Influenza Vaccine Effectiveness in Preventing Outpatient, Inpatient, and Severe Cases of Laboratory-Confirmed Influenza
Influenza Vaccine Effectiveness in Preventing Outpatient, Inpatient, and Severe Cases of Laboratory-Confirmed Influenza
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DOI：
10.1093/cid/cit194
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发表时间：
2013-07-15
影响因子：
11.8
通讯作者：
Pumarola, Tomas
中科院分区：
文献类型：
--
作者：
Castilla, Jesus;Godoy, Pere;Pumarola, Tomas
背景。在大多数季节，流感疫苗都能有效预防流感，但尚不清楚它对预防轻症和重症病例是否同样有效。我们设计了一项病例对照研究，以比较流感疫苗在预防门诊、住院以及实验室确诊的流感重症或死亡病例方面的有效性。方法。 2010-2011 年季节，在西班牙 29 家医院招募的实验室确诊流感住院患者 (n = 691)，按照年龄、入院/就诊日期和省份分别与实验室确诊流感门诊患者和门诊对照患者进行匹配。重症病例被认为是那些住进重症监护室或在医院死亡的患者（n = 177）。我们使用针对潜在混杂因素进行调整的条件逻辑回归，比较了对照者和门诊病例、住院病例和重症病例的流感疫苗状况。使用非条件逻辑回归对严重和非严重住院流感病例进行比较。疫苗有效性为（1 - 优势比）x 100。结果。疫苗在预防流感门诊病例方面的有效性为 75%（调整后优势比 [AOR]，0.25；95% 置信区间 [CI]，.16-.39），在预防流感相关住院方面的有效性为 60%（AOR，0.40；95% CI，.25-.63），以及 89%（AOR，0.11；95% CI，.04-.37）以预防严重病例。在住院患者中，流感疫苗接种与较低的严重流感风险相关（AOR，0.42；95% CI，.22-.80）。结论。流感疫苗接种可以预防流感病例和住院治疗，并与流感住院患者更好的预后相关。这两种机制的综合作用可以解释疫苗在预防流感重症病例方面的高效性。
Background. In most seasons, the influenza vaccine is effective in preventing influenza, but it is not clear whether it is equally effective in preventing mild and severe cases. We designed a case-control study to compare the effectiveness of the influenza vaccine in preventing outpatient, inpatient, and severe or fatal cases of laboratory-confirmed influenza.Methods. Hospitalized patients (n = 691) with laboratory-confirmed influenza in the 2010-2011 season recruited in 29 Spanish hospitals were individually matched by age, admission/visit date, and province with an outpatient with laboratory-confirmed influenza and an outpatient control. Severe cases were considered those patients admitted to intensive care units or who died in the hospital (n = 177). We compared the influenza vaccine status of controls and outpatient cases, inpatient cases, and severe cases using conditional logistic regression adjusted for potential confounding factors. Severe and nonsevere inpatient influenza cases were compared using unconditional logistic regression. Vaccine effectiveness was (1 - odds ratio) x 100.Results. Vaccine effectiveness was 75% (adjusted odds ratio [AOR], 0.25; 95% confidence interval [CI],.16-.39) in preventing influenza outpatient cases, 60% (AOR, 0.40; 95% CI,.25-.63) in preventing influenza-associated hospitalizations, and 89% (AOR, 0.11; 95% CI,.04-.37) in preventing severe cases. In inpatients, influenza vaccination was associated with a lower risk of severe influenza (AOR, 0.42; 95% CI,.22-.80).Conclusions. Influenza vaccination prevented influenza cases and hospitalizations and was associated with a better prognosis in inpatients with influenza. The combined effect of these 2 mechanisms would explain the high effectiveness of the vaccine in preventing severe cases due to influenza.