various risk factors predict severe outcomes. Results Of 16 022 enrolled patients, 21.9% had laboratory-confirmed influenza; 49.2% of influenza cases were A/H1N1pdm09. Fever and cough were the most common symptoms, although they decreased with age (P < .001). Shortness of breath was uncommon among those <50 years but increased with age (P < .001). Middle and older age and history of underlying diabetes or chronic obstructive pulmonary disease were associated with increased odds of death and intensive care unit (ICU) admission, and male sex and influenza vaccination were associated with lower odds. The ICU admissions and mortality occurred across the age spectrum. Conclusions Both virus and host factors contributed to influenza burden. We identified age differences in comorbidities, presenting symptoms, and adverse clinical outcomes among those hospitalized with influenza and benefit from influenza vaccination in protecting against adverse clinical outcomes. The GIHSN provides an ongoing platform for global understanding of hospitalized influenza illness.
Collapse
Affiliation(s)
- Melissa K Andrew
- Correspondence: Melissa K. Andrew, MD, PhD, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada (); Bruno Lina, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon, 69317 CEDEX 04, France ()
| | - Henrique Pott
- Dalhousie University and Canadian Center for Vaccinology, Halifax, Canada
- Department of Medicine, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Lisa Staadegaard
- Netherlands Institute for Health Care Research (Nivel), Utrecht, Netherlands
| | - John Paget
- Netherlands Institute for Health Care Research (Nivel), Utrecht, Netherlands
| | - Sandra S Chaves
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John McCauley
- WHO Collaborating Centre for Reference and Research on Influenza, Crick Institute, London, United Kingdom
| | - Joseph Bresee
- Centre for Vaccine Equity, Task Force for Global Health, Atlanta, Georgia, USA
| | - Marta C Nunes
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Elsa Baumeister
- National Reference Laboratory for Viral Respiratory Diseases, Virology Department, INEI-ANLIS, Buenos Aires, Argentina
| | - Sonia Mara Raboni
- Molecular Biology/Microbiology Research Laboratory, Universidade Federal do Paraná, Curitiba, Brazil
| | - Heloisa I G Giamberardino
- Epidemiology, Immunization and Infection Control Department—Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Shelly A McNeil
- Dalhousie University and Canadian Center for Vaccinology, Halifax, Canada
| | - Doris Gomez
- Grupo de Investigación UNIMOL, Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Tao Zhang
- School of Public Health, Fudan University, Shanghai, China
| | | | | | - Daouda Coulibaly
- Institut National d'Hygiène Publique (INHP), Abidjan, Côte d’Ivoire
| | - Nancy A Otieno
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | | | | | | | - Elena Burtseva
- FSBI “N.F. Gamaleya NRCEM” Ministry of Health of the Russian Federation (Federal Research Budgetary Institute “National Research Center of Epidemiology and Microbiology named after honorary academician N.F. Gamaleya), Moscow, Russia
| | - Anna Sominina
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russia
| | - Daria Danilenko
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russia
| | - Snežana Medić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Bruno Lina
- Correspondence: Melissa K. Andrew, MD, PhD, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada (); Bruno Lina, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon, 69317 CEDEX 04, France ()
| |
Collapse
|
5
|
Ng QX, Lee DYX, Ng CX, Yau CE, Lim YL, Liew TM. Examining the Negative Sentiments Related to Influenza Vaccination from 2017 to 2022: An Unsupervised Deep Learning Analysis of 261,613 Twitter Posts. Vaccines (Basel) 2023; 11:1018. [PMID: 37376407 DOI: 10.3390/vaccines11061018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Several countries are witnessing significant increases in influenza cases and severity. Despite the availability, effectiveness and safety of influenza vaccination, vaccination coverage remains suboptimal globally. In this study, we examined the prevailing negative sentiments related to influenza vaccination via a deep learning analysis of public Twitter posts over the past five years. We extracted original tweets containing the terms 'flu jab', '#flujab', 'flu vaccine', '#fluvaccine', 'influenza vaccine', '#influenzavaccine', 'influenza jab', or '#influenzajab', and posted in English from 1 January 2017 to 1 November 2022. We then identified tweets with negative sentiment from individuals, and this was followed by topic modelling using machine learning models and qualitative thematic analysis performed independently by the study investigators. A total of 261,613 tweets were analyzed. Topic modelling and thematic analysis produced five topics grouped under two major themes: (1) criticisms of governmental policies related to influenza vaccination and (2) misinformation related to influenza vaccination. A significant majority of the tweets were centered around perceived influenza vaccine mandates or coercion to vaccinate. Our analysis of temporal trends also showed an increase in the prevalence of negative sentiments related to influenza vaccination from the year 2020 onwards, which possibly coincides with misinformation related to COVID-19 policies and vaccination. There was a typology of misperceptions and misinformation underlying the negative sentiments related to influenza vaccination. Public health communications should be mindful of these findings.
Collapse
Affiliation(s)
- Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore
| | - Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G12 8QQ, UK
| | - Clara Xinyi Ng
- NUS Yong Loo Lin School of Medicine, Singapore 117597, Singapore
| | - Chun En Yau
- NUS Yong Loo Lin School of Medicine, Singapore 117597, Singapore
| | - Yu Liang Lim
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore
| | - Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore 169608, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| |
Collapse
|
6
|
Majeed B, David JF, Bragazzi NL, McCarthy Z, Grunnill MD, Heffernan J, Wu J, Woldegerima WA. Mitigating co-circulation of seasonal influenza and COVID-19 pandemic in the presence of vaccination: A mathematical modeling approach. Front Public Health 2023; 10:1086849. [PMID: 36684896 PMCID: PMC9845909 DOI: 10.3389/fpubh.2022.1086849] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
The co-circulation of two respiratory infections with similar symptoms in a population can significantly overburden a healthcare system by slowing the testing and treatment. The persistent emergence of contagious variants of SARS-CoV-2, along with imperfect vaccines and their waning protections, have increased the likelihood of new COVID-19 outbreaks taking place during a typical flu season. Here, we developed a mathematical model for the co-circulation dynamics of COVID-19 and influenza, under different scenarios of influenza vaccine coverage, COVID-19 vaccine booster coverage and efficacy, and testing capacity. We investigated the required minimal and optimal coverage of COVID-19 booster (third) and fourth doses, in conjunction with the influenza vaccine, to avoid the coincidence of infection peaks for both diseases in a single season. We show that the testing delay brought on by the high number of influenza cases impacts the dynamics of influenza and COVID-19 transmission. The earlier the peak of the flu season and the greater the number of infections with flu-like symptoms, the greater the risk of flu transmission, which slows down COVID-19 testing, resulting in the delay of complete isolation of patients with COVID-19 who have not been isolated before the clinical presentation of symptoms and have been continuing their normal daily activities. Furthermore, our simulations stress the importance of vaccine uptake for preventing infection, severe illness, and hospitalization at the individual level and for disease outbreak control at the population level to avoid putting strain on already weak and overwhelmed healthcare systems. As such, ensuring optimal vaccine coverage for COVID-19 and influenza to reduce the burden of these infections is paramount. We showed that by keeping the influenza vaccine coverage about 35% and increasing the coverage of booster or fourth dose of COVID-19 not only reduces the infections with COVID-19 but also can delay its peak time. If the influenza vaccine coverage is increased to 55%, unexpectedly, it increases the peak size of influenza infections slightly, while it reduces the peak size of COVID-19 as well as significantly delays the peaks of both of these diseases. Mask-wearing coupled with a moderate increase in the vaccine uptake may mitigate COVID-19 and prevent an influenza outbreak.
Collapse
Affiliation(s)
- Bushra Majeed
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jummy Funke David
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Zack McCarthy
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Martin David Grunnill
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jane Heffernan
- Centre for Disease Modeling, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Modelling Infection and Immunity Lab, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Woldegebriel Assefa Woldegerima
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| |
Collapse
|
7
|
Sirois A, Deli GS, Parent AA, Bergeron DA. Enjeux actuels et pistes de solution pour améliorer les couvertures vaccinales antigrippales dans les milieux ruraux. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:833-836. [PMID: 37019796 DOI: 10.3917/spub.226.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Despite the positive impact of vaccination on health, influenza vaccination rates worldwide remain low for certain population groups. In Quebec, vaccination rates among populations with chronic diseases remain below what is expected by public health. Since this situation is also noticeable in rural areas, it is necessary to reflect on the current issues associated with low vaccination rates in the rural population. PURPOSE OF RESEARCH The purpose of this commentary is to explore the importance of obtaining a multifactorial understanding of the problem raised in order to propose possible solutions to increase influenza vaccination rates among people living in rural areas.
Collapse
Affiliation(s)
- Audrey Sirois
- Département des sciences de la santé – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Collectif de recherche sur la santé en région (CoRSeR) – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Programme Enfance-Jeunesse-Famille – Centre intégré de santé et des services sociaux du Bas-Saint-Laurent – CLSC de Rivière-du-Loup – Rivière-du-Loup (Québec) – Canada
- Centre de recherche – Centre intégré de santé et des services sociaux de Chaudière-Appalaches – Lévis (Québec) – Canada
| | - Gueu Sylvain Deli
- Département des sciences de la santé – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Collectif de recherche sur la santé en région (CoRSeR) – Université du Québec à Rimouski – Rimouski (Québec) – Canada
| | - Andrée-Anne Parent
- Département des sciences de la santé – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Collectif de recherche sur la santé en région (CoRSeR) – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Centre de recherche – Centre intégré de santé et des services sociaux de Chaudière-Appalaches – Lévis (Québec) – Canada
| | - Dave A Bergeron
- Département des sciences de la santé – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Collectif de recherche sur la santé en région (CoRSeR) – Université du Québec à Rimouski – Rimouski (Québec) – Canada
- Centre de recherche – Centre intégré de santé et des services sociaux de Chaudière-Appalaches – Lévis (Québec) – Canada
| |
Collapse
|
8
|
Distributed lag inspired machine learning for predicting vaccine-induced changes in COVID-19 hospitalization and intensive care unit admission. Sci Rep 2022; 12:18748. [PMID: 36335113 PMCID: PMC9637108 DOI: 10.1038/s41598-022-21969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
Distributed lags play important roles in explaining the short-run dynamic and long-run cumulative effects of features on a response variable. Unlike the usual lag length selection, important lags with significant weights are selected in a distributed lag model (DLM). Inspired by the importance of distributed lags, this research focuses on the construction of distributed lag inspired machine learning (DLIML) for predicting vaccine-induced changes in COVID-19 hospitalization and intensive care unit (ICU) admission rates. Importance of a lagged feature in DLM is examined by hypothesis testing and a subset of important features are selected by evaluating an information criterion. Akin to the DLM, we demonstrate the selection of distributed lags in machine learning by evaluating importance scores and objective functions. Finally, we apply the DLIML with supervised learning for forecasting daily changes in COVID-19 hospitalization and ICU admission rates in United Kingdom (UK) and United States of America (USA). A sharp decline in hospitalization and ICU admission rates are observed when around 40% people are vaccinated. For one percent more vaccination, daily changes in hospitalization and ICU admission rates are expected to reduce by 4.05 and 0.74 per million after 14 days in UK, and 5.98 and 1.04 per million after 20 days in USA, respectively. Long-run cumulative effects in the DLM demonstrate that the daily changes in hospitalization and ICU admission rates are expected to jitter around the zero line in a long-run. Application of the DLIML selects fewer lagged features but provides qualitatively better forecasting outcome for data-driven healthcare service planning.
Collapse
|
9
|
Dwipa L, Usman SY, Rakhimullah AB, Mutyara K, Indrati AR, Atik N, Muliasari R, Kartasasmita C. The Immunogenicity and Safety of Influenza Vaccines among Indonesian Older adult. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Immunosenescence, frailty, sarcopenia, and Vitamin D deficiency were thought of having a negative influence on adequate immune response following vaccination. Epidemiological data related to influenza vaccination and its immunogenicity and safety in Indonesia are still scarce.
AIM: This study aimed to assess the immunogenicity and safety of the influenza vaccine in older adults in Indonesia and common related conditions.
METHODS: This study was a one-group, pre-test, post-test, quasi-experimental study. The vaccine used was a trivalent type. Immunogenicity was assessed according to rate of seropositivity and seroconversion based on hemagglutination inhibition antibody titer. Immunization safety was assessed according to adverse events following immunization (AEFI).
RESULTS: A total of 227 subjects were involved in this study. Antibody titers were significantly increased after 28-day influenza vaccination for all strains (p < 0.001). Seropositive rate in 28-day post-vaccination for A/H1N1, A/H3N2, and influenza B was 98.7%, 99.1%, and 97.4%, respectively. Meanwhile, the seroconversion rate for A/H1N1, A/H3N2, and influenza B strains was 54.2%, 66.1%, and 60.4%, respectively. The conditions of the frailty status, sarcopenia, and Vitamin D level were not associated with either seroconversion or seropositive status, both at baseline and endpoint. AEFI was occurred on seven subjects (3.08%) with pain at the injection site and one subject (0.44%) with arm tenderness.
CONCLUSION: Influenza vaccination showed adequate immune response and safety regardless of the frailty status, sarcopenia, or Vitamin D level. This result strengthened the importance of influenza vaccine administration in Indonesia older adults.
Collapse
|
10
|
Liang CK, Lee WJ, Peng LN, Meng LC, Hsiao FY, Chen LK. COVID-19 Vaccines in Older Adults: Challenges in Vaccine Development and Policy-Making. Clin Geriatr Med 2022; 38:605-620. [PMID: 35868676 PMCID: PMC8934735 DOI: 10.1016/j.cger.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chih-Kuang Liang
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ju Lee
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan
| | - Li-Ning Peng
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Chieh Meng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
| |
Collapse
|
11
|
Tian M, Yu J, Lillvis DF, Vexler A. Influence function methods to assess the effectiveness of influenza vaccine with survey data. Health Serv Res 2022; 57:200-211. [PMID: 34643942 PMCID: PMC8763297 DOI: 10.1111/1475-6773.13895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To examine a robust relative risk (RR) estimation for survey data analysis with ideal inferential properties under various model assumptions. DATA SOURCES We employed secondary data from the Household Component of the 2000-2016 US Medical Expenditure Panel Survey (MEPS). STUDY DESIGN We investigate a broad range of data-balancing techniques by implementing influence function (IF) methods, which allows us to easily estimate the variability for the RR estimates in the complex survey setting. We conduct a simulation study of seasonal influenza vaccine effectiveness to evaluate these approaches and discuss techniques that show robust inferential performance across model assumptions. DATA COLLECTION/EXTRACTION METHODS Demographic information, vaccine status, and self-administered questionnaire surveys were obtained from the longitudinal data files. We linked this information with medical condition files and medical event to extract the disease type and associated expenditures for each medical visit. We excluded individuals who were 18 years or younger at the beginning of each panel. PRINCIPAL FINDINGS Under various model assumptions, the IF methods show robust inferential performance when the data-balancing procedures are incorporated. Once IF methods and data-balancing techniques are implemented, contingency table-based RR estimation yields a comparable result to the generalized linear model approach. We demonstrate the applicability of the proposed methods for complex survey data using 2000-2016 MEPS data. When employing these methods, we find a significant, negative association between vaccine effectiveness (VE) estimates and influenza-incurred expenditures. CONCLUSIONS We describe and demonstrate a robust method for RR estimation and relevant inferences for influenza vaccine effectiveness using MEPS data. The proposed method is flexible and can be extended to weighted data for survey data analysis. Hence, these methods have great potential for health services research, especially when data are nonexperimental and imbalanced.
Collapse
Affiliation(s)
- Mingmei Tian
- Department of BiostatisticsUniversity at Buffalo, State University of New YorkBuffaloNew YorkUSA
| | - Jihnhee Yu
- Department of BiostatisticsUniversity at Buffalo, State University of New YorkBuffaloNew YorkUSA
| | - Denise F. Lillvis
- Department of SurgeryJacobs School of Medicine and Biomedical SciencesBuffaloNew YorkUSA,Division of Health Services Policy & Practice, School of Public Health and Health ProfessionsUniversity at Buffalo, State University of New YorkBuffaloNew YorkUSA,Trauma DepartmentJohn R. Oishei Children's HospitalBuffaloNew YorkUSA
| | - Albert Vexler
- Department of BiostatisticsUniversity at Buffalo, State University of New YorkBuffaloNew YorkUSA
| |
Collapse
|
12
|
Amin AN, Cornelison S, Woods JA, Hanania NA. Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team. Postgrad Med 2021; 134:152-159. [PMID: 34913814 DOI: 10.1080/00325481.2021.2018257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with high rates of hospitalizations, costs, and morbidity. Therefore, hospitalists and the multidisciplinary team (hospital team) need to take a proactive approach to ensure patients are effectively managed from hospital admission to postdischarge. Comprehensive screening and diagnostic testing of patients at admission will enable an accurate diagnosis of COPD exacerbations, and severity, as well as other factors that may impact the length of hospital stay. Depending on the exacerbation severity and cause, pharmacotherapies may include short-acting bronchodilators, systemic corticosteroids, and antibiotics. Oxygen and/or ventilatory support may benefit patients with demonstrable hypoxemia. In preparation for discharge, the hospital team should ensure that patients receive the appropriate maintenance therapy, are counseled on their medications including inhalation devices, and proactively discuss smoking cessation and vaccinations. For follow-up, effective communication can be achieved by transferring discharge summaries to the primary care physician via an inpatient case manager. An inpatient case manager can support both the hospitalist and the patient in scheduling follow-up appointments, sending patient reminders, and confirming that a first outpatient visit has occurred. A PubMed search (prior to 26 January 2021) was conducted using terms such as: COPD, exacerbation, hospitalization. This narrative review focuses on the challenges the hospital team encounters in achieving optimal outcomes in the management of patients with COPD exacerbations. Additionally, we propose a novel simplified algorithm that may help the hospital team to be more proactive in the diagnosis and management of patients with COPD exacerbations.
Collapse
Affiliation(s)
- Alpesh N Amin
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Sharon Cornelison
- Department of Pulmonary and Cardiac Rehabilitation, J. Paul Sticht Center on Aging and Rehabilitation, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC, USA
| | - J Andrew Woods
- Wingate University School of Pharmacy, and Atrium Health, Carolinas Medical Center Main, Charlotte, NC, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
13
|
Clinical and economic outcomes associated with respiratory syncytial virus vaccination in older adults in the United States. Vaccine 2021; 40:483-493. [PMID: 34933763 DOI: 10.1016/j.vaccine.2021.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important cause of lower respiratory infections and hospitalizations among older adults. We aimed to estimate the potential clinical benefits and economic value of RSV vaccination of older adults in the United States (US). METHODS We developed an economic model using a decision-tree framework to capture outcomes associated with RSV infections in US adults aged ≥ 60 years occurring during one RSV season for a hypothetical vaccine versus no vaccine. Two co-base-case epidemiology sources were selected from a targeted review of the US literature: a landmark study capturing all RSV infections and a contemporary study reporting medically attended RSV that also distinguishes mild from moderate-to-severe disease. Both base-case analyses used recent data on mortality risk in the year after RSV hospitalizations. Direct medical costs and quality-adjusted life-years (QALYs) lost per case were obtained from the literature and publicly available sources. Model outcomes included the population-level clinical and economic RSV disease burden among older adults, potential vaccine-avoidable disease burden, and the potential value-based price of a vaccine from a third-party payer perspective. RESULTS Our two base-case analyses estimated that a vaccine with 50% efficacy and coverage matching that of influenza vaccination would prevent 43,700-81,500 RSV hospitalizations and 8,000-14,900 RSV-attributable deaths per RSV season, resulting in 1,800-3,900 fewer QALYs lost and avoiding $557-$1,024 million. Value-based prices for the co-base-case analyses were $152-$299 per vaccination at a willingness to pay of $100,000/QALY gained. Sensitivity analyses found that the economic value of vaccination was most sensitive to RSV incidence and increased posthospitalization mortality risks. CONCLUSIONS Despite variability and gaps in the epidemiology literature, this study highlights the potential value of RSV vaccination for older adults in the US. Our analysis provides contemporary estimates of the population-level RSV disease burden and insights into the economic value drivers for RSV vaccination.
Collapse
|
14
|
Shapiro JR, Li H, Morgan R, Chen Y, Kuo H, Ning X, Shea P, Wu C, Merport K, Saldanha R, Liu S, Abrams E, Chen Y, Kelly DC, Sheridan-Malone E, Wang L, Zeger SL, Klein SL, Leng SX. Sex-specific effects of aging on humoral immune responses to repeated influenza vaccination in older adults. NPJ Vaccines 2021; 6:147. [PMID: 34887436 PMCID: PMC8660902 DOI: 10.1038/s41541-021-00412-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/02/2021] [Indexed: 01/16/2023] Open
Abstract
Older adults (≥65 years of age) bear a significant burden of severe disease and mortality associated with influenza, despite relatively high annual vaccination coverage and substantial pre-existing immunity to influenza. To test the hypothesis that host factors, including age and sex, play a role in determining the effect of repeated vaccination and levels of pre-existing humoral immunity to influenza, we evaluated pre- and post-vaccination strain-specific hemagglutination inhibition (HAI) titers in adults over 75 years of age who received a high-dose influenza vaccine in at least four out of six influenza seasons. Pre-vaccination titers, rather than host factors and repeated vaccination were significantly associated with post-vaccination HAI titer outcomes, and displayed an age-by-sex interaction. Pre-vaccination titers to H1N1 remained constant with age. Titers to H3N2 and influenza B viruses decreased substantially with age in males, whereas titers in females remained constant with age. Our findings highlight the importance of pre-existing immunity in this highly vaccinated older adult population and suggest that older males are particularly vulnerable to reduced pre-existing humoral immunity to influenza.
Collapse
Affiliation(s)
- Janna R Shapiro
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yiyin Chen
- Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Helen Kuo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaoxuan Ning
- Department of Geriatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Patrick Shea
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cunjin Wu
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, Hebei, China
| | - Katherine Merport
- Zanvyl Krieger School of Arts and Science, Johns Hopkins University, Baltimore, MD, USA
| | - Rayna Saldanha
- Zanvyl Krieger School of Arts and Science, Johns Hopkins University, Baltimore, MD, USA
| | - Suifeng Liu
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Engle Abrams
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yan Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Denise C Kelly
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eileen Sheridan-Malone
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lan Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
15
|
Kline A, Trinh LN, Hussein MH, Elshazli RM, Toraih EA, Duchesne J, Fawzy MS, Kandil E. Annual flu shot: Does it help patients with COVID-19? Int J Clin Pract 2021; 75:e14901. [PMID: 34547161 PMCID: PMC8646810 DOI: 10.1111/ijcp.14901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/29/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023] Open
Abstract
AIM OF THE STUDY The impact of annual flu vaccination on the patients' clinical course with COVID-19 and the outcome were tested. METHODS A total of 149 patients with COVID-19-positive admitted from March 20 to May 10, 2020, were retrospectively enrolled. RESULTS Ninety-eight (65.8%) patients received at least a single annual flu shot in the last year, and fifty-one (34.2%) were never vaccinated. On presentation, vaccinated patients were more likely to present with gastrointestinal symptoms (P < .05). There were no significant differences between study groups in laboratory findings or clinical outcomes. In multivariate analysis, receiving the annual shot did not influence risk of intensive care unit admission (OR = 1.17, 95%CI = 0.50-2.72, P = .72), intubation (OR = 1.40, 95%CI = 0.60-3.23, P = .43), complications (OR = 1.08, 95%CI = 0.52-2.26, P = .83) or mortality (OR = 1.29, 95%CI = 0.31-5.29, P = .73). CONCLUSION Although the benefits of the influenza vaccine for preventing disease and reducing morbidity in influenza patients are well established, no differences in outcomes for hospitalised patients with COVID-19 who received their annual influenza vaccination versus the non-vaccinated cohort were evident. There is a need for future meta-analyses, including randomised controlled studies in which the number of cases is increased to validate these findings.
Collapse
Affiliation(s)
- Adam Kline
- Tulane UniversitySchool of MedicineNew OrleansLouisianaUSA
| | - Lily N. Trinh
- Tulane UniversitySchool of MedicineNew OrleansLouisianaUSA
| | - Mohammad H. Hussein
- Department of SurgeryTulane UniversitySchool of MedicineNew OrleansLouisianaUSA
| | - Rami M. Elshazli
- Department of Biochemistry and Molecular GeneticsFaculty of Physical TherapyHorus University ‐ EgyptNew DamiettaEgypt
| | - Eman A. Toraih
- Department of SurgeryTulane UniversitySchool of MedicineNew OrleansLouisianaUSA
- Genetics UnitDepartment of Histology and Cell BiologyFaculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Juan Duchesne
- Department of SurgeryTulane UniversitySchool of MedicineNew OrleansLouisianaUSA
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular BiologyFaculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Department of BiochemistryFaculty of MedicineNorthern Border UniversityArarSaudi Arabia
| | - Emad Kandil
- Department of SurgeryTulane UniversitySchool of MedicineNew OrleansLouisianaUSA
| |
Collapse
|
16
|
Yildirim I, Kao CM, Tippett A, Suntarattiwong P, Munye M, Yi J, Elmontser M, Quincer E, Focht C, Watson N, Bilen H, Baker JM, Lopman B, Hogenesch E, Rostad CA, Anderson EJ. A Retrospective Test-Negative Case-Control Study to Evaluate Influenza Vaccine Effectiveness in Preventing Hospitalizations in Children. Clin Infect Dis 2021; 73:1759-1767. [PMID: 34410341 PMCID: PMC8599178 DOI: 10.1093/cid/ciab709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaccination is the primary strategy to reduce influenza burden. Influenza vaccine effectiveness (VE) can vary annually depending on circulating strains. METHODS We used a test-negative case-control study design to estimate influenza VE against laboratory-confirmed influenza-related hospitalizations among children (aged 6 months-17 years) across 5 influenza seasons in Atlanta, Georgia, from 2012-2013 to 2016-2017. Influenza-positive cases were randomly matched to test-negative controls based on age and influenza season in a 1:1 ratio. We used logistic regression models to compare odds ratios (ORs) of vaccination in cases to controls. We calculated VE as [100% × (1 - adjusted OR)] and computed 95% confidence intervals (CIs) around the estimates. RESULTS We identified 14 596 hospitalizations of children who were tested for influenza using the multiplex respiratory molecular panel; influenza infection was detected in 1017 (7.0%). After exclusions, we included 512 influenza-positive cases and 512 influenza-negative controls. The median age was 5.9 years (interquartile range, 2.7-10.3), 497 (48.5%) were female, 567 (55.4%) were non-Hispanic Black, and 654 (63.9%) children were unvaccinated. Influenza A accounted for 370 (72.3%) of 512 cases and predominated during all 5 seasons. The adjusted VE against influenza-related hospitalizations during 2012-2013 to 2016-2017 was 51.3% (95% CI, 34.8% to 63.6%) and varied by season. Influenza VE was 54.7% (95% CI, 37.4% to 67.3%) for influenza A and 37.1% (95% CI, 2.3% to 59.5%) for influenza B. CONCLUSIONS Influenza vaccination decreased the risk of influenza-related pediatric hospitalizations by >50% across 5 influenza seasons.
Collapse
Affiliation(s)
- Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carol M Kao
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ashley Tippett
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Piyarat Suntarattiwong
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mohamed Munye
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jumi Yi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, University of San Francisco, San Francisco, California, USA
| | - Mohnd Elmontser
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Elizabeth Quincer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Hande Bilen
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Julia M Baker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ben Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elena Hogenesch
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
17
|
Forestal RL, Pi S. A hybrid approach based on
ELECTRE III
‐genetic algorithm and
TOPSIS
method for selection of optimal
COVID
‐19 vaccines. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [PMCID: PMC8646624 DOI: 10.1002/mcda.1772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COVID‐19 pandemic poses unprecedented challenges to the world health system, prompting academics and health professionals to develop appropriate solutions. Researchers reported different COVID‐19 vaccines introduced by institutions and companies around the globe, which are at different stages of development. However, research developing an integrated framework for selecting and ranking the optimal potential vaccine against COVID‐19 is minimal. This paper aimed to fill this gap by using a hybrid methodology based on ELimination Et Choice Translating REality III (ELECTRE III)–Genetic Algorithm (GA) and Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) approach to select the optimal SARS‐CoV‐2 vaccine. ELECTRE III method yields a fathomable analysis of the concordance index, while GA is known for its ability to disaggregate decision‐making preferences from holistic decisions. TOPSIS is preferred for picking an ideal and an anti‐ideal solution. Thus, combining ELECTRE III‐GA and TOPSIS is considered the best model to assess vaccines against the pandemic. The results confirm that the best vaccines rely on a high level of safety, efficacy, and availability. Our developed evaluation framework can help healthcare professionals and researchers gain research information and make critical decisions regarding potential vaccines against the disease.
Collapse
Affiliation(s)
| | - Shih‐Ming Pi
- Department of Information Management Chung Yuan Christian University Taoyuan Taiwan
| |
Collapse
|
18
|
Ecarnot F, Maggi S, Michel JP, Veronese N, Rossanese A. Vaccines and Senior Travellers. FRONTIERS IN AGING 2021; 2:677907. [PMID: 35822022 PMCID: PMC9261415 DOI: 10.3389/fragi.2021.677907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
Background: International tourist travel has been increasingly steadily in recent years, and looks set to reach unprecedented levels in the coming decades. Among these travellers, an increasing proportion is aged over 60 years, and is healthy and wealthy enough to be able to travel. However, senior travellers have specific risks linked to their age, health and travel patterns, as compared to their younger counterparts. Methods: We review here the risk of major vaccine-preventable travel-associated infectious diseases, and forms and efficacy of vaccination for these diseases. Results: Routine vaccinations are recommended for older persons, regardless of whether they travel or not (e.g., influenza, pneumococcal vaccines). Older individuals should be advised about the vaccines that are recommended for their age group in the framework of the national vaccination schedule. Travel-specific vaccines must be discussed in detail on a case-by-case basis, and the risk associated with the vaccine should be carefully weighed against the risk of contracting the disease during travel. Travel-specific vaccines reviewed here include yellow fever, hepatitis, meningococcal meningitis, typhoid fever, cholera, poliomyelitis, rabies, Japanese encephalitis, tick-borne encephalitis and dengue. Conclusion: The number of older people who have the good health and financial resources to travel is rising dramatically. Older travellers should be advised appropriately about routine and travel-specific vaccines, taking into account the destination, duration and purpose of the trip, the activities planned, the type of accommodation, as well as patient-specific characteristics, such as health status and current medications.
Collapse
Affiliation(s)
- Fiona Ecarnot
- University Hospital Besancon and University of Franche-Comté, Besancon, France
- *Correspondence: Fiona Ecarnot,
| | - Stefania Maggi
- CNR, Institute of Neuroscience – Aging Branch, Padua, Italy
| | - Jean-Pierre Michel
- Department of Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy
| | - Andrea Rossanese
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS “Sacro Cuore-Don Calabria,” Verona, Italy
| |
Collapse
|
19
|
Theou O, van der Valk AM, Godin J, Andrew MK, McElhaney JE, McNeil SA, Rockwood K. Exploring Clinically Meaningful Changes for the Frailty Index in a Longitudinal Cohort of Hospitalized Older Patients. J Gerontol A Biol Sci Med Sci 2021; 75:1928-1934. [PMID: 32274501 DOI: 10.1093/gerona/glaa084] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Clinically meaningful change (CMC) for frailty index (FI) scores is little studied. We estimated the CMC by associating changes in FI scores with changes in the Clinical Frailty Scale (CFS) in hospitalized patients. METHODS The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network enrolled older adults (65+ years) admitted to hospital with acute respiratory illness (mean age = 79.6 ± 8.4 years; 52.7% female). Patients were assigned CFS and 39-item FI scores in-person at admission and via telephone at 1-month postdischarge. Baseline frailty state was assessed at admission using health status 2 weeks before admission. We classified those whose CFS scores remained unchanged (n = 1,534) or increased (n = 4,390) from baseline to hospital admission, and whose CFS scores remained unchanged (n = 1,565) or decreased (n = 2,546) from admission to postdischarge. For each group, the CMC was represented as the FI score change value that best predicted one level CFS change, having the largest Youden J value in comparison to no change. RESULTS From baseline to admission, 74.1% increased CFS by ≥1 level. From admission to postdischarge, 61.9% decreased CFS by ≥1 levels. A change in FI score of 0.03 best predicted both one-level CFS increase (sensitivity = 70%; specificity = 69%) and decrease (sensitivity = 66%; specificity = 61%) in comparison to no change. Of those who changed CFS by ≥1 levels, 70.9% (baseline to admission) and 72.4% (admission to postdischarge) changed their FI score by at least 0.03. CONCLUSIONS A clinically meaningful change of 0.03 in the frailty index score holds promise as a benchmark for assessing the meaningfulness of frailty interventions.
Collapse
Affiliation(s)
- Olga Theou
- Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada.,Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Canada
| | | | - Judith Godin
- Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Canada
| | - Melissa K Andrew
- Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Canada
| | | | - Shelly A McNeil
- Infectious Diseases, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Canada
| |
Collapse
|
20
|
Mehrotra DV, Janes HE, Fleming TR, Annunziato PW, Neuzil KM, Carpp LN, Benkeser D, Brown ER, Carone M, Cho I, Donnell D, Fay MP, Fong Y, Han S, Hirsch I, Huang Y, Huang Y, Hyrien O, Juraska M, Luedtke A, Nason M, Vandebosch A, Zhou H, Cohen MS, Corey L, Hartzel J, Follmann D, Gilbert PB. Clinical Endpoints for Evaluating Efficacy in COVID-19 Vaccine Trials. Ann Intern Med 2021; 174:221-228. [PMID: 33090877 PMCID: PMC7596738 DOI: 10.7326/m20-6169] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Several vaccine candidates to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) have entered or will soon enter large-scale, phase 3, placebo-controlled randomized clinical trials. To facilitate harmonized evaluation and comparison of the efficacy of these vaccines, a general set of clinical endpoints is proposed, along with considerations to guide the selection of the primary endpoints on the basis of clinical and statistical reasoning. The plausibility that vaccine protection against symptomatic COVID-19 could be accompanied by a shift toward more SARS-CoV-2 infections that are asymptomatic is highlighted, as well as the potential implications of such a shift.
Collapse
Affiliation(s)
- Devan V Mehrotra
- Biostatistics and Research Decision Sciences, Merck & Co., North Wales, Pennsylvania (D.V.M., J.H.)
| | - Holly E Janes
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Thomas R Fleming
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington (T.R.F., E.R.B., M.C., L.C., P.B.G.)
| | - Paula W Annunziato
- Vaccines Clinical Research, Merck & Co., Kenilworth, New Jersey (P.W.A.)
| | - Kathleen M Neuzil
- University of Maryland School of Medicine, Baltimore, Maryland (K.M.N.)
| | - Lindsay N Carpp
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - David Benkeser
- Rollins School of Public Health, Emory University, Atlanta, Georgia (D.B.)
| | - Elizabeth R Brown
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington (T.R.F., E.R.B., M.C., L.C., P.B.G.)
| | - Marco Carone
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington (T.R.F., E.R.B., M.C., L.C., P.B.G.)
| | | | - Deborah Donnell
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Michael P Fay
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland (M.P.F., M.N., D.F.)
| | - Youyi Fong
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Shu Han
- Moderna, Cambridge, Massachusetts (S.H., H.Z.)
| | - Ian Hirsch
- AstraZeneca, Cambridge, United Kingdom (I.H.)
| | - Ying Huang
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Yunda Huang
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Ollivier Hyrien
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Michal Juraska
- Fred Hutchinson Cancer Research Center, Seattle, Washington (H.E.J., L.N.C., D.D., Y.F., Y.H., Y.H., O.H., M.J.)
| | - Alex Luedtke
- University of Washington, Seattle, Washington (A.L.)
| | - Martha Nason
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland (M.P.F., M.N., D.F.)
| | | | | | - Myron S Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina (M.S.C.)
| | - Lawrence Corey
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington (T.R.F., E.R.B., M.C., L.C., P.B.G.)
| | - Jonathan Hartzel
- Biostatistics and Research Decision Sciences, Merck & Co., North Wales, Pennsylvania (D.V.M., J.H.)
| | - Dean Follmann
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland (M.P.F., M.N., D.F.)
| | - Peter B Gilbert
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington (T.R.F., E.R.B., M.C., L.C., P.B.G.)
| |
Collapse
|
21
|
Hughes K, Middleton DB, Nowalk MP, Balasubramani GK, Martin ET, Gaglani M, Talbot HK, Patel MM, Ferdinands JM, Zimmerman RK, Silveira FP. Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults. Clin Infect Dis 2021; 73:e4353-e4360. [PMID: 33388741 DOI: 10.1093/cid/ciaa1927] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the non-immunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE against influenza-associated hospitalization among IC adults. METHODS We analyzed data from adults ≥ 18 years hospitalized with acute respiratory illness (ARI) during the 2017-2018 influenza season at 10 hospitals in the United States. IC adults were identified using pre-specified case-definitions, utilizing electronic medical record data. VE was evaluated with a test-negative case-control design using multivariable logistic regression with PCR-confirmed influenza as the outcome and vaccination status as the exposure, adjusting for age, enrolling site, illness onset date, race, days from onset to specimen collection, self-reported health, and self-reported hospitalizations. RESULTS Of 3,524 adults hospitalized with ARI, 1,210 (34.3%) had an immunocompromising condition. IC adults were more likely to be vaccinated than non-IC (69.5% vs 65.2%), and less likely to have influenza (22% vs 27.8%). The mean age did not differ among IC and non-IC (61.4 vs 60.8 years old). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% CI, 21% to 44%). VE among IC vs non-IC adults was lower at 5% (-29% to 31%) vs. 41% (27% to 52%) (p<0.05 for interaction term). CONCLUSIONS VE in one influenza season was very low among IC individuals. Future efforts should include evaluation of VE among the different immunocompromising conditions and whether enhanced vaccines improve the suboptimal effectiveness among the immunocompromised.
Collapse
Affiliation(s)
- Kailey Hughes
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Donald B Middleton
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard K Zimmerman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Fernanda P Silveira
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
22
|
Chung H, Buchan SA, Campigotto A, Campitelli MA, Crowcroft NS, Dubey V, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Mubareka S, Murti M, Richardson DC, Rosella LC, Schwartz KL, Smieja M, Zahariadis G, Kwong JC. Influenza vaccine effectiveness against all-cause mortality following laboratory-confirmed influenza in older adults, 2010-2011 to 2015-2016 seasons in Ontario, Canada. Clin Infect Dis 2020; 73:e1191-e1199. [PMID: 33354709 PMCID: PMC8423473 DOI: 10.1093/cid/ciaa1862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background Older adults are at increased risk of mortality from influenza infections. We estimated influenza vaccine effectiveness (VE) against mortality following laboratory-confirmed influenza. Methods Using a test-negative design study and linked laboratory and health administrative databases in Ontario, Canada, we estimated VE against all-cause mortality following laboratory-confirmed influenza for community-dwelling adults aged >65 years during the 2010–2011 to 2015–2016 influenza seasons. Results Among 54 116 older adults tested for influenza across the 6 seasons, 6837 died within 30 days of specimen collection. Thirteen percent (925 individuals) tested positive for influenza, and 50.6% were considered vaccinated for that season. Only 23.2% of influenza test-positive cases had influenza recorded as their underlying cause of death. Before and after multivariable adjustment, we estimated VE against all-cause mortality following laboratory-confirmed influenza to be 20% (95% confidence interval [CI], 8%–30%) and 20% (95% CI, 7%–30%), respectively. This estimate increased to 34% after correcting for influenza vaccination exposure misclassification. We observed significant VE against deaths following influenza confirmation during 2014–2015 (VE = 26% [95% CI, 5%–42%]). We also observed significant VE against deaths following confirmation of influenza A/H1N1 and A/H3N2, and against deaths with COPD as the underlying cause. Conclusions These results support the importance of influenza vaccination in older adults, who account for most influenza-associated deaths annually.
Collapse
Affiliation(s)
| | - Sarah A Buchan
- ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aaron Campigotto
- Hospital for Sick Children, Toronto, ON, Canada.,London Health Sciences Centre, London, ON, Canada
| | | | - Natasha S Crowcroft
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Vinita Dubey
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto Public Health
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Timothy Karnauchow
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, ON, Canada
| | - Allison J McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | | | | | - Michelle Murti
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Laura C Rosella
- ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kevin L Schwartz
- ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - George Zahariadis
- London Health Sciences Centre, London, ON, Canada.,Newfoundland & Labrador Public Health Laboratory, St. John's, NF&L, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| |
Collapse
|
23
|
Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, Bowie W, Katz K, McGeer A, Semret M, McNeil SA. Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness. J Am Geriatr Soc 2020; 69:696-703. [PMID: 33294986 PMCID: PMC7984066 DOI: 10.1111/jgs.16950] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/23/2023]
Abstract
Background/objectives Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under‐studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI). Design Protective observational cohort study. Setting Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season. Participants A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI. Measurements Influenza was laboratory‐confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100‐point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living. Results Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty‐six (37.4%) had laboratory‐confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI. Conclusion Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.
Collapse
Affiliation(s)
- Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada
| | - Sarah MacDonald
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jason LeBlanc
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- Department of Medicine (Infectious Diseases), University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Makeda Semret
- McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
24
|
MacDonald NE, Comeau J, Dubé E, Bucci L, Graham JE. A public health timeline to prepare for COVID-19 vaccines in Canada. Canadian Journal of Public Health 2020; 111:945-952. [PMID: 33151510 PMCID: PMC7643523 DOI: 10.17269/s41997-020-00423-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022]
Abstract
For control of COVID-19, community immunity is required, necessitating widespread immunization. COVID-19 vaccines are coming to Canada, with the government announcing in August 2020 agreements with four different companies for their COVID-19 vaccine if their trials are successful. Never before has public health had to rapidly develop a vaccine introduction program for multiple new but differing vaccines with the added pressure that the program is needed across all ages and in all Canadian communities and there is high probability of not enough vaccine to go around at the start. Traditional public health vaccine introduction planning will need to be both accelerated and more comprehensive to ensure optimal uptake across the country. This overview highlights a number of points for consideration by public health in their planning for COVID-19 vaccines before these COVID-19 vaccines are available, once they are available, once supplies are plentiful, and throughout the vaccine program. Targeted and tailored communications are key elements needed to reach and positively influence diverse communities, regions, ages, languages, education levels and lived experiences.
Collapse
Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Jeannette Comeau
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
| | - Janice E Graham
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
25
|
Andrew MK, McNeil SA. Influenza vaccination and the evolution of evidence-based recommendations for older adults: A Canadian perspective. Vaccine 2020; 39 Suppl 1:A36-A41. [PMID: 32958335 DOI: 10.1016/j.vaccine.2020.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Older adults are at high risk from influenza and its complications, and are therefore an important population for prevention efforts. In Canada, public health efforts targeting influenza are multi-pronged and include vaccination programs as well as surveillance which informs the national surveillance reporting platform FluWatch run by the Public Health Agency of Canada. Recommendations regarding use of vaccines are made nationally by the National Advisory Committee on Immunization (NACI) and by the Comité sur l'immunisation du Québec in Quebec, while vaccination programs are planned and delivered at the provincial/territorial level as opposed to as a harmonized national immunization program. NACI performs rigorous targeted literature reviews to inform their statements, and recommendations also vary by whether they apply on Individual (pertaining to decisions for individual patients) vs. Programmatic (informing policy decisions for implementation of publicly funded vaccination programs) levels. This unique context results in inter-provincial variation in vaccine schedules and funded vaccine products. In this paper, the importance of influenza vaccination for older adults is discussed; to provide insights from the Canadian context, the evolution of NACI evidence reviews and recommendations on influenza vaccination is presented.
Collapse
Affiliation(s)
- Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
26
|
Retrospective Assessment of the Antigenic Similarity of Egg-Propagated and Cell Culture-Propagated Reference Influenza Viruses as Compared with Circulating Viruses across Influenza Seasons 2002-2003 to 2017-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155423. [PMID: 32731417 PMCID: PMC7432082 DOI: 10.3390/ijerph17155423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 11/17/2022]
Abstract
Suboptimal vaccine effectiveness against seasonal influenza is a significant public health concern, partly explained by antigenic differences between vaccine viruses and viruses circulating in the environment. Haemagglutinin mutations within vaccine viruses acquired during serial passage in eggs have been identified as a source of antigenic variation between vaccine and circulating viruses. This study retrospectively compared the antigenic similarity of circulating influenza isolates with egg- and cell-propagated reference viruses to assess any observable trends over a 16-year period. Using annual and interim reports published by the Worldwide Influenza Centre, London, for the 2002-2003 to 2017-2018 influenza seasons, we assessed the proportions of circulating viruses which showed antigenic similarity to reference viruses by season. Egg-propagated reference viruses were well matched against circulating viruses for A/H1N1 and B/Yamagata. However, A/H3N2 and B/Victoria cell-propagated reference viruses appeared to be more antigenically similar to circulating A/H3N2 and B/Victoria viruses than egg-propagated reference viruses. These data support the possibility that A/H3N2 and B/Victoria viruses are relatively more prone to egg-adaptive mutation. Cell-propagated A/H3N2 and B/Victoria reference viruses were more antigenically similar to circulating A/H3N2 and B/Victoria viruses over a 16-year period than were egg-propagated reference viruses.
Collapse
|
27
|
Lees C, Godin J, McElhaney JE, McNeil SA, Loeb M, Hatchette TF, LeBlanc J, Bowie W, Boivin G, McGeer A, Poirier A, Powis J, Semret M, Webster D, Andrew MK. Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults. J Infect Dis 2020; 222:428-437. [PMID: 32147711 PMCID: PMC7336554 DOI: 10.1093/infdis/jiaa092] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness. METHODS A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status. RESULTS Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59-0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66-0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69-0.82); results varied by season, influenza status, vaccination status, and age. CONCLUSIONS Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness.
Collapse
Affiliation(s)
- Caitlin Lees
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelly A McNeil
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd F Hatchette
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | | | - André Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec City, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Duncan Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
28
|
Lina B, Georges A, Burtseva E, Nunes MC, Andrew MK, McNeil SA, Ruiz-Palacios GM, Feng L, Kyncl J, Vanhems P, Ortiz JR, Paget J, Reiner RC. Complicated hospitalization due to influenza: results from the Global Hospital Influenza Network for the 2017-2018 season. BMC Infect Dis 2020; 20:465. [PMID: 32615985 PMCID: PMC7330273 DOI: 10.1186/s12879-020-05167-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017-2018 season and examine factors associated with complicated hospitalization among patients admitted with laboratory-confirmed influenza illness. METHODS The study enrolled patients who were hospitalized in a GIHSN hospital in the previous 48 h with acute respiratory symptoms and who had symptoms consistent with influenza within the 7 days before admission. Enrolled patients were tested by reverse transcription-polymerase chain reaction to confirm influenza virus infection. "Complicated hospitalization" was defined as a need for mechanical ventilation, admission to an intensive care unit, or in-hospital death. In each of four age strata (< 15, 15-< 50, 50-< 65, and ≥ 65 years), factors associated with complicated hospitalization in influenza-positive patients were identified by mixed effects logistic regression and those associated with length of hospital stay using a linear mixed-effects regression model. RESULTS The study included 12,803 hospitalized patients at 14 coordinating sites in 13 countries, of which 4306 (34%) tested positive for influenza. Influenza viruses B/Yamagata, A/H3N2, and A/H1N1pdm09 strains dominated and cocirculated, although the dominant strains varied between sites. Complicated hospitalization occurred in 10.6% of influenza-positive patients. Factors associated with complicated hospitalization in influenza-positive patients included chronic obstructive pulmonary disease (15-< 50 years and ≥ 65 years), diabetes (15-< 50 years), male sex (50-< 65 years), hospitalization during the last 12 months (50-< 65 years), and current smoking (≥65 years). Chronic obstructive pulmonary disease (50-< 65 years), other chronic conditions (15-< 50 years), influenza A (50-< 65 years), and hospitalization during the last 12 months (< 15 years) were associated with a longer hospital stay. The proportion of patients with complicated influenza did not differ between influenza A and B. CONCLUSIONS Complicated hospitalizations occurred in over 10% of patients hospitalized with influenza virus infection. Factors commonly associated with complicated or longer hospitalization differed by age group but commonly included chronic obstructive pulmonary disease, diabetes, and hospitalization during the last 12 months.
Collapse
Affiliation(s)
- Bruno Lina
- CIRI, Lyon University, Inserm U 1111, Lyon, France.
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Infectious Agents Institute (IAI) Laboratory of Virology-National Reference Center for Respiratory Viruses (Including Influenza), Lyon, France.
- Claude Bernard University (Lyon 1), Lyon, France.
| | | | | | - Marta C Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | | | - Luzhao Feng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jan Kyncl
- National Institute of Public Health, Prague, Czech Republic
| | - Philippe Vanhems
- Groupement Hospitalier Edouard Herriot, Unité d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, Lyon, France
- Emerging Pathogens Laboratory - Epidemiology and International Health, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Lyon, France
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), CIC, 1417, Paris, France
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Robert C Reiner
- Institute of Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
29
|
Lee N, Smith SW, Hui DSC, Ye M, Zelyas N, Chan PKS, Drews SJ, Zapernick L, Wong R, Labib M, Shokoples S, Eurich DT. Development of an Ordinal Scale Treatment Endpoint for Adults Hospitalized With Influenza. Clin Infect Dis 2020; 73:e4369-e4374. [PMID: 32827251 DOI: 10.1093/cid/ciaa777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/11/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND An obstacle in influenza therapeutics development is the lack of clinical endpoints, especially in hospitalized patients. A single time-point binary outcome measure is limited by patients' diverse clinical trajectories and low event rates. METHODS A 6-point ordinal scale with ascending clinical status severity (scoring: discharged; subacute care; acute care without/with respiratory failure; intensive care unit [ICU]; death) was proposed to study outcomes of adults hospitalized with influenza. Individual patient data from 2 active surveillance cohorts' datasets (2015/2016-2017/2018; Edmonton, Hong Kong) was used for evaluation. The impact of neuraminidase inhibitor (NAI) treatment on longitudinal ordinal outcome changes over 30 days was analyzed using mixed-effects ordinal logistic regression and group-based trajectory models. RESULTS Patient (n = 1226) baseline characteristics included age (mean 68.0 years), virus-type (A 78.1%, B 21.9%), respiratory failure (57.2%), ICU admittance (14.4%), and NAI treatment within 5 days of illness (69.2%). Outcomes at 30 days included discharged (75.2%), subacute care (13.7%), acute care (4.5%), and death (6.6%). Two main clinical trajectories were identified, predictive by baseline scoring (mean ± SD, 4.3 ± 0.6 vs 3.5 ± 0.6, P < .001). Improved outcomes with NAI treatment within 5 days were indicated by significantly lower clinical status scores over time (unadjusted odds ratio [OR], 0.53; 95% confidence interval [CI], .41-.69; P < .001; adjusted OR, 0.62; 95% CI, .50-.77; P < .001, for baseline score, age, and within-patient correlations). In subanalysis, influenza vaccination was also associated with lower scores (adjusted OR, 0.67; 95% CI, .50-.90; P = .007). Analyses of binary endpoints showed insignificant results. CONCLUSIONS The ordinal outcome scale is a potentially useful clinical endpoint for influenza therapeutic trials, which could account for the diverse clinical trajectories of hospitalized patients, warranting further development.
Collapse
Affiliation(s)
- Nelson Lee
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - David S C Hui
- Department of Medicine, Chinese University of Hong Kong, HKSAR, PRC.,Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, HKSAR, PRC
| | - Ming Ye
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Nathan Zelyas
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Paul K S Chan
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, HKSAR, PRC.,Department of Microbiology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Steven J Drews
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Lori Zapernick
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Rity Wong
- Department of Medicine, Chinese University of Hong Kong, HKSAR, PRC
| | - Mary Labib
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| |
Collapse
|
30
|
McElhaney JE, Verschoor CP, Andrew MK, Haynes L, Kuchel GA, Pawelec G. The immune response to influenza in older humans: beyond immune senescence. Immun Ageing 2020; 17:10. [PMID: 32399058 PMCID: PMC7204009 DOI: 10.1186/s12979-020-00181-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/13/2020] [Indexed: 01/18/2023]
Abstract
Despite widespread influenza vaccination programs, influenza remains a major cause of morbidity and mortality in older adults. Age-related changes in multiple aspects of the adaptive immune response to influenza have been well-documented including a decline in antibody responses to influenza vaccination and changes in the cell-mediated response associated with immune senescence. This review will focus on T cell responses to influenza and influenza vaccination in older adults, and how increasing frailty or coexistence of multiple (≥2) chronic conditions contributes to the loss of vaccine effectiveness for the prevention of hospitalization. Further, dysregulation of the production of pro- and anti-inflammatory mediators contributes to a decline in the generation of an effective CD8 T cell response needed to clear influenza virus from the lungs. Current influenza vaccines provide only a weak stimulus to this arm of the adaptive immune response and rely on re-stimulation of CD8 T cell memory related to prior exposure to influenza virus. Efforts to improve vaccine effectiveness in older adults will be fruitless until CD8 responses take center stage.
Collapse
Affiliation(s)
- Janet E. McElhaney
- Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury, ON P3E 5J1 Canada
| | - Chris P. Verschoor
- Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury, ON P3E 5J1 Canada
| | - Melissa K. Andrew
- Department of Medicine and Canadian Centre for Vaccinology, Dalhousie University, Halifax, NS Canada
| | - Laura Haynes
- University of Connecticut Center on Aging, UConn Health Center, Farmington, CT USA
| | - George A. Kuchel
- University of Connecticut Center on Aging, UConn Health Center, Farmington, CT USA
| | - Graham Pawelec
- Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury, ON P3E 5J1 Canada
- Department of Immunology, University of Tübingen, Tübingen, Germany
| |
Collapse
|
31
|
Quinn B, Giuliano KK, Baker D. Non-ventilator health care-associated pneumonia (NV-HAP): Best practices for prevention of NV-HAP. Am J Infect Control 2020; 48:A23-A27. [PMID: 32331561 DOI: 10.1016/j.ajic.2020.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
Although the latest research and data show decreases in many health care-associated infections, recent publications highlight the understated but significant burden of nonventilator hospital-acquired pneumonia (NV-HAP). This section presents best practices to prevent NV-HAP. Many of the tools and interventions address basic nursing care such as oral care, oral and nonoral alimentation, patient positioning and mobility, pharmacologic and immunologic controls. The section stresses the importance of working with an interdisciplinary caregiver team to address fundamental activities of daily living that mitigate risk of developing NV-HAP.
Collapse
|
32
|
Meng Z, Zhang J, Shi J, Zhao W, Huang X, Cheng L, Yang X. Immunogenicity of influenza vaccine in elderly people: a systematic review and meta-analysis of randomized controlled trials, and its association with real-world effectiveness. Hum Vaccin Immunother 2020; 16:2680-2689. [PMID: 32347787 PMCID: PMC7746244 DOI: 10.1080/21645515.2020.1747375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Older people (≥60 years old) are particularly vulnerable to influenza virus infection, and vaccine is effective in reducing the disease burden in this population. However, it remains obscure whether their antibody response is lower than those of younger adults (18–60 years old). Thus, this meta-analysis was performed to compare the immunogenicity of influenza vaccines and understand their association with real-world vaccine effectiveness (VE) between these two age groups. Methods: A systematic literature search was conducted to identify relevant studies from Jan 01, 2008 to Nov 10, 2018. These are randomized controlled trials that included older adult samples, which assessed the immunogenicity of inactivated quadrivalent influenza vaccines produced in embryonated eggs. We excluded the studies focused only in children or adults. The outcomes were seroprotecton rate (SPR) and seroconversion rate (SCR). Results: Six studies were eventually included in the present meta-analysis (7,976 participants). For the SPR, the pooled risk ratio (RR) was 0.92 (95% CI: 0.90–0.94, I2 = 66%, P < .0001) for A/H1N1 and 0.94 (95% CI: 0.90–0.98, I2 = 91%, P = .002) for B/Victoria, and the antibody responses of A/H3N2 and B/Yamagata were similar in the two age groups. For the SCR, the pooled RR was 0.85 (95% CI: 0.76–0.94, I2 = 93%, P = .003), 0.77 (95% CI: 0.66–0.91, I2 = 94%, P = .002), and 0.83 (95% CI: 0.71–0.96, I2 = 94%, P = .02) for A/H1N1, B/Victoria and B/Yamagata, respectively, and the antibody responses of A/H3N2 were similar in the two groups. Some variations were found in the antibody responses across virus types and subtypes after influenza vaccination. Conclusion: The SPR and SCR of older adults were lower than those in younger adults for A/H1N1 and B/Victoria, while the two age groups had similar antibody responses for A/H3N2. The antibody responses to vaccines were not significantly associated with real-world VE, indicating that antibody response might not fully reflect the vaccine effectiveness of A/H3N2.
Collapse
Affiliation(s)
- Ziyan Meng
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Jiayou Zhang
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Jinrong Shi
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Wei Zhao
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Xiaoyuan Huang
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Li Cheng
- Center for Evaluation and Inspection of Hubei Food and Drug Administration , Wuhan, China
| | - Xiaoming Yang
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,China National Biotech Group Company Limited , Beijing, China
| |
Collapse
|
33
|
Patel M, Chen J, Kim S, Garg S, Flannery B, Haddadin Z, Rankin D, Halasa N, Talbot HK, Reed C. Analysis of MarketScan Data for Immunosuppressive Conditions and Hospitalizations for Acute Respiratory Illness, United States. Emerg Infect Dis 2020; 26:1720-1730. [PMID: 32348234 PMCID: PMC7392442 DOI: 10.3201/eid2608.191493] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases. Immunosuppressed patients have a high risk for influenza complications and an impaired immune response to vaccines. The total burden of immunosuppressive conditions in the United States, including those receiving emerging biologic therapies, remains unknown. We used the national claims database MarketScan to estimate the prevalence of immunosuppressive conditions and risk for acute respiratory illnesses (ARIs). We studied 47.2 million unique enrollees, representing 115 million person-years of observation during 2012–2017, and identified immunosuppressive conditions in 6.2% adults 18–64 years of age and 2.6% of children <18 years of age. Among 542,105 ARI hospitalizations, 32% of patients had immunosuppressive conditions. The risk for ARI hospitalizations was higher among enrollees with immunosuppression than among nonimmunosuppressed enrollees. Future efforts should focus on developing improved strategies, including vaccines, for preventing influenza in immunosuppressed patients, who are an increasing population in the United States.
Collapse
|
34
|
Lee CC, Liu Y, Lu KT, Wei C, Su K, Hsu WT, Chen SC. Comparison of influenza hospitalization outcomes among adults, older adults, and octogenarians: a US national population-based study. Clin Microbiol Infect 2020; 27:435-442. [PMID: 32325126 DOI: 10.1016/j.cmi.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to more fully elucidate the age-related trends in influenza mortality with a secondary goal of uncovering implications for treatment and prevention. METHODS In this retrospective cohort analysis of data from the Nationwide Readmission Database, patients with influenza as a primary or secondary discharge diagnosis were separated into three age groups: 55 638 adults aged 20-64 years, 36 862 adults aged 65-79 years and 41 806 octogenarians aged ≥80 years. Propensity score (PS) weighting was performed to isolate age from other baseline differences. Crude and PS-weighted hazard ratios (HR) were calculated from the in-hospital all-cause 30-day mortality rate. Admission threshold bias was minimized by comparison of influenza with bacterial pneumonia mortality. RESULTS Adults aged 20-64 years experienced higher in-hospital 30-day mortality compared with older adults aged 65-79 years (HR 0.66; 95% CI 0.55-0.79). Octogenarians had the highest mortality rate, but this was statistically insignificant compared with the adult cohort (HR 1.09; 95% CI 0.94-1.27). This trend was not explained by admission threshold bias: the 30-day mortality rate due to in-hospital bacterial pneumonia increased consistently with age (older adult HR 1.45; 95% CI 1.32-1.59; octogenarian HR 1.99; 95% CI 1.82-2.18). CONCLUSIONS Adults aged 20-64 years and octogenarians were more likely to experience all-cause 30-day mortality during influenza hospitalization compared with older adults aged 65-79 years. These data emphasize the importance of prevention and suggest the need for more tailored treatment interventions based on risk stratification that includes age.
Collapse
Affiliation(s)
- C-C Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Y Liu
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - K-T Lu
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - C Wei
- Harvard Medical School, Boston, MA, USA
| | - K Su
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - W-T Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S-C Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
35
|
Fabiani M, Volpe E, Faraone M, Bella A, Pezzotti P, Chini F. Effectiveness of influenza vaccine in reducing influenza-associated hospitalizations and deaths among the elderly population; Lazio region, Italy, season 2016-2017. Expert Rev Vaccines 2020; 19:479-489. [PMID: 32237925 DOI: 10.1080/14760584.2020.1750380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to estimate influenza vaccine effectiveness (VE) in preventing influenza-related deaths and hospitalizations in the elderly population. METHODS We retrospectively analyzed the cohort of 1,251,218 elderly aged ≥65 years who were residing in the Lazio region in 2016-2017. We estimated influenza VE using the Cox proportional hazards model, adjusting for demographic characteristics, preexisting health-risk conditions, and prior vaccinations. RESULTS Estimated VE was 14% (95% confidence interval (CI): 11 to 17); 26% (95%CI: 19 to 33) in preventing influenza-related deaths and 13% (95%CI: 10 to 16) in preventing influenza-related hospitalizations. Seasonal VE was higher in the elderly vaccinated in prior seasons (VE = 20%, 95%CI: 17 to 23). We found no significant differences in effectiveness by vaccine type, although the MF59-adjuvanted vaccine appeared more effective than other vaccines in individuals aged ≥75 years, particularly in those aged ≥90 years (VE = 18%, 95%CI: 9 to 26). CONCLUSIONS Although VE was low, vaccination still provided benefits in preventing influenza-related hospitalizations and deaths in the elderly, particularly among those vaccinated in prior seasons. Efforts should therefore be made to improve vaccine uptake and the utilization of vaccines with greater effectiveness in the oldest elderly (e.g. high-dose and adjuvanted cell-based vaccines).
Collapse
Affiliation(s)
- Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS) , Rome, Italy
| | - Enrico Volpe
- Regional Directorate for Health and Social Policy, Lazio Region , Rome, Italy
| | - Maurizio Faraone
- Regional Directorate for Health and Social Policy, Lazio Region , Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS) , Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS) , Rome, Italy
| | - Francesco Chini
- Regional Directorate for Health and Social Policy, Lazio Region , Rome, Italy
| |
Collapse
|
36
|
Influenza surveillance case definitions miss a substantial proportion of older adults hospitalized with laboratory-confirmed influenza: A report from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network. Infect Control Hosp Epidemiol 2020; 41:499-504. [PMID: 32146920 DOI: 10.1017/ice.2020.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults. DESIGN Prospective cohort study. SETTING The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults. METHODS Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index. RESULTS Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58-82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6-52.6) for younger adults versus 44.6% (95% CI, 43.6-45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7-65.6) of younger adults versus 57.1% (95% CI, 55.9-58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions. CONCLUSIONS A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.
Collapse
|
37
|
LeBlanc JJ, ElSherif M, Mulpuru S, Warhuus M, Ambrose A, Andrew M, Boivin G, Bowie W, Chit A, Dos Santos G, Green K, Halperin SA, Hatchette TF, Ibarguchi B, Johnstone J, Katz K, Langley JM, Lagacé-Wiens P, Loeb M, Lund A, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Shinde V, Smyth D, Trottier S, Valiquette L, Webster D, Ye L, McNeil S. Validation of the Seegene RV15 multiplex PCR for the detection of influenza A subtypes and influenza B lineages during national influenza surveillance in hospitalized adults. J Med Microbiol 2020; 69:256-264. [PMID: 31264957 PMCID: PMC7431100 DOI: 10.1099/jmm.0.001032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background. The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) has been performing active influenza surveillance since 2009 (ClinicalTrials.gov identifier: NCT01517191). Influenza A and B viruses are identified and characterized using real-time reverse-transcriptase polymerase chain reaction (RT-PCR), and multiplex testing has been performed on a subset of patients to identify other respiratory virus aetiologies. Since both methods can identify influenza A and B, a direct comparison was performed.Methods. Validated real-time RT-PCRs from the World Health Organization (WHO) to identify influenza A and B viruses, characterize influenza A viruses into the H1N1 or H3N2 subtypes and describe influenza B viruses belonging to the Yamagata or Victoria lineages. In a subset of patients, the Seeplex RV15 One-Step ACE Detection assay (RV15) kit was also used for the detection of other respiratory viruses.Results. In total, 1111 nasopharyngeal swabs were tested by RV15 and real-time RT-PCRs for influenza A and B identification and characterization. For influenza A, RV15 showed 98.0 % sensitivity, 100 % specificity and 99.7 % accuracy. The performance characteristics of RV15 were similar for influenza A subtypes H1N1 and H3N2. For influenza B, RV15 had 99.2 % sensitivity, 100 % specificity and 99.8 % accuracy, with similar assay performance being shown for both the Yamagata and Victoria lineages.Conclusions. Overall, the detection of circulating subtypes of influenza A and lineages of influenza B by RV15 was similar to detection by real-time RT-PCR. Multiplex testing with RV15 allows for a more comprehensive respiratory virus surveillance in hospitalized adults, without significantly compromising the reliability of influenza A or B virus detection.
Collapse
Affiliation(s)
- J. J. LeBlanc
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - M. ElSherif
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - S. Mulpuru
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - M. Warhuus
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - A. Ambrose
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - M. Andrew
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - G. Boivin
- Centre Hospitalier Universitaire de Québec, QC, Canada
| | - W. Bowie
- University of British Columbia, Vancouver, BC, Canada
| | - A. Chit
- Sanofi Pasteur, Swiftwater, PA, USA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - G. Dos Santos
- Business & Decision Life Sciences (on behalf of GSK), Bruxelles, Belgium
- Present address: GSK, Wavre, Belgium
| | - K. Green
- Mount Sinai Hospital, Toronto, ON, Canada
| | - S. A. Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - T. F. Hatchette
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - B. Ibarguchi
- GSK, Mississauga, ON, Canada
- Present address: Bayer, Inc., Mississauga, Ontario, Canada
| | - J. Johnstone
- Public Health Ontario and University of Toronto, Toronto, ON, Canada
| | - K. Katz
- North York General Hospital, Toronto, ON, Canada
| | - J. M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - M. Loeb
- Public Health Ontario and University of Toronto, Toronto, ON, Canada
| | - A. Lund
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - D. MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - A. McCarthy
- Ottawa Hospital General, Ottawa, Ontario, Canada
| | - J. E. McElhaney
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - A. McGeer
- Mount Sinai Hospital, Toronto, ON, Canada
| | - A. Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec, QC, Canada
| | - J. Powis
- Toronto East General Hospital, Toronto, ON, Canada
| | | | - M. Semret
- McGill University, Montreal, QC, Canada
| | - V. Shinde
- GSK, King of Prussia, PA, USA
- Present address: Novavax Vaccines, Washington, DC, USA
| | - D. Smyth
- The Moncton Hospital, Moncton, NB, Canada
| | - S. Trottier
- Centre Hospitalier Universitaire de Québec, QC, Canada
| | | | | | - L. Ye
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - S. A. McNeil
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
38
|
Torres A, Loeches IM, Sligl W, Lee N. Severe flu management: a point of view. Intensive Care Med 2020; 46:153-162. [PMID: 31912206 PMCID: PMC7095473 DOI: 10.1007/s00134-019-05868-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022]
Abstract
Annual flu seasons are typically characterized by changes in types and subtypes of influenza, with variations in terms of severity. Despite remarkable improvements in the prevention and management of patients with suspected or laboratory-confirmed diagnosis of influenza, annual seasonal influenza continues to be associated with a high morbidity and mortality. Admission to the intensive care unit is required for patients with severe forms of seasonal influenza infection, with primary pneumonia being present in most of the cases. This review summarizes the most recent knowledge on the diagnosis and treatment strategies in critically ill patients with influenza, focused on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, and supportive measures. The review focuses on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, supportive measures and relevant existing evidence, in order to provide the non-expert clinician a useful overview. An enhanced understanding of current diagnostic and treatment aspects of influenza infection can contribute to improve outcomes and reduce mortality among ICU patients with influenza.
Collapse
Affiliation(s)
- Antoni Torres
- Service of Pneumology, Hospital Clinic of Barcelona, University of Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red, Enfermedades Respiratorias (CIBERES), C/Villarroel 170, 08036, Barcelona, Spain.
| | - Ignacio-Martin- Loeches
- Service of Pneumology, Hospital Clinic of Barcelona, University of Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red, Enfermedades Respiratorias (CIBERES), C/Villarroel 170, 08036, Barcelona, Spain.,Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
| | - Wendy Sligl
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
| | - Nelson Lee
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
39
|
Nation ML, Moss R, Spittal MJ, Kotsimbos T, Kelly PM, Cheng AC. Influenza Vaccine Effectiveness Against Influenza-Related Mortality in Australian Hospitalized Patients: A Propensity Score Analysis. Clin Infect Dis 2020; 72:99-107. [DOI: 10.1093/cid/ciz1238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/02/2020] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background
Data on influenza vaccine effectiveness (IVE) against mortality are limited, with no Australian data to guide vaccine uptake. We aimed to assess IVE against influenza-related mortality in Australian hospitalized patients, assess residual confounding in the association between influenza vaccination and mortality, and assess whether influenza vaccination reduces the severity of influenza illness.
Methods
Data were collected between 2010 and 2017 from a national Australian hospital-based sentinel surveillance system using a case-control design. Adults and children admitted to the 17 study hospitals with acute respiratory symptoms were tested for influenza using nucleic acid testing; all eligible test-positive cases, and a subset of test-negative controls, were included. Propensity score analysis and multivariable logistic regression were used to determine the adjusted odds ratio (aOR) of vaccination, with IVE = 1 – aOR × 100%. Residual confounding was assessed by examining mortality in controls.
Results
Over 8 seasons, 14038 patients were admitted with laboratory-confirmed influenza. The primary analysis included 9298 cases and 6451 controls, with 194 cases and 136 controls dying during hospitalization. Vaccination was associated with a 31% (95% confidence interval [CI], 3%–51%; P = .033) reduction in influenza-related mortality, with similar estimates in the National Immunisation Program target group. Residual confounding was identified in patients ≥65 years old (aOR, 1.92 [95% CI, 1.06–3.46]; P = .031). There was no evidence that vaccination reduced the severity of influenza illness (aOR, 1.07 [95% CI, .76–1.50]; P = .713).
Conclusions
Influenza vaccination is associated with a moderate reduction in influenza-related mortality. This finding reinforces the utility of the Australian vaccination program in protecting those most at risk of influenza-related deaths.
Collapse
Affiliation(s)
- Monica L Nation
- Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert Moss
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tom Kotsimbos
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Monash University, Monash University, Melbourne, Victoria, Australia
| | - Paul M Kelly
- Australian National University Medical School, Monash University, Canberra, Australian Capital Territory, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
40
|
Chua H, Feng S, Lewnard JA, Sullivan SG, Blyth CC, Lipsitch M, Cowling BJ. The Use of Test-negative Controls to Monitor Vaccine Effectiveness: A Systematic Review of Methodology. Epidemiology 2020; 31:43-64. [PMID: 31609860 PMCID: PMC6888869 DOI: 10.1097/ede.0000000000001116] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The test-negative design is an increasingly popular approach for estimating vaccine effectiveness (VE) due to its efficiency. This review aims to examine published test-negative design studies of VE and to explore similarities and differences in methodological choices for different diseases and vaccines. METHODS We conducted a systematic search on PubMed, Web of Science, and Medline, for studies reporting the effectiveness of any vaccines using a test-negative design. We screened titles and abstracts and reviewed full texts to identify relevant articles. We created a standardized form for each included article to extract information on the pathogen of interest, vaccine(s) being evaluated, study setting, clinical case definition, choices of cases and controls, and statistical approaches used to estimate VE. RESULTS We identified a total of 348 articles, including studies on VE against influenza virus (n = 253), rotavirus (n = 48), pneumococcus (n = 24), and nine other pathogens. Clinical case definitions used to enroll patients were similar by pathogens of interest but the sets of symptoms that defined them varied substantially. Controls could be those testing negative for the pathogen of interest, those testing positive for nonvaccine type of the pathogen of interest, or a subset of those testing positive for alternative pathogens. Most studies controlled for age, calendar time, and comorbidities. CONCLUSIONS Our review highlights similarities and differences in the application of the test-negative design that deserve further examination. If vaccination reduces disease severity in breakthrough infections, particular care must be taken in interpreting vaccine effectiveness estimates from test-negative design studies.
Collapse
Affiliation(s)
- Huiying Chua
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Benjamin J Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
41
|
Keitel WA, Atmar RL. Influenza Vaccines After 7 Decades: Still on the Learning Curve. J Infect Dis 2019; 220:1240-1242. [PMID: 30561693 DOI: 10.1093/infdis/jiy724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Wendy A Keitel
- Departments of Molecular Virology and Microbiology, Houston, Texas
- Departments of Medicine, Baylor College of Medicine, Houston, Texas
| | - Robert L Atmar
- Departments of Molecular Virology and Microbiology, Houston, Texas
- Departments of Medicine, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
42
|
Ferdinands JM, Gaglani M, Martin ET, Middleton D, Monto AS, Murthy K, Silveira FP, Talbot HK, Zimmerman R, Alyanak E, Strickland C, Spencer S, Fry AM. Prevention of Influenza Hospitalization Among Adults in the United States, 2015-2016: Results From the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). J Infect Dis 2019; 220:1265-1275. [PMID: 30561689 PMCID: PMC6743848 DOI: 10.1093/infdis/jiy723] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Evidence establishing effectiveness of influenza vaccination for prevention of severe illness is limited. The US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) is a multiyear test-negative case-control study initiated in 2015-2016 to estimate effectiveness of vaccine in preventing influenza hospitalization among adults. METHODS Adults aged ≥18 years admitted to 8 US hospitals with acute respiratory illness and testing positive for influenza by polymerase chain reaction were cases; those testing negative were controls. Vaccine effectiveness was estimated with logistic regression adjusting for age, comorbidities, and other confounding factors and stratified by frailty, 2-year vaccination history, and clinical presentation. RESULTS We analyzed data from 236 cases and 1231 controls; mean age was 58 years. More than 90% of patients had ≥1 comorbidity elevating risk of influenza complications. Fifty percent of cases and 70% of controls were vaccinated. Vaccination was 51% (95% confidence interval [CI], 29%-65%) and 53% (95% CI, 11%-76%) effective in preventing hospitalization due to influenza A(H1N1)pdm09 and influenza B virus infection, respectively. Vaccine was protective for all age groups. CONCLUSIONS During the 2015-2016 US influenza A(H1N1)pdm09-predominant season, we found that vaccination halved the risk of influenza-association hospitalization among adults, most of whom were at increased risk of serious influenza complications due to comorbidity or age.
Collapse
Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor
| | - Don Middleton
- University of Pittsburgh Medical Center, Pennsylvania
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor
| | | | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Elif Alyanak
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Courtney Strickland
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
43
|
Blanchette PS, Chung H, Pritchard KI, Earle CC, Campitelli MA, Buchan SA, Schwartz KL, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Simor A, Smieja M, Zahariadis G, Campigotto A, Kwong JC. Influenza Vaccine Effectiveness Among Patients With Cancer: A Population-Based Study Using Health Administrative and Laboratory Testing Data From Ontario, Canada. J Clin Oncol 2019; 37:2795-2804. [PMID: 31465264 DOI: 10.1200/jco.19.00354] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
Collapse
Affiliation(s)
- Phillip S Blanchette
- University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,ICES London and Toronto, Ontario, Canada
| | | | | | - Craig C Earle
- ICES London and Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Katz
- University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Ontario, Canada
| | - James D McNally
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | | | - Aaron Campigotto
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
44
|
Zhang ZX, Mar Kyaw W, Ho HJ, Tay MZ, Huang H, Aung Hein A, Chow A. Seasonal influenza-associated intensive care unit admission and death in tropical Singapore, 2011-2015. J Clin Virol 2019; 117:73-79. [DOI: 10.1016/j.jcv.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/06/2019] [Accepted: 06/15/2019] [Indexed: 12/16/2022]
|
45
|
Ortiz JR, Neuzil KM. Influenza Immunization in Low- and Middle-Income Countries: Preparing for Next-Generation Influenza Vaccines. J Infect Dis 2019; 219:S97-S106. [DOI: 10.1093/infdis/jiz024] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| |
Collapse
|
46
|
Petrie JG, Martin ET, Truscon R, Johnson E, Cheng CK, McSpadden EJ, Malosh RE, Lauring AS, Lamerato LE, Eichelberger MC, Ferdinands JM, Monto AS. Evaluation of correlates of protection against influenza A(H3N2) and A(H1N1)pdm09 infection: Applications to the hospitalized patient population. Vaccine 2019; 37:1284-1292. [PMID: 30738647 PMCID: PMC6595494 DOI: 10.1016/j.vaccine.2019.01.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Influenza vaccines are important for prevention of influenza-associated hospitalization. However, the effectiveness of influenza vaccines can vary by year and influenza type and subtype and mechanisms underlying this variation are incompletely understood. Assessments of serologic correlates of protection can support interpretation of influenza vaccine effectiveness in hospitalized populations. METHODS We enrolled adults hospitalized for treatment of acute respiratory illnesses during the 2014-2015 and 2015-2016 influenza seasons whose symptoms began <10 days prior to enrollment. Influenza infection status was determined by RT-PCR. Influenza vaccination status was defined by self-report and medical record/registry documentation. Serum specimens collected at hospital admission were tested in hemagglutination-inhibition (HAI) and neuraminidase-inhibition (NAI) assays. We evaluated how well antibody measured in these specimens represented pre-infection immune status, and measured associations between antibody and influenza vaccination and infection. RESULTS Serum specimens were retrieved for 315 participants enrolled during the 2014-2015 season and 339 participants during the 2015-2016 season. Specimens were collected within 3 days of illness onset from 65% of participants. Geometric mean titers (GMTs) did not vary by the number of days from illness onset to specimen collection among influenza positive participants suggesting that measured antibody was representative of pre-infection immune status rather than a de novo response to infection. In both seasons, vaccinated participants had higher HAI and NAI GMTs than unvaccinated. HAI titers against the 2014-2015 A(H3N2) vaccine strain did not correlate with protection from infection with antigenically-drifted A(H3N2) viruses that circulated that season. In contrast, higher HAI titers against the A(H1N1)pdm09 vaccine strain were associated with reduced odds of A(H1N1)pdm09 infection in 2015-2016. CONCLUSIONS Serum collected shortly after illness onset at hospital admission can be used to assess correlates of protection against influenza infection. Broader implementation of similar studies would provide an opportunity to understand the successes and shortcomings of current influenza vaccines.
Collapse
Affiliation(s)
- Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States.
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| | - Rachel Truscon
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| | - Emileigh Johnson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| | - Caroline K Cheng
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| | - E J McSpadden
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| | - Ryan E Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| | - Adam S Lauring
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, United States; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, United States
| | - Lois E Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, United States
| | - Maryna C Eichelberger
- Division of Biological Standards and Quality Control, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, United States
| |
Collapse
|
47
|
Andrew MK, Bowles SK, Pawelec G, Haynes L, Kuchel GA, McNeil SA, McElhaney JE. Influenza Vaccination in Older Adults: Recent Innovations and Practical Applications. Drugs Aging 2019; 36:29-37. [PMID: 30411283 DOI: 10.1007/s40266-018-0597-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Influenza can lead to serious illness, particularly for older adults. In addition to short-term morbidity and mortality during the acute infection, recovery can be prolonged and often incomplete. This may lead to persistent declines in health and function, including catastrophic disability, which has dramatic implications for the well-being and support needs of older adults and their caregivers. All of this means that prevention of infection and effective treatment when illness has occurred are of paramount importance. In this narrative review, we discuss the effectiveness of influenza vaccines for the prevention of influenza illness and serious outcomes in older adults. We review evidence of vaccine effectiveness for older adults in comparison with younger age groups, and also highlight the importance of frailty as a determinant of vaccine effectiveness. We then turn our attention to the question of why older and frailer individuals have poorer vaccine responses, and consider changes in immune function and inflammatory responses. This sets the stage for a discussion of newer influenza vaccine products that have been developed with the aim of enhancing vaccine effectiveness in older adults. We review the available evidence on vaccine efficacy, effectiveness and cost benefits, consider the potential place of these innovations in clinical geriatric practice, and discuss international advisory committee recommendations on influenza vaccination in older adults. Finally, we highlight the importance of influenza prevention to support healthy aging, along with the need to improve vaccine coverage rates using available vaccine products, and to spur development of better influenza vaccines for older adults in the near future.
Collapse
Affiliation(s)
- Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, Canada. .,Canadian Center for Vaccinology, Halifax, NS, Canada.
| | - Susan K Bowles
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, Canada.,Canadian Center for Vaccinology, Halifax, NS, Canada.,Department of Pharmacy, Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
| | - Graham Pawelec
- Second Department of Internal Medicine, University of Tübingen, Tübingen, Germany.,Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Laura Haynes
- Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - George A Kuchel
- Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Halifax, NS, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, NS, Canada
| | - Janet E McElhaney
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
| |
Collapse
|
48
|
Ambrosino N, Bertella E. Lifestyle interventions in prevention and comprehensive management of COPD. Breathe (Sheff) 2018; 14:186-194. [PMID: 30186516 PMCID: PMC6118879 DOI: 10.1183/20734735.018618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chronic respiratory diseases are among the four major human chronic diseases. Tobacco smoke as well as environmental pollutants, infections, physical activity and nutritional status play a role in the prevalence, development and/or progression of chronic obstructive pulmonary disease (COPD). Changes in lifestyle are possible and may be beneficial in prevention and comprehensive management of COPD. Population-level interventions aimed at early diagnosis, promotion of vaccinations and prevention of infections, and reductions in smoking, environmental pollutants, physical inactivity, obesity and malnutrition may increase the number of life-years lived in good health. EDUCATIONAL AIMS To improve awareness of the influence of lifestyle on natural history of COPD.To describe the effects of some interventions to modify lifestyle in prevention and management.To provide information on the main clinical results.To define recommendations and limitations.
Collapse
Affiliation(s)
| | - Enrica Bertella
- Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Brescia, Italy
| |
Collapse
|