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Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010-2013.

ABSTRACT: Background:Preventing severe complications of influenza such as hospitalization is a public health priority; however, estimates of influenza vaccine effectiveness (VE) against influenza-associated acute lower respiratory tract infection (LRTI) hospitalizations are limited. We examined influenza VE against influenza-associated LRTIs in hospitalized adult patients. Methods:We retrospectively analyzed data from a randomized trial of oseltamivir treatment in adults hospitalized with LRTI in Louisville, Kentucky, from 2010 to 2013. Patients were systematically tested for influenza at the time of enrollment. We estimated VE as 1 - the adjusted odds ratio (aOR) of antecedent vaccination in influenza-positives vs negatives?×?100%. Vaccination status was obtained by patient self-report. Using logistic regression adjusting for age, sex, season, timing of illness, history of chronic lung disease, and activities of daily living, we estimated VE against hospitalized influenza-associated LRTIs and community-acquired pneumonia (CAP) with radiographic findings of infiltrate. Results:Of 810 patients with LRTI (median age, 62 years), 184 (23%) were influenza-positive and 57% had radiographically confirmed CAP. Among influenza-positives and -negatives, respectively, 61% and 69% were vaccinated. Overall, 29% were hospitalized in the prior 90 days and?>80% had comorbidities. Influenza-negatives were more likely to have a history of chronic obstructive pulmonary disease than influenza-positives (59% vs 48%; P?=?.01), but baseline medical conditions were otherwise similar. Overall, VE was 35% (95% CI,?4% to 56%) against influenza-associated LRTI and 51% (95% CI,?13% to 72%) against influenza-associated radiographically confirmed CAP. Conclusions:Vaccination reduced the risk of hospitalization for influenza-associated LRTI and radiographically confirmed CAP. Clinicians should maintain high rates of influenza vaccination to prevent severe influenza-associated complications.

SUBMITTER: Chow EJ

PROVIDER: S-EPMC7372707 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010-2013.

Chow Eric J EJ Rolfes Melissa A MA Carrico Ruth L RL Furmanek Stephen S Ramirez Julio A JA Ferdinands Jill M JM Fry Alicia M AM Patel Manish M MM

Open forum infectious diseases 20200630 7

<h4>Background</h4>Preventing severe complications of influenza such as hospitalization is a public health priority; however, estimates of influenza vaccine effectiveness (VE) against influenza-associated acute lower respiratory tract infection (LRTI) hospitalizations are limited. We examined influenza VE against influenza-associated LRTIs in hospitalized adult patients.<h4>Methods</h4>We retrospectively analyzed data from a randomized trial of oseltamivir treatment in adults hospitalized with L ...[more]

PMID: 32715020

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Project description:INTRODUCTION:Lower respiratory tract infections (LRTIs) are a leading cause of mortality in sub-Saharan Africa. Triaging identifies patients at high risk of death, but laboratory tests proposed for use in severity-of-illness scores are not readily available, limiting their clinical use. Our objective was to determine whether baseline characteristics in hospitalized participants with LRTI predicted increased risk of death. METHODS:This was a secondary analysis from the Mulago Inpatient Non-invasive Diagnosis-International HIV-associated Opportunistic Pneumonias (MIND-IHOP) cohort of adults hospitalized with LRTI who underwent standardized investigations and treatment. The primary outcome was all-cause mortality at 2 months. Predictors of mortality were determined using multiple logistic regression. RESULTS:Of 1887 hospitalized participants with LRTI, 372 (19.7%) died. The median participant age was 34.3 years (interquartile range, 28.0-43.3 years), 978 (51.8%) were men, and 1192 (63.2%) were HIV-positive with median CD4 counts of 81 cells/µL (interquartile range, 21-226 cells/µL). Seven hundred eleven (37.7%) participants had a microbiologically confirmed diagnosis. Temperature <35.5°C [adjusted odds ratio (aOR) = 1.77, 95% confidence intervals (CI): 1.20 to 2.60; P = 0.004], heart rate >120/min (aOR = 1.82, 95% CI: 1.37 to 2.43; P < 0.0001), oxygen saturation <90% (aOR = 2.74, 95% CI: 1.97 to 3.81; P < 0.0001), being bed-bound (aOR = 1.88, 95% CI: 1.47 to 2.41; P < 0.0001), and being HIV-positive (aOR = 1.49, 95% CI: 1.14 to 1.94; P = 0.003) were independently associated with mortality at 2 months. CONCLUSIONS:Having temperature <35.5°C, heart rate >120/min, hypoxia, being HIV-positive, and bed-bound independently predicts mortality in participants hospitalized with LRTI. These readily available characteristics could be used to triage patients with LRTI in low-income settings. Providing adequate oxygen, adequate intravenous fluids, and early antiretroviral therapy (in people living with HIV/AIDS) may be life-saving in hospitalized patients with LRTI.

Dataset Information

Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010-2013.

Publications

Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010-2013.

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