Identifier: TDX:1167
Authors: Diego Cabanes, Cinta de
Abstract:
The infection of influenza virus has a high incidence in young people and children rather than the elderly, but the morbidity and mortality associated with influenza virus infection increases with age, especially in patients with concomitant pathology . In this thesis, we followed a cohort of 11,240 people over 65 in Tarragona, assigned to eight basic health areas (ABS) for 4 years (between January 2002 and April 2005), studying the relationship between receipt the vaccine (VAG) and the winter mortality in the whole population aged 65 years and in subgroups of people with chronic diseases, such as chronic obstructive pulmonary disease (COPD), people with chronic heart disease and diabetes mellitus (DM). Four articles were used for the realization of this thesis 1- Ángel Vila-Córcoles, Teresa Rodríguez, Cinta de Diego, Olga Ochoa, Amparo Valdivieso, Elisabet Salsench, Xabier Ansa, Waleska Badía, Neus Saún, EPIVAC Study Group. Effect of influenza vaccine status on winter mortality in Spanish community-dwelling elderly people during 2002–2005 influenza periods. Vaccine. 2007 Sep 17;25(37-38):6699-707. This study assessed the relationship between the reception of conventional inactivated influenza vaccine and winter mortality in a prospective cohort that included 11,240 Spanish community-dwelling elderly individuals followed from January 2002 to April 2005. Annual influenza vaccine status was a time-varying condition and primary outcome was all-cause death during study period. Multivariable Cox proportional- hazard models adjusted by age, sex and co-morbidity were used to evaluate vaccine effectiveness. Influenza vaccination was associated with a significant reduction of 23% in winter mortality risk during overall influenza periods. The attributable mortality risk in non-vaccinated people was 24 deaths per 100,000 persons-week within influenza periods, the prevented fraction for the population was 14%, and one death was prevented for every 239 annual vaccinations (ranging from 144 in Winter 2005 to 1748 in Winter 2002). 2- A. Vila-Córcoles, O. Ochoa, C. de Diego, A. Valdivieso, I. Herreros, F. Bobé, M. Alvarez, M. Juárez, I. Guinea, X. Ansa, N. Saún. Effects of annual influenza vaccination on winter mortality in elderly people with chronic pulmonary disease. Int J Clin Pract, January 2008, 62, 1, 10–17. Background: Although there is a general agreement for the recommendation of the influenza vaccine to persons with chronic obstructive pulmonary disease (COPD), the magnitude of clinical effectiveness and benefit from the annual vaccin- ation is controversial. We assessed the effects of annual influenza vaccination on winter mortality in older adults with COPD. Methods: This prospective cohort study included 1298 Spanish community-dwelling individuals aged 65 years or older with a diagnosis of COPD followed from 1 January 2002 to 30 April 2005. The primary outcome was all-cause death during influenza periods (January–April). Multivariable Cox proportional hazard models adjusted by age, sex and comorbidity were used to evaluate vaccine effectiveness. Results: Influenza vaccination was associated with a non-statistically significant 16% reduction in winter mortality among vaccinated COPD patients [unadjusted hazard ratio (HR): 0.84; 95% confid- ence interval (CI): 0.60–1.17]. Multivariable analysis showed that there was an insignificant trend towards a reduced mortality in the vaccinated group considering overall influenza periods 2002–2005 (adjusted HR: 0.76; 95% CI: 0.52–1.06; p 1⁄4 0.098). We estimated that, in the total COPD population, one death was pre- vented for every 187 annual vaccinations (95% CI: 62 to ¥). Conclusions: Our data suggest benefit from the influenza vaccination and support an annual vaccin- ation strategy for elderly COPD patients. 3-Cinta de Diego, Angel Vila-Córcoles, Olga Ochoa, Teresa Rodriguez-Blanco, Elisabeth Salsench, Imma Hospital, Ferran Bejarano, M. del Puy Muniain, Mercé Fortin, Montserrat Canals, and EPIVAC Study Group. Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. European Heart Journal (2009) 30, 209–216. Aims Although there is general agreement for the recommendation of the influenza vaccine to elderly and high-risk adults, the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial. In this study, we have assessed the effects of annual influenza vaccination on winter mortality in older adults with chronic heart disease. Methods and results Cohort study that included 1340 Spanish community-dwelling individuals 65 years or older who had chronic heart disease (congestive heart failure or coronary artery disease) followed from January 2002 to April 2005. Annual influenza vaccine status was a time-varying condition and primary outcome was all-cause death during the study period. Multivariable Cox proportional-hazard models adjusted by age, sex, and comorbidity were used to evaluate vaccine effectiveness. Influenza vaccination was associated with a significant reduction of 37% in the adjusted risk of winter mortality during the overall period 2002 – 2005. The attributable mortality risk reduction in vaccinated people was 8.2 deaths per 1000 person-winters. We estimated that one death was prevented for every 122 annual vaccinations (ranging between 49 in Winter 2005 and 455 in Winter 2003). Conclusion Our results suggest a benefit from the influenza vaccination and support an annual vaccination strategy for elderly people with cardiac diseases. Keywords Influenza vaccine † Effectiveness † Elderly † Heart disease † Mortality 4- C. de Diego, Á. Vila-Córcoles, O. Ochoa-Gondar, A. Valdivieso, V.Arija y T. Rodríguez-Blanco. Vacunación antigripal y mortalidad invernal en pacientes diabéticos mayores de 65 años. Semergen.2010;36(1):3–9. Introduction: To analyze the effectiveness of annual influenza vaccination on winter mortality in a cohort of diabetic patients over 65 years followed-up for 4 years. Methods: Cohort of 2650 non-institutionalized, individuals older than 65 years with Diabetes Mellitus, followed-up from January 2002 until April 2005, from 8 primary health care centers. The vaccination status was considered as a condition changing over time and the endpoint was death from all causes in the period from January to April of the 4-year study period. Results: Overall, during the January to April periods including the years 2002–2005, the winter mortality (per 100,000 person-week) was 97.0 for vaccinated and 110.5 for non- vaccinated subjects, with an attributable risk of 13.5 deaths per 100,000 person-weeks in winter (95% CI:11.4 to 38.4). The reception of the influenza vaccine was associated with a non-significant reduction of 12% in the risk of mortality from all causes during winter in the 2002–2005 overall period (relative risk 0.88; 95% CI: 0.67–1.19). Conclusion: Our data suggest a small benefit of influenza vaccination to reduce winter mortality in diabetic patients over 65 years, although the possibility of no effect cannot be excluded completely.
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