Identification of Two Novel Candidate Genetic Variants Associated With the Responsiveness to Influenza Vaccination

BackgroundAnnual vaccination is the most effective prevention of influenza infection. Up to now, a series of studies have demonstrated the role of genetic variants in regulating the antibody response to influenza vaccine. However, among the Chinese population, the relationship between genetic factors and the responsiveness to influenza vaccination has not been clarified through genome-wide association study (GWAS).MethodA total of 1,968 healthy volunteers of Chinese descent were recruited and 1,582 of them were available for the subsequent two-stage analysis. In the discovery stage, according to our inclusion criteria, 123 of 1,582 subjects were selected as group 1 and received whole-genome sequencing to identify potential variants and genes. In the verification stage, 29 candidate variants identified by GWAS were selected for further validation in 481 subjects in group 2. Besides, we also analyzed nine variants from previously published reports in our study.ResultsMultivariate logistic regression analysis showed that compared with the TT genotype of ZBTB46 rs2281929, the TC + CC genotype was associated with a lower risk of low responsiveness to influenza vaccination adjusted for gender and age (Group 2: P = 7.75E-05, OR = 0.466, 95%CI = 0.319–0.680; Combined group: P = 1.18E-06, OR = 0.423, 95%CI = 0.299–0.599). In the combined group, IQGAP2 rs2455230 GC + CC genotype was correlated with a lower risk of low responsiveness to influenza vaccination compared with the GG genotype (P = 8.90E-04, OR = 0.535, 95%CI = 0.370–0.774), but the difference was not statistically significant in group 2 (P = 0.008). The antibody fold rises of subjects with ZBTB46 rs2281929 TT genotype against H1N1, H3N2,and B were all significantly lower than that of subjects with TC + CC genotype (P < 0.001). Compared with IQGAP2 rs2455230 GC + CC carriers, GG carriers had lower antibody fold rises to H1N1 (P = 0.001) and B (P = 0.032). The GG genotype of rs2455230 tended to be correlated with lower antibody fold rises (P = 0.096) against H3N2, but the difference was not statistically significant. No correlation was found between nine SNPs from previously published reports and the serological response to influenza vaccine in our study.ConclusionOur study identified two novel candidate missense variants, ZBTB46 rs2281929 and IQGAP2 rs2455230, were associated with the immune response to influenza vaccination among the Chinese population. Identifying these variants will provide more evidence for future research and improve the individualized influenza vaccination program.

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Influenza Vaccination in Cancer Patients Undergoing Systemic Therapy

Clinical Medicine Insights Oncology ◽

10.4137/cmo.s13774 ◽

2014 ◽

Vol 8 ◽

pp. CMO.S13774 ◽

Cited By ~ 16

Author(s):

Mahmoud A. Shehata ◽

Nagla Abdel Karim

Keyword(s):

Adverse Effects ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Cancer Patients ◽

Clinical Outcomes ◽

Influenza Infection ◽

Immunological Response ◽

Morbidity And Mortality ◽

Serological Response ◽

Patients With Cancer

Background Cancer patients often experience preventable infections, including influenza A and B. These infections can be a cause of significant morbidity and mortality. The increased risk of infection may be because of either cancer itself or treatment-induced immunosuppression. 1 Influenza immunization has been shown to decrease the risk of influenza infection in patients with intact immunity. 2 In cancer patients, active immunization has been shown to confer protective immunity against several infections at similar rates to healthy individuals, which has translated into decreased duration and severity of infection and potentially improved morbidity and mortality. 3 Objectives 1. To assess the efficacy of influenza vaccination in stimulating immunological response in patients with cancer during chemotherapy compared to control groups. 2. To assess the efficacy of influenza vaccination in preventing confirmed influenza and influenza-like illness and/or stimulating immunological response in children with cancer treated with chemotherapy, compared to placebo, no intervention, or different dosage schedules. 3. To determine the adverse effects associated with influenza vaccination in patients with cancer. Search Methods We searched MEDLINE/PubMed database for articles published from 1964 to 2013 using the search terms “cancer,” “adult,” “influenza vaccination,” and “chemotherapy.” Selection Criteria We included studies based on systematic sampling with defined clinical criteria irrespective of the vaccination status of cancer patients. Studies measure the serological response or clinical response to compare between the study group and the control group. Studies assessed the inactivated influenza vaccines and live attenuated influenza vaccine (LAIV) protective serological reaction and the clinical outcomes after vaccination. Data Collection and Analysis Two independent authors assessed the methodological quality of included studies and extracted data. Main Results We included 16 studies (total number of participants = 1,076). None of the included studies reported clinical outcomes. All included studies reported on influenza immunity and adverse reaction on vaccination. We included 6 solid tumor studies and 10 hematological studies. In 12 studies, the serological response to influenza vaccine was compared in patients receiving chemotherapy (n = 425) versus those not receiving chemotherapy (n = 376). In three studies, the serological responses to influenza vaccination in patients receiving chemotherapy are compared to that in healthy adult. Measures used to assess the serological responses included a four-fold rise increase in antibody titer development of hemagglutination inhibition (HI) titer >40, and pre- and post-vaccination geometric mean titers (GMTs). Immune responses in patients receiving chemotherapy were consistently weaker (four-fold rise of 17–52%) than in those who had completed chemotherapy (50–83%) and healthy patients (67–100%). Concerning adverse effects, oncology patients received influenza vaccine, and the side effects described were mild local reactions and low-grade fever. No life-threatening or persistent adverse effects were reported. Authors’ Conclusion Patients with solid and some of hematological tumors are able to mount a serological response to influenza vaccine, but it remains unclear how much this response protects them from influenza infection or its complications. Meanwhile, influenza vaccine appears to be safe in these patients. While waiting results of randomized controlled trials to give us more details about the clinical benefits of the influenza vaccination, the clinicians should consider the currently proved benefits of influenza vaccination on management of the cancer patients undergoing systematic chemotherapy such as decrease in the duration and severity of the of the disease, and significant decrease in influenza-associated morbidity and mortality in these high-risk patients. 3

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Do Turkish Gynecologists and Obstetricians recommend pregnant women the influenza vaccine?

Infectious Diseases and Clinical Microbiology ◽

10.36519/idcm.2020.0005 ◽

2020 ◽

Vol 2 (1) ◽

pp. 16-23

Author(s):

Irem Akdemir Kalkan ◽

Ayşe Nur Usturalı Mut ◽

Gule Cinar ◽

Fatih Keskin ◽

Kemal Osman Memikoglu ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Pregnant Women ◽

Social Insurance ◽

Viral Infections ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccination Rates ◽

Immunization Rates

Objective: Influenza is a systemic infectious disease. It is recommended that all pregnant women receive the influenza vaccine because the mortality of the disease is high during pregnancy. However, the rates of influenza vaccination in pregnant women are low. This study aims to estimate the rate at which Turkish gynecologists and obstetricians (GOs) recommend the influenza vaccine to their pregnant patients.. Materials and Methods: This study was designed as a cross-sectional survey. The sample size was calculated to be 364 based on 95% confidence interval and 5% margin of error. The data were collected through a questionnaire consisting of 17 questions, which was distributed through social media. The final study group included in the research consisted of 384 GOs. Results:The mean age of the GOs that participated in the study was 39.7 years (SD = 10.2). 43.5% of the GOs reported that they recommended the influenza vaccine to pregnant women who had consulted with them, while 62.8% reported that at least 50% of the pregnant women they had recommended the vaccine rejected it. According to multivariate logistic regression analysis, three factors increased the rate of GOs’ not to recommend influenza vaccination: the GOs’ age, not receiving influenza vaccination themselves, and not knowing the social insurance reimbursement for the vaccine. Conclusion: Vaccination of pregnant women is necessary because of the increased mortality risk of influenza during pregnancy. Even though GOs are not in charge of vaccinating their patients during their routine pregnancy follow-up, they can contribute to vaccination rates by recommending the vaccine. Physicians’ application of scientific knowledge and transferring it to their patients can contribute to increased adult immunization rates. Conclusion: Influenza, Influenza Vaccine, Pregnancy, Vaccination, Viral Infections

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An Internet-Based Survey of Influenza Vaccination Coverage in Healthcare Workers in China, 2018/2019 Season

Vaccines ◽

10.3390/vaccines8010006 ◽

2019 ◽

Vol 8 (1) ◽

pp. 6 ◽

Cited By ~ 4

Author(s):

Haitao Liu ◽

Yayun Tan ◽

Muli Zhang ◽

Zhibin Peng ◽

Jiandong Zheng ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Healthcare Workers ◽

Online Survey ◽

Vaccine Coverage ◽

National Level ◽

Influence Factors ◽

Multivariate Logistic Regression Analysis ◽

Vaccine Uptake

Influenza vaccination coverage was low among healthcare workers (HCWs) in China. In October 2018, the National Health Commission of China began to require all hospitals to provide free influenza vaccination for HCWs to increase vaccine uptake, and no study on vaccine coverage among HCWs at the national level after the announcement of new policy. This evaluation aims to investigate self-reported influenza vaccination coverage among HCWs and factors that may affect vaccine receipt during the 2018/2019 influenza season. We delivered an opt-in internet panel survey among registered HCWs of DXY forum (the biggest online forum for HCWs in China). The survey was self-administered using a standard questionnaire to collect information on demographics, occupational characteristics, policy implementation, influenza vaccination and influence factors. We conducted multivariate logistic regression analysis to assess factors associated with receipt of influenza vaccine. The response rate of this online survey was 3.6%. The seasonal influenza vaccine coverage reported among HCWs surveyed during the 2018/2019 season was 11.6% (472/4078). Only 19.0% (774/4078) of HCWs surveyed reported free policy in their workplace. Combing free policy and workplace requirement proved to be effective to improve influenza vaccination coverage in HCWs (PR = 6.90, 95% CI: 6.03–7.65). The influenza vaccination coverage among surveyed HCWs in China was low during the 2018/2019 season. To increase future vaccination uptake, we recommend a multi-faceted strategy that include free policy, workplace requirement and promotion, on-site vaccination, and monitoring.

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Influenza Vaccination During Pregnancy And Influencing Factors In Korea: A Multicenter Questionnaires Study of Pregnant Women and Obstetrics and Gynecology Doctors.

10.21203/rs.3.rs-76094/v1 ◽

2020 ◽

Author(s):

Byung Soo Kang ◽

San Ha Lee ◽

Woo Jeng Kim ◽

Jeong Ha Wie ◽

In Yang Park ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Pregnant Women ◽

Influencing Factors ◽

Multivariate Logistic Regression Analysis ◽

Public Health Care ◽

Vaccination Program ◽

Obstetrics And Gynecology ◽

The Government ◽

Maternal Influenza

Abstract BackgroundOur objective was to investigate: (1) the proportion of influenza vaccination, attitudes, and barriers among pregnant women, (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination in pregnant women, and (3) the influencing factors in Korea, during the flu season of 2019-2020, following the introduction of free influenza vaccination program for pregnant women.MethodsTwo separate anonymized questionnaires were developed for pregnant or postpartum women and physicians, and distributed to public or private healthcare centers and clinics, in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend influenza vaccine for pregnant women were analyzed. Independent influencing factors of influenza vaccination and OBGYN doctors’ routine recommendation for pregnant women were analyzed using multivariate logistic regression analysis, respectively.Result The self-reported proportion of influenza vaccination during pregnancy among 522 women was 63.2%. Independent factors influencing maternal influenza vaccination were ‘(ever) received information about influenza vaccination during pregnancy’, ‘information obtained from OBGYN doctors’, and ‘2nd/3rd trimester or postpartum period’ (OR 8.988, 95% CI 4.21–19.188, p < 0.001, OR 2.611, 95% CI 1.705-3.998, p < 0.001 and OR 3.082, 95% CI 1.508–6.297, p < 0.001, respectively).In 372 OBGYN doctors, the proportion of doctors with the routine recommendation of influenza vaccine for pregnant women was 76.9%. Independent factors affecting the routine recommendation were: 1) affiliation with private hospital or clinic (OR 4.508, 95% CI 2.225–9.133, p<0.001); 2) awareness of guidelines (OR 3.153, 95% CI 1.118–8.894, p=0.03); (3) awareness of 2019 National free influenza vaccination program for pregnant women (OR 4.955, 95%CI 2.377–10.329, p<0.001). For a future recommendation of influenza vaccine for pregnant women, the guidelines proposed by the government or public health care [108 (46%)] and academic committees [59 (25%)] were most commonly chosen by OBGYN doctors.Conclusion This study demonstrated that providing information about maternal influenza vaccination and the recommendation by OBGYN doctors are crucial for increasing the vaccination coverage in pregnant women.

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FRI0525 INFLUENZA VACCINATION COMPLIANCE AND RESPONSE IN AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASE PATIENTS: A COHORT STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1754 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 862.1-862

Author(s):

P. Kumar ◽

R. Trebbien ◽

P. C. Leutscher ◽

L. Strandbygaard ◽

C. Rasmussen

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Rheumatic Diseases ◽

Geometric Mean ◽

Winter Season ◽

Fold Increase ◽

Inflammatory Rheumatic Diseases ◽

Serological Response ◽

Vaccination Recommendations ◽

Antibody Titers

Background:Patients diagnosed with autoimmune inflammatory rheumatic diseases (AIIRD) have higher risk of developing infections due to immunological dysfunction and immunosuppressive treatments. Current guidelines recommend annual influenza vaccination to reduce infection risk in this group of patients. However, vaccination response in these patients is uncertain.Objectives:To study influenza vaccination compliance and response in a Danish AIIRD patient population.Methods:AIIRD patients on biological treatment ± synthetic disease-modifying antirheumatic drugs (sDMARDs) in our department of rheumatology and registered in the Danish Rheumatology database (DANBIO) were included in the current study. The patients were encouraged to be vaccinated against influenza in the 2018/19 winter season. Status of influenza vaccination for the period of 1.9.2018 to 31.12.2018 was reviewed in each patient using the Danish Vaccination Register (DDV) and Danish Electronic Medicine Module (FMK). Patient data were collected by review of the medical files. Serum samples from each patient were collected on two occasions: 1) from 1.6.2017 to 15.5.2018 (before vaccination) and 2) from 1.11.2018 to 1.3.2019 (after vaccination), respectively. Antibody titers against the three antigens included in the trivalent 2018/2019 seasonal influenza vaccine were measured by hemagglutination inhibition assay followed by determination of geometric mean titers (GMT).Results:Among a total of 226 study eligible AIIRD patients, 111 (49%) had been influenza vaccinated. In the remaining group of 115 (51%) non-vaccinated patients, 50 were randomly contacted by telephone to ensure the accuracy of DDV registration. All 50 confirmed non-vaccinated status. Median age of vaccinated group was 65 years while of non-vaccinated group was 57 years (p≤0.00001). Median GMT increased from 10 to 22 in the group of vaccinated patients versus from 6 to 10 in the group of non-vaccinated patients (p<0.0001). GMT increased ≥2-fold in 79 (71%) of 111 influenza vaccinated in comparison to 60 (52%) of 115 non-vaccinated patients (p≤0.003). Among influenza vaccinated patients, median age of responders (≥2-fold increase in GMT) was 66 years versus non-responders 63 years (p=0.3). In the influenza vaccinated group, ≥2-fold increase in GMT was seen in 51 (73%) of 70 patients receiving methotrexate compared to 28 (68%) of 41 in patients not receiving methotrexate (p=0,6).Conclusion:Only half of the patients were compliant to the vaccination recommendations in the 2018/2019 influenza season despite the information campaign. Response rate of influenza vaccination (≥2-fold GMT increase) was 71% in AIIRD patients receiving immunosuppressive treatments. In contrast to other studies, concurrent methotrexate treatment did not attenuate serological response of influenza vaccination. We are still exploring the causes of increased influenza antibody titers in non-vaccinated group.References:[1] Kapetanovic MC, Kristensen LE, Saxne T, et al. Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritis. Arthritis Res Ther 2014;16:R2.[2] Hua C, Barnetche T, Combe B, et al. Effect of methotrexate, anti-tumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res 2014;66:1016–26.[3] Furer V, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020;79:39–52. doi:10.1136/annrheumdis-2019-215882Disclosure of Interests:None declared

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Influenza vaccination coverage in a population-based cohort of Australian-born Aboriginal and non-Indigenous older adults

Communicable Diseases Intelligence ◽

10.33321/cdi.2019.43.30 ◽

2019 ◽

Vol 43 ◽

Author(s):

Amalie Dyda ◽

Surendra Karki ◽

Marlene Kong ◽

Heather F Gidding ◽

John M Kaldor ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Torres Strait Islander ◽

Vaccine Coverage ◽

Vaccine Uptake ◽

P Value ◽

Healthy Weight ◽

Medical Risk ◽

Torres Strait

Background: There is limited information on vaccination coverage and characteristics associated with vaccine uptake in Aboriginal and/or Torres Strait Islander adults. We aimed to provide more current estimates of influenza vaccination coverage in Aboriginal adults. Methods: Self-reported vaccination status (n=559 Aboriginal and/or Torres Strait Islander participants, n=80,655 non-Indigenous participants) from the 45 and Up Study, a large cohort of adults aged 45 years or older, was used to compare influenza vaccination coverage in Aboriginal and/or Torres Strait Islander adults with coverage in non-Indigenous adults. Results: Of Aboriginal and non-Indigenous respondents aged 49 to <65 years, age-standardised influenza coverage was respectively 45.2% (95% CI 39.5–50.9%) and 38.5%, (37.9–39.0%), p-value for heterogeneity=0.02. Coverage for Aboriginal and non-Indigenous respondents aged ≥65 years was respectively 67.3% (59.9–74.7%) and 72.6% (72.2–73.0%), p-heterogeneity=0.16. Among Aboriginal adults, coverage was higher in obese than in healthy weight participants (adjusted odds ratio (aOR)=2.38, 95%CI 1.44–3.94); in those aged <65 years with a medical risk factor than in those without medical risk factors (aOR=2.13, 1.37–3.30); and in those who rated their health as fair/poor compared to those who rated it excellent (aOR=2.57, 1.26–5.20). Similar associations were found among non-Indigenous adults. Conclusions: In this sample of adults ≥65 years, self-reported influenza vaccine coverage was not significantly different between Aboriginal and non-Indigenous adults whereas in those <65 years, coverage was higher among Aboriginal adults. Overall, coverage in the whole cohort was suboptimal. If these findings are replicated in other samples and in the Australian Immunisation Register, it suggests that measures to improve uptake, such as communication about the importance of influenza vaccine and more effective reminder systems, are needed among adults.

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22. Description of Hospitalized Patients with Influenza Vaccine Failure

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.067 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S35-S35

Author(s):

Joanna Kimball ◽

Yuwei Zhu ◽

Dayna Wyatt ◽

Helen Talbot

Keyword(s):

Logistic Regression ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Older Patients ◽

Influenza A ◽

Influenza Season ◽

Hospitalized Patients ◽

Vaccine Failure ◽

Increased Risk ◽

Immunosuppressed Patients

Abstract Background Despite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza. Methods This study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression. Results 1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39). Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. Conclusion Our study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued. Disclosures All Authors: No reported disclosures

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Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01836-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abhijit Sen ◽

Inger Johanne Bakken ◽

Ragna Elise Støre Govatsmark ◽

Torunn Varmdal ◽

Kaare Harald Bønaa ◽

...

Keyword(s):

Pulmonary Embolism ◽

Influenza Vaccination ◽

Lower Risk ◽

Cardiovascular Events ◽

Case Series ◽

Baseline Risk ◽

Inverse Association ◽

Relative Risks ◽

Case Series Study ◽

Cardiovascular Medications

Abstract Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination.

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Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza during the 2017–2018 Season. A Retrospective Cohort Study in Catalonia (Spain)

Viruses ◽

10.3390/v13081465 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1465

Author(s):

Lesly Acosta ◽

Nuria Soldevila ◽

Nuria Torner ◽

Ana Martínez ◽

Xavier Ayneto ◽

...

Keyword(s):

Cohort Study ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Vaccine Effectiveness ◽

Public Hospitals ◽

Categorical Variables ◽

Type B ◽

Icu Admission

Seasonal influenza is a common cause of hospital admission, especially in older people and those with comorbidities. The objective of this study was to determine influenza vaccine effectiveness (VE) in preventing intensive care admissions and shortening the length of stay (LOS) in hospitalized laboratory-confirmed influenza cases (HLCI) in Catalonia (Spain). A retrospective cohort study was carried out during the 2017–2018 season in HLCI aged ≥18 years from 14 public hospitals. Differences in means and proportions were assessed using a t-test or a chi-square test as necessary and the differences were quantified using standardized effect measures: Cohen’s d for quantitative and Cohen’s w for categorical variables. Adjusted influenza vaccine effectiveness in preventing severity was estimated by multivariate logistic regression where the adjusted VE = (1 − adjusted odds ratio) · 100%; adjustment was also made using the propensity score. We analyzed 1414 HLCI aged ≥18 years; 465 (33%) were vaccinated, of whom 437 (94%) were aged ≥60 years, 269 (57.8%) were male and 295 (63.4%) were positive for influenza type B. ICU admission was required in 214 (15.1%) cases. There were 141/1118 (12.6%) ICU admissions in patients aged ≥60 years and 73/296 (24.7%) in those aged <60 years (p < 0.001). The mean LOS and ICU LOS did not differ significantly between vaccinated and unvaccinated patients. There were 52/465 (11.2%) ICU admissions in vaccinated cases vs. 162/949 (17.1%) in unvaccinated cases. Patients admitted to the ICU had a longer hospital LOS (mean: 22.4 [SD 20.3] days) than those who were not (mean: 11.1 [SD 14.4] days); p < 0.001. Overall, vaccination was associated with a lower risk of ICU admission. Taking virus types A and B together, the estimated adjusted VE in preventing ICU admission was 31% (95% CI 1–52; p = 0.04). When stratified by viral type, the aVE was 40% for type A (95% CI -11–68; p = 0.09) and 25% for type B (95% CI -18–52; p = 0.21). Annual influenza vaccination may prevent ICU admission in cases of HLCI. A non-significantly shorter mean hospital stay was observed in vaccinated cases. Our results support the need to increase vaccination uptake and public perception of the benefits of influenza vaccination in groups at a higher risk of hospitalization and severe outcomes.

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Administration of Single-Dose Antibiotic Does Not Decrease Oronasal Fistula Rates After Primary Palatoplasty

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621992653 ◽

2021 ◽

pp. 105566562199265

Author(s):

Ishwarya Shradha Mamidi ◽

Esperanza Mantilla-Rivas ◽

Brynne A. Ichiuji ◽

Md Sohel Rana ◽

Karen I. Ramirez ◽

...

Keyword(s):

Single Dose ◽

Fistula Formation ◽

Readmission Rates ◽

Oronasal Fistula ◽

Inadequate Sample Size ◽

Perioperative Antibiotics ◽

The Difference ◽

Group 2 ◽

National Databases ◽

Group 1

Objective: Oronasal fistula (ONF) is a known complication after primary palatoplasty (PP). Studies investigating the effect of perioperative antibiotics on fistula rates after PP are limited by inadequate sample size or reliance on self-reporting through national databases. In this study, the authors evaluated the association between single-dose perioperative antibiotics and postoperative fistula rates after PP at a single institution. Design: A retrospective study. Participants: Children younger than 2 years who underwent PP from April 2009 to September 2019 were included. Interventions: Patients were divided into 2 categories: Group 1 received a single intraoperative dose of IV antibiotic, while group 2 did not. Main Outcome Measure(s): Outcome measures included ONF formation, length of stay (LOS), and 30-day readmission rates. Multivariable firth logistic regression, quantile regression, and χ2 tests were performed. Results: Of the 424 patients, 215 and 209 patients were in groups 1 and 2, respectively. The overall ONF rate was 1.9% among all patients. Patients in group 1 experienced an ONF rate of 3.3%, while patients in group 2 had an ONF rate of 0.5%. After correcting for confounding variables, the difference in ONF rates was not statistically different ( P = .68). Median LOS was 35.7 hours and 35.5 hours ( P = .17), while the rate of readmission within 30 days was 4.7% and 2.4% for group 1 and 2, respectively ( P = .96). Conclusions: Administration of a single-dose perioperative antibiotic did not decrease fistula formation after PP, nor did it affect the patient’s LOS or 30-day readmission rate.

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