Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination.
Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination.
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DOI：
10.1001/jama.2015.12160
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发表时间：
2015-10-13
期刊：
影响因子：
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通讯作者：
Edwards KM
中科院分区：
文献类型：
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作者：
Grijalva CG;Zhu Y;Williams DJ;Self WH;Ampofo K;Pavia AT;Stockmann CR;McCullers J;Arnold SR;Wunderink RG;Anderson EJ;Lindstrom S;Fry AM;Foppa IM;Finelli L;Bramley AM;Jain S;Griffin MR;Edwards KM
很少有研究评估流感疫苗接种与肺炎（流感感染的严重并发症）之间的关系。评估流感疫苗接种状况与社区获得性实验室确诊的流感肺炎住院之间的关系。社区肺炎病原学（EPIC）研究是一项前瞻性观察性多中心研究，研究了2010年1月至2012年6月在4家美国研究中心进行的社区获得性肺炎住院情况。我们使用的EPIC研究数据来自年龄≥6个月、实验室确诊的流感感染患者，并在流感季节期间验证了疫苗接种状态，排除了近期住院、长期护理住宿设施和重度免疫抑制的患者。使用逻辑回归计算比值比，比较流感阳性（病例）和流感阴性（对照）肺炎患者之间的疫苗接种比值，控制人口统计学、合并症、季节、研究地点和疾病发作时间。疫苗有效性估计为（1-比值比）× 100%。流感疫苗接种，通过记录审查进行验证。流感性肺炎，通过对鼻/口咽拭子进行实时逆转录-聚合酶链反应证实。总体而言，2767例因肺炎住院的患者符合研究条件; 162例（5.9%）为流感阳性。162例流感相关肺炎患者中有28例（17%）和2605例流感阴性肺炎对照中有766例（29%）接种了疫苗。病例组和对照组之间既往流感疫苗接种的校正比值比为0.43（95% CI 0.28-0.68 [估计疫苗有效性56.7%（95% CI 31.9-72.5）]）。在因社区获得性肺炎住院的儿童和成人中，与那些与流感无关的肺炎患者相比，实验室确诊的流感相关肺炎患者接受流感疫苗接种的几率较低。
Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection. Assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia. The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 in four US sites. We used EPIC study data from patients ≥6 months of age with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons, and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (cases) and influenza-negative (controls) pneumonia patients, controlling for demographics, co-morbidities, season, study site and timing of disease onset. Vaccine effectiveness was estimated as (1-odds ratio) × 100%. Influenza vaccination, verified through record review. Influenza pneumonia, confirmed by real-time reverse transcription-polymerase chain reaction performed on nasal/oropharyngeal swabs. Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) were influenza positive. Twenty-eight (17%) of 162 cases with influenza-associated pneumonia and 766 (29%) of 2605 controls with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI 0.28–0.68 [estimated vaccine effectiveness 56.7% (95% CI 31.9–72.5)]). Among children and adults hospitalized with community-acquired pneumonia, those with laboratory confirmed influenza-associated pneumonia, compared to those with pneumonia not associated with influenza, had lower odds of having received influenza vaccination.