Relative Vaccine Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among Veterans Health Administration Patients
Relative Vaccine Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among Veterans Health Administration Patients
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DOI：
10.1093/infdis/jiy088
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发表时间：
2018-06-01
影响因子：
6.4
通讯作者：
Chit, Ayman
中科院分区：
文献类型：
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作者：
Young-Xu, Yinong;Van Aalst, Robertus;Chit, Ayman
背景。我们研究了在退伍军人健康管理局（VHA）的老年人群中，高剂量灭活流感疫苗是否比标准剂量疫苗更有效地预防住院。本研究对2015-2016年流感季节65岁及以上的VHA患者进行回顾性队列研究，评估了高剂量与标准剂量的相对疫苗有效性（rVE）。为了调整测量到的混杂因素，我们将每个高剂量受体与多达4个标准剂量受体进行匹配，这些受体在2周内在同一地点接种了疫苗，并且有2种或更多的既往医疗合并症。我们使用先前的事件率比方法（PERR），一种差异中差异分析，来调整未测量的混杂因素。我们评估了104 965名标准剂量受者和125 776名高剂量受者；匹配将人口减少到49091名标准剂量和24682名高剂量接受者。经perr校正的匹配rVE对流感或肺炎相关住院的影响为25%(95%置信区间[CI]， 2%-43%)，对全因住院的影响为7% (95% CI, -2% - 14%)，对流感或肺炎相关门诊的影响为14% (95% CI, -8% - 32%)，对全因门诊的影响为5% (95% CI, 2%-8%)，对实验室确诊流感的影响为38% （95% CI, -5% - 65%）。在保护VHA老年患者免受流感或肺炎相关住院治疗方面，高剂量流感疫苗比标准剂量疫苗更有效。
Background. We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population.Methods. This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015-2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders.Results. We evaluated 104 965 standard-dose and 125 776 high-dose recipients; matching decreased the population to 49 091 standard-dose and 24 682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%-43%) against influenza-or pneumonia-associated hospitalization, 7% (95% CI, -2% to 14%) against all-cause hospitalization, 14% (95% CI, -8% to 32%) against influenza-or pneumonia-associated outpatient visit, 5% (95% CI, 2%-8%) against all-cause outpatient visit, and 38% (95% CI, -5% to 65%) against laboratory-confirmed influenza.Conclusions. In protecting senior VHA patients against influenza-or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.