Sunita Mulpuru1, Li Li2, Lingyun Ye2, Todd Hatchette2, Melissa K Andrew2, Ardith Ambrose2, Guy Boivin3, William Bowie4, Ayman Chit5, Gael Dos Santos6, May ElSherif2, Karen Green7, Francois Haguinet8, Scott A Halperin2, Barbara Ibarguchi9, Jennie Johnstone10, Kevin Katz11, Joanne M Langley2, Jason LeBlanc2, Mark Loeb12, Donna MacKinnon-Cameron2, Anne McCarthy13, Janet E McElhaney14, Allison McGeer7, Jeff Powis15, David Richardson16, Makeda Semret17, Vivek Shinde18, Daniel Smyth19, Sylvie Trottier3, Louis Valiquette20, Duncan Webster21, Shelly A McNeil2. 1. Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, ON, Canada. Electronic address: smulpuru@toh.ca. 2. Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada. 3. Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada. 4. Faculty of Medicine, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 5. Sanofi Pasteur, Swiftwater, PA; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 6. Business & Decision Life Sciences, Brussels, Belgium (GlaxoSmithKline). 7. Mount Sinai Hospital, Toronto, ON, Canada. 8. GlaxoSmithKline, Wavre, Belgium. 9. GlaxoSmithKline, Mississauga, ON, Canada. 10. Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada. 11. North York General Hospital, Toronto, ON, Canada. 12. Division of Infectious Diseases, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. 13. Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, ON, Canada. 14. Health Sciences North Research Institute, Sudbury, ON, Canada. 15. Toronto East General Hospital, Toronto, ON, Canada. 16. William Osler Health System, Brampton, ON, Canada. 17. Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, McGill University, Montreal, QC, Canada. 18. GlaxoSmithKline, King of Prussia, PA. 19. The Moncton Hospital, Moncton, NB, Canada. 20. Université de Sherbrooke, Sherbrooke, QC, Canada. 21. Horizon Health, Saint John, NB, Canada.
Abstract
BACKGROUND: The effectiveness of influenza vaccination in reducing influenza-related hospitalizations among patients with COPD is not well described, and influenza vaccination uptake remains suboptimal. METHODS: Data were analyzed from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization. We identified influenza-positive cases and negative control subjects and used multivariable logistic regression with a standard test-negative design to estimate the vaccine effectiveness for preventing influenza-related hospitalizations. RESULTS: Among 4,755 hospitalized patients with COPD, 4,198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals. Influenza-positive patients (n = 1,833 [38.5%]) experienced higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) compared with influenza-negative patients. Risk factors for mortality in influenza-positive patients included age > 75 years (OR, 3.7 [95% CI, 0.4-30.3]), cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]), residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]). CONCLUSIONS: Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD. Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population. TRIAL REGISTRY: ClinicalTrials.govNo.:NCT01517191; URL www.clinicaltrials.gov.
BACKGROUND: The effectiveness of influenza vaccination in reducing influenza-related hospitalizations among patients with COPD is not well described, and influenza vaccination uptake remains suboptimal. METHODS: Data were analyzed from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization. We identified influenza-positive cases and negative control subjects and used multivariable logistic regression with a standard test-negative design to estimate the vaccine effectiveness for preventing influenza-related hospitalizations. RESULTS: Among 4,755 hospitalized patients with COPD, 4,198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals. Influenza-positive patients (n = 1,833 [38.5%]) experienced higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) compared with influenza-negative patients. Risk factors for mortality in influenza-positive patients included age > 75 years (OR, 3.7 [95% CI, 0.4-30.3]), cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]), residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]). CONCLUSIONS: Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD. Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population. TRIAL REGISTRY: ClinicalTrials.govNo.:NCT01517191; URL www.clinicaltrials.gov.
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