Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study

Itziar Casado; Ángela Domínguez; Diana Toledo; Judith Chamorro; Jenaro Astray; Mikel Egurrola; María Amelia Fernández-Sierra; Vicente Martín; María Morales-Suárez-Varela; Pere Godoy; Jesús Castilla; J. M. Mayoral; J. Díaz-Borrego; A. Morillo; M. J. Pérez-Lozano; J. Gutiérrez; M. Pérez-Ruiz; S. Tamames; S. Rojo-Rello; R. Ortiz De Lejarazu; M. I. Fernández-Natal; T. Fernández-Villa; A. Pueyo; A. Vilella; M. Campins; A. Antón; G. Navarro; M. Riera; E. Espejo; M. D. Mas; R. Pérez; J. A. Cayla; C. Rius; N. Torner; C. Izquierdo; R. Torra; L. Force; N. Soldevila; I. Crespo; F. Sanz; M. F. Domínguez-Berjon; M. A. Gutiérrez; S. Jiménez; E. Gil; F. Martín; R. Génova-Maleras; M. C. Prados; F. Enzzine De Blas; M. A. Salvador; S. Rodríguez; M. Romero; J. C. Galán; E. Navas; L. Rodríguez; C. J. Álvarez; E. Banderas; S. Fernández; M. J. López De Goicoechea; J. Díaz-González

doi:10.1503/cmaj.170910

Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study

Itziar Casado, Ángela Domínguez, Diana Toledo, Judith Chamorro, Jenaro Astray, Mikel Egurrola, María Amelia Fernández-Sierra, Vicente Martín, María Morales-Suárez-Varela, Pere Godoy, Jesús Castilla, J. M. Mayoral, J. Díaz-Borrego, A. Morillo, M. J. Pérez-Lozano, J. Gutiérrez, M. Pérez-Ruiz, S. Tamames, S. Rojo-Rello, R. Ortiz De LejarazuM. I. Fernández-Natal, T. Fernández-Villa, A. Pueyo, A. Vilella, M. Campins, A. Antón, G. Navarro, M. Riera, E. Espejo, M. D. Mas, R. Pérez, J. A. Cayla, C. Rius, N. Torner, C. Izquierdo, R. Torra, L. Force, N. Soldevila, I. Crespo, F. Sanz, M. F. Domínguez-Berjon, M. A. Gutiérrez, S. Jiménez, E. Gil, F. Martín, R. Génova-Maleras, M. C. Prados, F. Enzzine De Blas, M. A. Salvador, S. Rodríguez, M. Romero, J. C. Galán, E. Navas, L. Rodríguez, C. J. Álvarez, E. Banderas, S. Fernández, M. J. López De Goicoechea, J. Díaz-González

Research output: Contribution to journal › Article › Research › peer-review

19 Citations (Scopus)

Abstract

© 2018 Joule Inc. or its licensors. BACKGROUND: The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS: We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. RESULTS: We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). INTERPRETATION: Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults.

Original language	English
Pages (from-to)	E3-E12
Journal	CMAJ
Volume	190
Issue number	1
DOIs	https://doi.org/10.1503/cmaj.170910
Publication status	Published - 8 Jan 2018

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Casado, I., Domínguez, Á., Toledo, D., Chamorro, J., Astray, J., Egurrola, M., Fernández-Sierra, M. A., Martín, V., Morales-Suárez-Varela, M., Godoy, P., Castilla, J., Mayoral, J. M., Díaz-Borrego, J., Morillo, A., Pérez-Lozano, M. J., Gutiérrez, J., Pérez-Ruiz, M., Tamames, S., Rojo-Rello, S., ... Díaz-González, J. (2018). Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study. CMAJ, 190(1), E3-E12. https://doi.org/10.1503/cmaj.170910

Casado, Itziar ; Domínguez, Ángela ; Toledo, Diana ; Chamorro, Judith ; Astray, Jenaro ; Egurrola, Mikel ; Fernández-Sierra, María Amelia ; Martín, Vicente ; Morales-Suárez-Varela, María ; Godoy, Pere ; Castilla, Jesús ; Mayoral, J. M. ; Díaz-Borrego, J. ; Morillo, A. ; Pérez-Lozano, M. J. ; Gutiérrez, J. ; Pérez-Ruiz, M. ; Tamames, S. ; Rojo-Rello, S. ; Ortiz De Lejarazu, R. ; Fernández-Natal, M. I. ; Fernández-Villa, T. ; Pueyo, A. ; Vilella, A. ; Campins, M. ; Antón, A. ; Navarro, G. ; Riera, M. ; Espejo, E. ; Mas, M. D. ; Pérez, R. ; Cayla, J. A. ; Rius, C. ; Torner, N. ; Izquierdo, C. ; Torra, R. ; Force, L. ; Soldevila, N. ; Crespo, I. ; Sanz, F. ; Domínguez-Berjon, M. F. ; Gutiérrez, M. A. ; Jiménez, S. ; Gil, E. ; Martín, F. ; Génova-Maleras, R. ; Prados, M. C. ; Enzzine De Blas, F. ; Salvador, M. A. ; Rodríguez, S. ; Romero, M. ; Galán, J. C. ; Navas, E. ; Rodríguez, L. ; Álvarez, C. J. ; Banderas, E. ; Fernández, S. ; López De Goicoechea, M. J. ; Díaz-González, J. / Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study. In: CMAJ. 2018 ; Vol. 190, No. 1. pp. E3-E12.

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title = "Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study",

abstract = "{\textcopyright} 2018 Joule Inc. or its licensors. BACKGROUND: The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS: We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. RESULTS: We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). INTERPRETATION: Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults.",

author = "Itziar Casado and {\'A}ngela Dom{\'i}nguez and Diana Toledo and Judith Chamorro and Jenaro Astray and Mikel Egurrola and Fern{\'a}ndez-Sierra, {Mar{\'i}a Amelia} and Vicente Mart{\'i}n and Mar{\'i}a Morales-Su{\'a}rez-Varela and Pere Godoy and Jes{\'u}s Castilla and Mayoral, {J. M.} and J. D{\'i}az-Borrego and A. Morillo and P{\'e}rez-Lozano, {M. J.} and J. Guti{\'e}rrez and M. P{\'e}rez-Ruiz and S. Tamames and S. Rojo-Rello and {Ortiz De Lejarazu}, R. and Fern{\'a}ndez-Natal, {M. I.} and T. Fern{\'a}ndez-Villa and A. Pueyo and A. Vilella and M. Campins and A. Ant{\'o}n and G. Navarro and M. Riera and E. Espejo and Mas, {M. D.} and R. P{\'e}rez and Cayla, {J. A.} and C. Rius and N. Torner and C. Izquierdo and R. Torra and L. Force and N. Soldevila and I. Crespo and F. Sanz and Dom{\'i}nguez-Berjon, {M. F.} and Guti{\'e}rrez, {M. A.} and S. Jim{\'e}nez and E. Gil and F. Mart{\'i}n and R. G{\'e}nova-Maleras and Prados, {M. C.} and {Enzzine De Blas}, F. and Salvador, {M. A.} and S. Rodr{\'i}guez and M. Romero and Gal{\'a}n, {J. C.} and E. Navas and L. Rodr{\'i}guez and {\'A}lvarez, {C. J.} and E. Banderas and S. Fern{\'a}ndez and {L{\'o}pez De Goicoechea}, {M. J.} and J. D{\'i}az-Gonz{\'a}lez",

year = "2018",

month = jan,

day = "8",

doi = "10.1503/cmaj.170910",

language = "English",

volume = "190",

pages = "E3--E12",

journal = "CMAJ",

issn = "0008-4409",

publisher = "Canadian Medical Association",

number = "1",

}

Casado, I, Domínguez, Á, Toledo, D, Chamorro, J, Astray, J, Egurrola, M, Fernández-Sierra, MA, Martín, V, Morales-Suárez-Varela, M, Godoy, P, Castilla, J, Mayoral, JM, Díaz-Borrego, J, Morillo, A, Pérez-Lozano, MJ, Gutiérrez, J, Pérez-Ruiz, M, Tamames, S, Rojo-Rello, S, Ortiz De Lejarazu, R, Fernández-Natal, MI, Fernández-Villa, T, Pueyo, A, Vilella, A, Campins, M, Antón, A, Navarro, G, Riera, M, Espejo, E, Mas, MD, Pérez, R, Cayla, JA, Rius, C, Torner, N, Izquierdo, C, Torra, R, Force, L, Soldevila, N, Crespo, I, Sanz, F, Domínguez-Berjon, MF, Gutiérrez, MA, Jiménez, S, Gil, E, Martín, F, Génova-Maleras, R, Prados, MC, Enzzine De Blas, F, Salvador, MA, Rodríguez, S, Romero, M, Galán, JC, Navas, E, Rodríguez, L, Álvarez, CJ, Banderas, E, Fernández, S, López De Goicoechea, MJ & Díaz-González, J 2018, 'Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study', CMAJ, vol. 190, no. 1, pp. E3-E12. https://doi.org/10.1503/cmaj.170910

Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study. / Casado, Itziar; Domínguez, Ángela; Toledo, Diana; Chamorro, Judith; Astray, Jenaro; Egurrola, Mikel; Fernández-Sierra, María Amelia; Martín, Vicente; Morales-Suárez-Varela, María; Godoy, Pere; Castilla, Jesús; Mayoral, J. M.; Díaz-Borrego, J.; Morillo, A.; Pérez-Lozano, M. J.; Gutiérrez, J.; Pérez-Ruiz, M.; Tamames, S.; Rojo-Rello, S.; Ortiz De Lejarazu, R.; Fernández-Natal, M. I.; Fernández-Villa, T.; Pueyo, A.; Vilella, A.; Campins, M.; Antón, A.; Navarro, G.; Riera, M.; Espejo, E.; Mas, M. D.; Pérez, R.; Cayla, J. A.; Rius, C.; Torner, N.; Izquierdo, C.; Torra, R.; Force, L.; Soldevila, N.; Crespo, I.; Sanz, F.; Domínguez-Berjon, M. F.; Gutiérrez, M. A.; Jiménez, S.; Gil, E.; Martín, F.; Génova-Maleras, R.; Prados, M. C.; Enzzine De Blas, F.; Salvador, M. A.; Rodríguez, S.; Romero, M.; Galán, J. C.; Navas, E.; Rodríguez, L.; Álvarez, C. J.; Banderas, E.; Fernández, S.; López De Goicoechea, M. J.; Díaz-González, J.

In: CMAJ, Vol. 190, No. 1, 08.01.2018, p. E3-E12.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: A multicentre case-control study

AU - Casado, Itziar

AU - Domínguez, Ángela

AU - Toledo, Diana

AU - Chamorro, Judith

AU - Astray, Jenaro

AU - Egurrola, Mikel

AU - Fernández-Sierra, María Amelia

AU - Martín, Vicente

AU - Morales-Suárez-Varela, María

AU - Godoy, Pere

AU - Castilla, Jesús

AU - Mayoral, J. M.

AU - Díaz-Borrego, J.

AU - Morillo, A.

AU - Pérez-Lozano, M. J.

AU - Gutiérrez, J.

AU - Pérez-Ruiz, M.

AU - Tamames, S.

AU - Rojo-Rello, S.

AU - Ortiz De Lejarazu, R.

AU - Fernández-Natal, M. I.

AU - Fernández-Villa, T.

AU - Pueyo, A.

AU - Vilella, A.

AU - Campins, M.

AU - Antón, A.

AU - Navarro, G.

AU - Riera, M.

AU - Espejo, E.

AU - Mas, M. D.

AU - Pérez, R.

AU - Cayla, J. A.

AU - Rius, C.

AU - Torner, N.

AU - Izquierdo, C.

AU - Torra, R.

AU - Force, L.

AU - Soldevila, N.

AU - Crespo, I.

AU - Sanz, F.

AU - Domínguez-Berjon, M. F.

AU - Gutiérrez, M. A.

AU - Jiménez, S.

AU - Gil, E.

AU - Martín, F.

AU - Génova-Maleras, R.

AU - Prados, M. C.

AU - Enzzine De Blas, F.

AU - Salvador, M. A.

AU - Rodríguez, S.

AU - Romero, M.

AU - Galán, J. C.

AU - Navas, E.

AU - Rodríguez, L.

AU - Álvarez, C. J.

AU - Banderas, E.

AU - Fernández, S.

AU - López De Goicoechea, M. J.

AU - Díaz-González, J.

PY - 2018/1/8

Y1 - 2018/1/8

N2 - © 2018 Joule Inc. or its licensors. BACKGROUND: The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS: We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. RESULTS: We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). INTERPRETATION: Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults.

AB - © 2018 Joule Inc. or its licensors. BACKGROUND: The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS: We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. RESULTS: We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). INTERPRETATION: Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults.

U2 - 10.1503/cmaj.170910

DO - 10.1503/cmaj.170910

M3 - Article

C2 - 29311098

VL - 190

SP - E3-E12

JO - CMAJ

JF - CMAJ

SN - 0008-4409

IS - 1

ER -