Chest. 2019 Jan;155(1):69-78. doi: 10.1016/j.chest.2018.10.044.
Effectiveness of Influenza Vaccination on Hospitalizations and Risk Factors for Severe Outcomes in Hospitalized Patients With COPD.

Mulpuru S1, Li L2, Ye L2, Hatchette T2, Andrew MK2, Ambrose A2, Boivin G3, Bowie W4, Chit A5, Dos Santos G6, ElSherif M2, Green K7, Haguinet F8, Halperin SA2, Ibarguchi B9, Johnstone J10, Katz K11, Langley JM2, LeBlanc J2, Loeb M12, MacKinnon-Cameron D2, McCarthy A13, McElhaney JE14, McGeer A7, Powis J15, Richardson D16, Semret M17, Shinde V18, Smyth D19, Trottier S3, Valiquette L20, Webster D21, McNeil SA2; Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN).
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The effectiveness of influenza vaccination in reducing influenza-related hospitalizations among patients with COPD is not well described, and influenza vaccination uptake remains suboptimal.

Data were analyzed from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization. We identified influenza-positive cases and negative control subjects and used multivariable logistic regression with a standard test-negative design to estimate the vaccine effectiveness for preventing influenza-related hospitalizations.

Among 4,755 hospitalized patients with COPD, 4,198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals. Influenza-positive patients (n = 1,833 [38.5%]) experienced higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) compared with influenza-negative patients. Risk factors for mortality in influenza-positive patients included age > 75 years (OR, 3.7 [95% CI, 0.4-30.3]), cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]), residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]).

Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD. Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population.

ClinicalTrials.govNo.:NCT01517191; URL
Copyright 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.


COPD; hospitalization; influenza; pulmonary; vaccine effectiveness

PMID: 30616737 DOI: 10.1016/j.chest.2018.10.044