The Result of Seasonal influenza vaccine against all-cause mortality following laboratory-confirmed influenza in patient with chronic obstructive pulmonary disease in Thailand 2011-2016: A Test negative design analysis
Keywords:
seasonal influenza, vaccine effectiveness, mortality, COPD, TNDAbstract
Thailand Ministry of Public Health (MOPH) prioritizes and recommends influenza vaccination for patients with chronic obstructive pulmonary disease (COPD). But little is known about the influenza vaccine effectiveness (VE) against mortality among this population in Thailand. This study aimed to estimate influenza VE against mortality following laboratory-confirmed influenza in COPD patient in Thailand during the 2011-2016 influenza seasons. Using Thailand National Health Security Office’s services database (43 folders), by a test-negative design study we estimated VE against all-cause mortality following laboratory-confirmed influenza in Thai adults aged ≥18 years patient with chronic obstructive pulmonary disease during the 2011–2012 to 2015–2016 influenza seasons. Using multivariable logistic regression to determine the ratio between the odds of vaccination in cases to the odds of vaccination in control, and calculated VE as (1–adjusted odds ratio) x100. Adjusted VE for age, sex, co-morbidity, number of hospital visits in previous years, number of exacerbations in previous years, influenza activity, influenza season smoking, and COPD severity. Of those 49,584 COPD patients, 16,489 (33%) patients tested for influenza across the 5 seasons and died within 30 days of specimen collection. 17% (2,768 individuals) tested positive for influenza, and 5,738 (35%) were considered vaccinated for that season. Before and after multivariable adjustment, in 5 season we estimated VE against all-cause mortality following laboratory-confirmed influenza to be 31% (95% confidence interval [CI], 24-37%) and 32% (95%CI, 26-38%), respectively. By strain, adjusted VE of influenza A/H3N2 was 38% [95%CI, 30-45%] and Influenza B was 30% [95%CI, 19-40%], but not found significant VE of A/H1N1 [VE=8; 95%CI, -17-27%]. We observed significant VE against deaths following influenza confirmation during 2012-2016 (adjusted VE= 40%, 29%, 35%, 30% respectively). Overall, influenza vaccination was associated with a modest protection among people with COPD against mortality following laboratory-confirmed influenza. These results support the importance of influenza vaccination in COPD patients.
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