Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults
Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults
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DOI：
10.1093/cid/ciaa1927
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发表时间：
2021-12-01
影响因子：
11.8
通讯作者：
Silveira, Fernanda P.
中科院分区：
文献类型：
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作者：
Hughes, Kailey;Middleton, Donald B.;Silveira, Fernanda P.
背景。建议免疫功能低下（IC）个体每年进行流感免疫接种，尽管免疫应答低于非免疫功能低下者，并且IC中疫苗有效性（VE）的数据很少。我们在IC成人中评估VE对流感相关住院的影响。我们分析了2017-2018年流感季节美国10家医院因急性呼吸道疾病（ARI）住院的18岁成人的数据。使用电子病历数据使用预先指定的病例定义确定IC成人。采用检测阴性病例对照设计，采用多变量logistic回归，以聚合酶链反应确诊的流感为结果，疫苗接种状态为暴露，调整年龄、入组地点、发病日期、种族、发病至标本采集天数、自我报告健康状况和自我报告住院情况。在因ARI住院的3524名成人中，1210名（34.3%）存在免疫功能低下。IC成年人比非IC成年人更有可能接种疫苗（69.5%对65.2%），患流感的可能性更低（22%对27.8%）。IC和非IC患者的平均年龄没有差异（61.4岁vs 60.8岁）。包括免疫功能正常的成年人在内，流感住院的总体VE为33%（95%可信区间[CI]， 21-44）。与非IC成人相比，IC成人的VE较低，分别为5% （95% CI， -29%至31%）和41% （95% CI, 27-52）
Background. Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the nonimmunocompromised 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 prespecified case definitions using electronic medical record data. VE was evaluated with a test-negative case-control design using multivariable logistic regression with polymerase chain reaction-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 3524 adults hospitalized with ARI, 1210 (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 of age). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% confidence interval [CI], 21-44). VE among IC vs non-IC adults was lower at 5% (95% CI, -29% to 31%) vs 41% (95% CI, 27-52) (P