Journal Reading

EFFECTIVENESS OF INFLUENZA VACCINATION

ON
HOSPITALIZATIONS AND RISK FACTORS FOR
SEVERE
OUTCOMES IN HOSPITALIZED PATIENTS WITH
COPD
Yuly Rahmawati
Arief Bakhtiar
INTRODUCTION

■ Previous studies reported a 5% to 22% prevalence of influenza virus among patients

experiencing an exacerbation
■ International guidelines recommend annual influenza vaccination for patients with
COPD to reduce influenza related exacerbations and acute respiratory infections.
Aim

• effectiveness of the influenza

determine
vaccine
• The severity
describe
• risk factors for poor outcomes
 PATIENT AND METHODS
Data Treatment Outcome

• Canadian • influenza testing • Primary :

Immunization by nasopharyngeal influenza-related
Research Network (NP) swab with hospitalization
Serious Outcomes (PCR) • Secondary
Surveillance (SOS) • standard-dose outcomes : ICU,
• collected during trivalent admission, all-
influenza seasons inactivated cause mortality up
(2011-2015) influenza vaccines to 30 days’
• 46 hospitals across were administered postdischarge, use
5 Canadian during the study of noninvasive
provinces period positive pressure
• Adult patient with ventilation,
COPD mechanical
ventilation, and
length of stay.
Design
■ A test-negative design
■ A multivariate regression model was used to determine the association between
influenza vaccination and hospitalization
■ Oneway ANOVA and χ2 testing was used to compare continuous and categorical
variables between COPD patients with and without home oxygen use
■ Multivariable logistic regression was used to determine risk factors for mortality, ICU
care, use of noninvasive positive pressure ventilation, and mechanical ventilation among
patients with confirmed influenza.
Clinical Outcomes
■ Outcomes Among Patients With Confirmed Influenza and COPD
– Approximately 1 of 10 influenza-positive patients required mechanical ventilation
(9.7% [177 of 1,833]),
– 11.1% (204 of 1,833) died.
– One of five patients was admitted to the ICU (18.1% [332 of 1,833])
– Mean SD length of stay was 11 13.3 days.
Risk Factors for Poor Outcomes Among Influenza-
Positive Patients
■ The crude mortality rate was significantly higher in the vaccinated group vs the
unvaccinated group (11.0% vs 7.8%; P < .001).
■ Risk factors for mechanical ventilation :
– Diabetes (OR, 1.7 [95% CI, 1.1-2.6])
– current smoking (OR,3.2 [95% CI, 1.5-7.2]).
– home oxygen use (OR, 2.0 [95% CI, 1.3-3.2])
DISCUSSION

■ Influenza vaccination was associated with a significant reduction in influenza-related

hospitalizations (38%).
■ Influenza burden was high (38.5%) among hospitalized patients, and influenza-infected
patients experienced significant crude mortality (1 of 10) and critical illness (1 of 5)
■ A systematic review of randomized studies found that influenza vaccination reduced
COPDE in the same season but did not show a significant effect on hospitalizations.
■ in the present study, there’s no significant reduction in mortality associated with
vaccination
■ Our results suggest that patients with COPD are at higher risk of death if hospitalized
with influenza, compared with estimates in the general hospitalized patient population.
■ antiviral use in the hospital is another potential strategy to reduce influenza-associated
complications.
■ The Centers for Disease Control and Prevention recommend use of antiviral
medications as early as possible in the course of hospitalization for any patient with
confirmed or suspected influenza
■ Limitation :
– cannot confirm the rate of noninfluenza viruses in the case subjects and control
subjects.
– The COPD diagnosis was confirmed by using medical records rather than by
spirometry
– this study did not account for bacterial co-infections in
CONCLUSSION

■ The re’s a significant reduction in influenza-related hospitalizations associated with

seasonal influenza vaccination and identified a highburden of influenza infection among
hospitalized patients with COPD.
■ Important clinical care gaps were also identified, including low influenza vaccination
rates and delayed initiation of antiviral therapy in this highhrisk population of patients
with COPD.
■ Future research should focus on knowledge translation interventions to increase and
sustain vaccine uptake in this highly vulnerable population, and should explore the
value of nonvaccine strategies for influenza prevention in highest risk populations.
Thank you