Influenza vaccine in chronic obstructive pulmonary disease among elderly male veterans

Background Prior studies have established those elderly patients with chronic obstructive pulmonary disease (COPD) are at elevated risk for developing influenza-associated complications such as hospitalization, intensive-care admission, and death. This study sought to determine whether influenza vaccination could improve survival among elderly patients with COPD. Materials/Methods This study included Veterans (age ≥ 65 years) diagnosed with COPD that received care at the United States Veterans Health Administration (VHA) during four influenza seasons, from 2012–2013 to 2015–2016. We linked VHA electronic medical records and Medicare administrative files to Centers for Disease Control and Prevention National Death Index cause of death records as well as influenza surveillance data. A multivariable time-dependent Cox proportional hazards model was used to compare rates of mortality of recipients of influenza vaccination to those who did not have records of influenza vaccination. We estimated hazard ratios (HRs) adjusted for age, gender, race, socioeconomic status, comorbidities, and healthcare utilization. Results Over a span of four influenza seasons, we included 1,856,970 person-seasons of observation where 1,199,275 (65%) had a record of influenza vaccination and 657,695 (35%) did not have a record of influenza vaccination. After adjusting for comorbidities, demographic and socioeconomic characteristics, influenza vaccination was associated with reduced risk of death during the most severe periods of influenza seasons: 75% all-cause (HR = 0.25; 95% CI: 0.24–0.26), 76% respiratory causes (HR = 0.24; 95% CI: 0.21–0.26), and 82% pneumonia/influenza cause (HR = 0.18; 95% CI: 0.13–0.26). A significant part of the effect could be attributed to “healthy vaccinee” bias as reduced risk of mortality was also found during the periods when there was no influenza activity and before patients received vaccination: 30% all-cause (HR = 0.70; 95% CI: 0.65–0.75), 32% respiratory causes (HR = 0.68; 95% CI: 0.60–0.78), and 51% pneumonia/influenza cause (HR = 0.49; 95% CI: 0.31–0.78). However, as a falsification study, we found that influenza vaccination had no impact on hospitalization due to urinary tract infection (HR = 0.97; 95% CI: 0.80–1.18). Conclusions Among elderly patients with COPD, influenza vaccination was associated with reduced risk for all-cause and cause-specific mortality.

Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination During Pregnancy, Pregnancy Risk Assessment Monitoring System, 2019

Background Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines is recommended for pregnant women to protect themselves and their infants from adverse health outcomes. Objectives To estimate the prevalence of maternal influenza and Tdap vaccination and determine factors associated with receipt of these vaccines. Methods We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System, from 43 jurisdictions. We estimated the overall prevalence of women reporting receipt of a healthcare provider offer or recommendation for influenza vaccine (n=44,528), and influenza vaccine during the 12 months before delivery (n=44,213). We also estimated Tdap vaccine receipt during pregnancy from the 21 jurisdictions (n=22,972). Maternal influenza and Tdap vaccination were examined by selected maternal characteristics and by jurisdiction. Results Overall, 86.4% of women reported being offered or recommended an influenza vaccination, and 60.8% of women reported receiving an influenza vaccination in the 12 months prior to their delivery, ranging from 36.0% in Puerto Rico to 82.1% in Rhode Island. Tdap receipt during pregnancy was 73.7%, ranging from 52.2% in Mississippi to 85.1% in Vermont. Prevalence of influenza vaccination was lower among women aged 18–24 years (52.2%), who are non-Hispanic black (44.5%), with a high school diploma or less education (51.3%), with no prenatal insurance (43.2%), having no (42.0%) prenatal care, with ≥3 previous live births (49.3%) and not offered or recommended the influenza vaccine by a healthcare provider (20.0%). Tdap vaccination also varied by all characteristics examined and was lower among similar groups of women observed to have lower influenza vaccination uptake. Conclusion In 2019, influenza and Tdap vaccination were suboptimal among women with a recent live birth. It is important that U.S. jurisdictions provide equitable access to these vaccines during pregnancy. These results may also inform efforts for vaccination for other infectious diseases among pregnant women.