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Paquet S, Ringa V, Panjo H, Sassenou J, Zins M, Rigal L. Factors determining first influenza vaccination among individuals with type 2 diabetes in the CONSTANCES cohort by age group (younger than 65 years or 65 and older). Hum Vaccin Immunother 2025; 21:2437911. [PMID: 39757514 DOI: 10.1080/21645515.2024.2437911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 11/17/2024] [Accepted: 12/01/2024] [Indexed: 01/07/2025] Open
Abstract
Vaccine coverage against influenza is suboptimal among people with diabetes. Our principal objective was to study and compare the factors related to a first influenza vaccination in individuals with type 2 diabetes according to age group (<65 years and ≥ 65 years) and then to compare the older age group with diabetes to the general population of that age. This is a descriptive cross-sectional study within the French Constances cohort. The study populations were composed of people with type 2 diabetes and individuals without diabetes 65 years and older. Our variable of interest was the first reimbursement for a vaccine against influenza over the period from 2009 to 2019. We identified 2540 cohort members with type 2 diabetes (<65 years n = 1583; ≥65 years n = 957). The population without diabetes (≥65 years) comprised 18,364 individuals. The factors related to the first influenza vaccination differed significantly between the persons with diabetes younger than 65 years and those aged at least 65 years: age (OR = 1.01/OR = 0.89-P-interaction<0.001), poor perceived health (OR = 1.24/OR = 0.79-P-interaction = 0.048), and indicators of diabetes treatment quality [at least 2 hbA1c assays/year (OR = 1.91/0 R = 0.90-P-interaction<0.001), and blood pressure < 140/90 (OR = 1.24/OR = 0.90-P-interaction = 0.059)]. The only factor related to first influenza vaccination significantly different between individuals aged at least 65 years with and without diabetes was age (OR = 0.83/OR = 1.05-P-interaction<0.001). This study shows that trials are now needed to test the effectiveness of age- and sex-specific messages to increase influenza vaccination coverage among people with diabetes.
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Affiliation(s)
- Sylvain Paquet
- Department of General Practice, University of Paris-Saclay, Paris, France
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention institution, Villejuif, France
| | - Virginie Ringa
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention institution, Villejuif, France
| | - Henri Panjo
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention institution, Villejuif, France
| | - Jeanne Sassenou
- Department of General Practice, University of Paris-Saclay, Paris, France
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention institution, Villejuif, France
| | - Marie Zins
- INSERM, Population-based Epidemiologic Cohorts Units, Villejuif, France
| | - Laurent Rigal
- Department of General Practice, University of Paris-Saclay, Paris, France
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention institution, Villejuif, France
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Chen Z, Yang T. Effectiveness of inactivated influenza vaccine against laboratory-confirmed influenza in elderly Chinese patients with diabetes: A test-negative design case-control study. Hum Vaccin Immunother 2025; 21:2458814. [PMID: 39885661 PMCID: PMC11792806 DOI: 10.1080/21645515.2025.2458814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 01/02/2025] [Accepted: 01/22/2025] [Indexed: 02/01/2025] Open
Abstract
Vaccination coverage for influenza among diabetic populations remains suboptimal. Various factors contribute to this low vaccination rate, with a prominent issue being skepticism among potential vaccine recipients regarding vaccine effectiveness. We conducted a retrospective test-negative case-control study among diabetic patients aged 60 years and older in Ningbo, Zhejiang Province, China, spanning for four influenza seasons from 2018-19 to 2021-22. A total of 2,204 elderly patients were tested for influenza virus nucleic acid or antigen during the study period. After applying exclusion criteria, 199 influenza-positive cases and 199 matched influenza-negative controls were included in the final analysis. Vaccine effectiveness (VE) was estimated using an unconditional multiple logistic regression model, adjusted for age, gender, household registration and underlying health status. VE was calculated as (1-odds ratio(OR)) × 100%. Overall, the adjusted VE against laboratory-confirmed influenza from inactivated influenza vaccines over the study period was 59.4% (95%CI, 36.3% to 74.4%). VE varied across seasons, with the highest observed in the 2020-21 season and the lowest in the 2019-20 season. Importantly, repeated vaccination did not diminish vaccine effectiveness (OR = 1.2; 95% CI: 0.6 to 2.5). These findings provide a robust basis for recommending annual influenza vaccination among all elderly individuals with diabetes, absent any known contraindications.
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Affiliation(s)
- Zhengyan Chen
- Medical Record Statistics Office, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Tianchi Yang
- Immunization Program Department, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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Gallo M, Lasagna A, Renzelli V, Morviducci L, Cortellini A, Monami M, Marino G, Gori S, Verzé M, Ragni A, Tuveri E, Sciacca L, D'Oronzo S, Giuffrida D, Natalicchio A, Giorgino F, Marrano N, Zatelli MC, Montagnani M, Felicetti F, Mazzilli R, Fogli S, Franchina T, Argentiero A, Candido R, Perrone F, Aimaretti G, Avogaro A, Silvestris N, Faggiano A. Vaccination of people with solid tumors and diabetes: existing evidence and recommendations. A position statement from a multidisciplinary panel of scientific societies. J Endocrinol Invest 2025:10.1007/s40618-025-02586-5. [PMID: 40266540 DOI: 10.1007/s40618-025-02586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 04/06/2025] [Indexed: 04/24/2025]
Abstract
Diabetes and cancer are two of the most common public health concerns worldwide. The complex interplay of these two conditions is a growing area of research, as patients with diabetes are at increased risk for developing cancer, and vice versa. Furthermore, both patient populations show increased risk of many communicable infectious diseases and their adverse consequences, while vaccination can play a crucial role in their prevention, improving patient outcomes. Vaccination should represent a standard part of care for patients with cancer, diabetes, and both the diseases simultaneously, including people undergoing cancer treatment or in remission. Several international guidelines provide recommendations for vaccinating people with cancer or diabetes, but the two conditions have not been specifically evaluated together. Here we present a multidisciplinary consensus position paper on vaccination in patients with cancer and diabetes. The position paper is the result of a collaborative effort between experts from the Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), and Italian Society of Pharmacology (SIF). The paper provides a comprehensive overview of the current state-of-the-art knowledge on vaccination in patients with cancer and diabetes. It discusses the importance of vaccination in preventing infections, focuses attention on the need to consider the unique challenges faced by patients with cancer and diabetes when it comes to vaccine administration, and highlights the need for coordinated care to optimize treatment outcomes. Overall, the consensus position paper provides healthcare professionals caring for patients with cancer and diabetes recommendations on the use of various vaccines, including influenza, COVID-19, HZV, and HPV vaccines, as well as guidance on how to address common concerns and challenges related to vaccine administration.
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Affiliation(s)
- Marco Gallo
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, 15121, Italy.
| | - Angioletta Lasagna
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Valerio Renzelli
- Diabetologist and Endocrinologist, Italian Association of Clinical Diabetologists, Rome, Italy
| | - Lelio Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialties, ASL Roma 1- S. Spirito Hospital, Rome, Italy
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Matteo Monami
- Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | - Giampiero Marino
- Internal Medicine Department, Ospedale dei Castelli, Asl Roma 6, Ariccia, RM, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Matteo Verzé
- Medical Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alberto Ragni
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, 15121, Italy
| | - Enzo Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Unit, ASL-Sulcis, Carbonia, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Catania, Catania, Italy
| | - Stella D'Oronzo
- Oncology and Oncohematology Division, Acquaviva delle Fonti; and Medicine and Surgery Department, "F. Miulli" General Regional Hospital, LUM University, Casamassima, Bari, Italy
| | - Dario Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - Annalisa Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Nicola Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Monica Montagnani
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pharmacology, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Felicetti
- Division of Oncological Endocrinology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", Torino, 10126, Italy
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Stefano Fogli
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tindara Franchina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Antonella Argentiero
- Medical Oncology Department, IRCCS Istituto "Tumori Giovanni Paolo II", Bari, Italy
| | - Riccardo Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, 34149, Italy
| | | | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | | | - Nicola Silvestris
- Medical Oncology Department, IRCCS Istituto "Tumori Giovanni Paolo II", Bari, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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D’Addio F, Lazzaroni E, Lunati ME, Preziosi G, Ercolanoni M, Turola G, Marrocu C, Cicconi G, Sharma S, Scarioni S, Montefusco L, Pastore I, Morpurgo PS, Rossi A, Gandolfi A, Tinari C, Rossi G, Ben Nasr M, Loretelli C, Fiorina RM, Grassa B, Terranova R, Bucciarelli L, Berra C, Cereda D, Zuccotti G, Borriello CR, Fiorina P. Vaccinome Landscape in Nearly 620 000 Patients With Diabetes. J Clin Endocrinol Metab 2025; 110:e1590-e1597. [PMID: 39040010 PMCID: PMC12012803 DOI: 10.1210/clinem/dgae476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
CONTEXT Type 1 (T1D) and type 2 diabetes (T2D) are associated with an elevated incidence of infectious diseases and a higher risk of infections-related hospitalization and death. OBJECTIVE In this study, we delineated the "vaccinome" landscape obtained with a large immunization schedule offered by the Regional Government of Lombardy in a cohort of 618 396 patients with diabetes (T1D and T2D). METHODS Between September 2021 and September 2022, immunization coverage for influenza, meningococcus, pneumococcus, and herpes zoster was obtained from the public computerized registry of the health care system of Lombardy Region (Italy) in 618 396 patients with diabetes and in 9 534 087 subjects without diabetes. Type of diabetes, age, mortality, and hospitalizations were retrospectively analyzed in vaccinated and unvaccinated patients. RESULTS Among patients with diabetes (T1D and T2D), 44.6% received the influenza vaccine, 10.9% the pneumococcal vaccine, 2.5% the antimeningococcus vaccine, and 0.7% the antizoster vaccine. Patients with diabetes immunized for influenza, zoster, and meningococcus showed a 2-fold overall reduction in mortality risk and a decrease in hospitalizations. A 3-fold lower risk of mortality and a decrease in hospitalizations for both cardiac and pulmonary causes were also observed after influenza, zoster, and meningococcus immunization in older patients with diabetes. CONCLUSION Immunization coverage is still far from the recommended targets in patients with diabetes. Despite this, influenza vaccination protected nearly 3800 per 100 000 patients with diabetes from risk of death. The overall impressive decrease in mortality and hospitalizations observed in vaccinated patients strengthens the need for scaling up the "vaccinome" landscape in patients with diabetes.
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Affiliation(s)
- Francesca D’Addio
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Elisa Lazzaroni
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Maria Elena Lunati
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Giuseppe Preziosi
- ARIA S.p.A. (The Innovation and Procurement Regional Company of Regione Lombardia), 20124 Milano, Lombardia, Italy
| | - Michele Ercolanoni
- ARIA S.p.A. (The Innovation and Procurement Regional Company of Regione Lombardia), 20124 Milano, Lombardia, Italy
| | - Giulio Turola
- ARIA S.p.A. (The Innovation and Procurement Regional Company of Regione Lombardia), 20124 Milano, Lombardia, Italy
| | - Chiara Marrocu
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Giovanni Cicconi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Sudwaric Sharma
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Simona Scarioni
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Ida Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | | | - Antonio Rossi
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, Internal Medicine, 20157 Milan, Italy
| | | | - Camilla Tinari
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Giada Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Moufida Ben Nasr
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Cristian Loretelli
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Roberta Maria Fiorina
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | | | - Rosa Terranova
- Division of Diabetology, Niguarda Hospital, 20162 Milan, Italy
| | - Loredana Bucciarelli
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
- IRCCS MultiMedica Sesto San Giovanni, 20099 Milano, Italy
| | - Cesare Berra
- IRCCS MultiMedica Sesto San Giovanni, 20099 Milano, Italy
| | - Danilo Cereda
- Directorate General for Health, 20124 Milano, Lombardia, Italy
| | - Gianvincenzo Zuccotti
- Buzzi Children's Hospital, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
| | | | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Falsey A. Neurologic Complications of Influenza and Potential Protective Vaccine Effects. Influenza Other Respir Viruses 2025; 19:e70071. [PMID: 40045906 PMCID: PMC11883286 DOI: 10.1111/irv.70071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/13/2024] [Accepted: 12/18/2024] [Indexed: 03/09/2025] Open
Abstract
Influenza is a common respiratory infection affecting persons of all ages and results in significant morbidity and mortality. Respiratory complications are well known, but important nonpulmonary complications are less well recognized. Neurologic complications following influenza infection may accompany the acute illness or may be chronic in nature. The acute complications such as seizures, encephalitis, myelitis and Guillain Barre Syndrome are well documented but fortunately are uncommon. However, stroke and dementia are leading causes of death and disability worldwide, and there is increasing evidence linking these devasting illnesses with influenza. In addition, influenza vaccine has been associated with protective effects against stroke and dementia risk.
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Affiliation(s)
- Ann R. Falsey
- School of Medicine and DentistryUniversity of RochesterRochesterNew YorkUSA
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Tsang CCS, Wang J. Enhancing pharmacist intervention targeting based on patient clustering with unsupervised machine learning. Expert Rev Pharmacoecon Outcomes Res 2025; 25:187-195. [PMID: 39311657 PMCID: PMC11786995 DOI: 10.1080/14737167.2024.2406810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/05/2024] [Indexed: 02/02/2025]
Abstract
OBJECTIVES Adherence to the American Diabetes Association (ADA) Standards of Medical Care is low. This study aimed to assist pharmacists in identifying patients for diabetes control interventions using unsupervised machine learning. METHODS This study analyzed the 2021 Medical Expenditure Panel Survey and used a k-mode cluster analysis. Patient features analyzed were adherence to a select set of preventive measures from the ADA Standards of Medical Care (HbA1c test, foot examination, blood cholesterol test, dilated eye examination, and influenza vaccination) and some patient characteristics (age, gender, health insurance, insulin use, and diabetes-related complications). RESULTS The study included 1,219 patients with self-reported diabetes, and the adherence rate to the ADA standards was 33.72%. Five distinct clusters emerged: (A) moderate-complexity, privately insured male; (B) moderate-complexity, publicly insured female; (C) low-complexity, privately insured female; (D) high-complexity, publicly insured female; (E) moderate-complexity, publicly insured male. Groups B, C, and E exhibited nonadherence. CONCLUSIONS Pharmacists can target publicly insured elderly (Groups B and E) and privately insured middle-aged females (Group C) for interventions. For instance, pharmacists may help patients in Groups B and E locate existing resources in their insurance program and remind those in Group C of the importance of adequate diabetes care.
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Affiliation(s)
- Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
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Clark TW, Tregoning JS, Lister H, Poletti T, Amin F, Nguyen-Van-Tam JS. Recent advances in the influenza virus vaccine landscape: a comprehensive overview of technologies and trials. Clin Microbiol Rev 2024; 37:e0002524. [PMID: 39360831 PMCID: PMC11629632 DOI: 10.1128/cmr.00025-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
SUMMARYIn the United Kingdom (UK) in 2022/23, influenza virus infections returned to the levels recorded before the COVID-19 pandemic, exerting a substantial burden on an already stretched National Health Service (NHS) through increased primary and emergency care visits and subsequent hospitalizations. Population groups ≤4 years and ≥65 years of age, and those with underlying health conditions, are at the greatest risk of influenza-related hospitalization. Recent advances in influenza virus vaccine technologies may help to mitigate this burden. This review aims to summarize advances in the influenza virus vaccine landscape by describing the different technologies that are currently in use in the UK and more widely. The review also describes vaccine technologies that are under development, including mRNA, and universal influenza virus vaccines which aim to provide broader or increased protection. This is an exciting and important era for influenza virus vaccinations, and advances are critical to protect against a disease that still exerts a substantial burden across all populations and disproportionately impacts the most vulnerable, despite it being over 80 years since the first influenza virus vaccines were deployed.
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Affiliation(s)
- Tristan W. Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - John S. Tregoning
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Colombo L, Hadigal S. Flu Vaccination Among Patients with Noncommunicable Diseases: A Survey About Awareness, Usage, Gaps and Barriers in Europe. Patient Prefer Adherence 2024; 18:2311-2324. [PMID: 39568654 PMCID: PMC11577933 DOI: 10.2147/ppa.s484302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 10/22/2024] [Indexed: 11/22/2024] Open
Abstract
Purpose People with noncommunicable diseases (NCDs) have a high risk of contracting flu and suffering from its associated complications; however, in many countries flu vaccine uptake in this group is sub-optimal. This survey assessed the knowledge, attitudes, and gaps toward vaccination in general and flu in particular among adults with NCDs in Europe. Patients and Methods The survey was conducted in France, Italy, Spain, Germany, Poland, Belgium, Portugal, and the Czech Republic. A structured web-based questionnaire was administered to the subjects. Results In total, 1106 subjects were enrolled, with 61% aged between 41 and 60 years. The main reasons for getting vaccinated were disease prevention and healthcare practitioner recommendations. Protection against infection and the risks of not receiving a vaccination was the most common vaccine information received, followed by information about possible side effects, duration of protection, and need for a booster dose. In the unvaccinated group, there was a lack of belief in the need for a flu vaccine, with a lack of recommendation from treating practitioners, and the experience of mild severity of flu being the main barriers against the vaccine. The physician remained the most preferred and tapped resource for information followed by dedicated websites. Understanding of flu vaccine benefits was particularly widespread among vaccinated patients, yet >50% wanted to know more about them. There was less clarity of the benefits of flu vaccine among unvaccinated patients; however, approximately 50% of them wanted to know more about it. Between January 2021 and December 2022, about 30% and 36% of the vaccinated and unvaccinated individuals, respectively, reported having suffered from flu. Conclusion Healthcare practitioners are the key influencers for people to get vaccinated. The dissemination of information about the importance of flu vaccines needs to be increased, and clear and explanatory messaging based on country-specific characteristics is important.
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Liu G, Pang Y, Lv M, Lu M, Huang Y, Ge F, Ma S, Qiu Y. Effectiveness of influenza vaccination on hospitalization outcomes among older patients with diabetes. Vaccine 2024; 42:126142. [PMID: 39019658 DOI: 10.1016/j.vaccine.2024.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/12/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE In older populations admitted for diabetes, limited evidence suggests that influenza vaccination protects against hospitalization outcomes. METHODS This study pooled 27,620 hospitalizations recorded for elderly diabetes patients from the Beijing Elderly Influenza Vaccination Information Registration Database (2013-2018) and the Beijing Urban Employee Basic Medical Insurance Database (2013-2018). Generalized linear regression and propensity score matching were conducted to estimate the effects of influenza vaccination on hospitalization outcomes (in-hospital all-cause mortality, readmission, length and costs of hospitalization), adjusting for measurable confounding factors. The low influenza period (May-July) was used as a reference period to adjust for unmeasured confounding factors during the peak influenza period (November-January). RESULTS In propensity score matching, influenza vaccination in peak influenza period could reduce the risk of in-hospital death (OR: 0.47[0.22,0.97]) and readmission (OR: 0.70[0.60,0.81]), length of hospitalization (β: -1.32[-1.47, -1.17]) and medical costs (GMR: 0.90[0.88,0.92]). After adjusting for unmeasured confounding factors, influenza vaccination was associated with 17% (ratio of ORs: 0.83 [0.69, 1.02]) lower risk of readmission and shorter length of hospitalization (difference in β: -0.23 [-0.62, 0.16]). The subgroup analyses showed that male patients with older age and poorer health conditions could benefit more after influenza vaccination. CONCLUSION Influenza vaccination could significantly improve hospitalization outcomes in elderly diabetic patients. This provides evidence supporting free influenza vaccination policies for vulnerable populations in low- and middle-income countries.
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Affiliation(s)
- Guangqi Liu
- Department of Global Health, School of Public Health, Peking University, Beijing. China; Energy Saving & Environmental Protection & Occupational Safety and Health Research Institute, China Academy of Railway Sciences Co., Ltd, Beijing 100081, China
| | - Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing. China
| | - Min Lv
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing. China
| | - Ming Lu
- Department of Biomedical Informatics, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yangmu Huang
- Department of Global Health, School of Public Health, Peking University, Beijing. China.
| | - Fei Ge
- Energy Saving & Environmental Protection & Occupational Safety and Health Research Institute, China Academy of Railway Sciences Co., Ltd, Beijing 100081, China
| | - Shiwei Ma
- Energy Saving & Environmental Protection & Occupational Safety and Health Research Institute, China Academy of Railway Sciences Co., Ltd, Beijing 100081, China.
| | - Yongxiang Qiu
- Energy Saving & Environmental Protection & Occupational Safety and Health Research Institute, China Academy of Railway Sciences Co., Ltd, Beijing 100081, China
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Yang C, Liu S, Xu J, Fu W, Qiu X, Jiang C. Influenza Vaccination Coverage and Influencing Factors in Type 2 Diabetes in Mainland China: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:1259. [PMID: 39591162 PMCID: PMC11598730 DOI: 10.3390/vaccines12111259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/23/2024] [Accepted: 10/29/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Influenza has many harmful effects on people with type 2 diabetes mellitus (T2DM), such as hyperglycemia and increasing incidence of cardiovascular and cerebrovascular diseases. Epidemiological evidence shows that influenza vaccinations can effectively prevent deterioration in T2DM patients. At present, there is a lack of nationwide studies on the vaccination status of influenza vaccines for patients with certain chronic diseases. This study aimed to evaluate the influenza vaccination status of T2DM patients in mainland China and the factors affecting their influenza vaccination. METHODS Data were sourced from PubMed, Embase, Web of Science, the China Biology Medicine Disc (CBMdisc), the China National Knowledge Infrastructure (CNKI), and the Wanfang Database. The keywords used in the literature search included "diabetes", "diabetes mellitus", "DM", "diabetic", "T2DM", "influenza vaccine", "flu vaccine", "China", and "Chinese". A total of 249 articles were retrieved through the searches; 7 articles met the inclusion criteria. The fixed-effects model was used when heterogeneity was low and a random-effects model was used when the heterogeneity was high. RESULTS The influenza vaccination coverage rate was 1.46% in diabetic patients and 9.99% in elderly diabetic patients. The influenza vaccination rate of type 2 diabetes patients with a high education level is higher than that of patients with a low education level. (OR: 1.462 [1.123, 1.903]). Meanwhile, gender (OR: 1.076, 95%CI: 0.893-1.295), marriage (OR: 1.283; 95%CI: 0.931-1.766), and occupation (OR: 1.049; 95% CI: 4.422-2.606) have no significant impact on influenza vaccination in patients with type 2 diabetes. CONCLUSIONS This study found that the coverage of influenza vaccination in patients with T2DM in Chinese mainland was low, and there were few relevant research articles. In China's mainland areas, education background is an important factor affecting the influenza vaccination of T2DM patients. China should continue to improve the influenza vaccination rate of patients with type 2 diabetes.
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Affiliation(s)
| | | | | | | | | | - Caixia Jiang
- Department of NCDs Control and Prevention, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310021, China; (C.Y.); (S.L.); (J.X.)
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11
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Froes F, Timóteo A, Almeida B, Raposo JF, Oliveira J, Carrageta M, Duque S, Morais A. Influenza vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Society of Cardiology, the Portuguese Society of Diabetology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Geriatrics and Gerontology, and the Study Group of Geriatrics of the Portuguese Society of Internal Medicine. Pulmonology 2024; 30:422-436. [PMID: 38129238 DOI: 10.1016/j.pulmoe.2023.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Influenza affects millions of people worldwide each year and can lead to severe complications, hospitalizations, and even death, especially among vulnerable populations such as older adults and those with chronic medical conditions. Annual vaccination is considered the most effective measure for preventing influenza and its complications. Despite the widespread availability of influenza vaccines, however, vaccination coverage rates remain suboptimal in several countries. Based on the latest scientific evidence and expert opinions on influenza vaccination in older people and patients with chronic disease, the Portuguese Society of Pulmonology (SPP), the Portuguese Society of Diabetology (SPD), the Portuguese Society of Cardiology (SPC), the Portuguese Society of Geriatrics and Gerontology (SPGG), the Study Group of Geriatrics of the Portuguese Society of Internal Medicine (NEGERMI-SPMI), and the Portuguese Society of Infectious Diseases and Clinical Microbiology (SPDIMC) discussed best practices for promoting vaccination uptake and coverage and drew up several recommendations to mitigate the impact of influenza. These recommendations focus on the efficacy and safety of available vaccines; the impact of influenza vaccination on older adults; patients with chronic medical conditions, namely cardiac and respiratory conditions, diabetes, and immunosuppressive diseases; and health care professionals, optimal vaccination timing, and strategies to increase vaccination uptake and coverage. The resulting position paper highlights the critical role that vaccinations play in promoting public health, raising awareness, and encouraging more people to get vaccinated.
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Affiliation(s)
- F Froes
- Torax Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Portuguese Society of Pulmonology (SPP), Portugal
| | - A Timóteo
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; NOVA Medical School, Lisboa, Portugal; Portuguese Society of Cardiology (SPC), Portugal
| | - B Almeida
- APDP Diabetes, Lisbon, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - J F Raposo
- NOVA Medical School, Lisboa, Portugal; APDP Diabetes, Lisbon, Portugal; Portuguese Society of Diabetology (SPD), Portugal
| | - J Oliveira
- Infection Control and Prevention and Antimicrobial Resistance Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Portuguese Society of Infectious Diseases and Clinical Microbiology (SPDIMC), Portugal
| | - M Carrageta
- Institute of Preventive Cardiology, Almada, Portugal; Portuguese Society of Geriatrics and Gerontology (SPGG), Portugal
| | - S Duque
- Hospital CUF Descobertas, Lisboa, Portugal; Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Study Group of Geriatrics of the Portuguese Society of Internal Medicine (NEGERMI-SPMI), Portugal
| | - A Morais
- Portuguese Society of Pulmonology (SPP), Portugal; Pulmonology Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; i3S - Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
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12
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Abbasihormozi S, Shirin A, Hosseini R, Moayedi M, Taghi Dizaj AV, Afghan M, Kouhkan A, Vesali S. COVID-19-related fear and anxiety in a sample of patients with type 2 diabetes: a cross-sectional study in Iran after several peaks of the pandemic. J Diabetes Metab Disord 2024; 23:789-796. [PMID: 38932871 PMCID: PMC11196430 DOI: 10.1007/s40200-023-01353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/18/2023] [Indexed: 06/28/2024]
Abstract
Purpose The aim of this study was to assess COVID-19-related anxiety, and fear burden in diabetic patients, as a risk group for severe COVID-19. Methods A cross-sectional online survey conducted on 111 type 2 diabetes mellitus (T2DM) patients referred to a Diabetes clinics of Royan institute, and 155 healthy controls recruited from normal population using a snowball sampling technique. Fear of COVID-19 Scale (FCV-19 S) and Coronavirus anxiety scale (CAS) were used. Results The total score of coronavirus fear in T2DM patients was 15.79 (6.39) and in healthy controls 15.48 (5.97) (p = 0.696). The total score of coronavirus fear in T2DM patients was 15.79 (6.39) and in healthy controls 15.48 (5.97) (p = 0.696). Correlation matrix between coronavirus anxiety and fear scores in these samples confirmed that in T2DM participants CAS was significantly positively associated with FCV-19 (r = 0.407, p = 0.000). There was also statistically and positively significant correlation between CAS and FCV-19 in healthy subjects (r = 0.495, p = 0.000). Conclusion The present study revealed that the level of fear and anxiety from COVID-19 was almost the same in a sample of Iranian T2DM patients and healthy controls. The pandemic with several peaks in the country cannot cause an increased anxiety and fear from COVID-19, especially in patients with diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01353-8.
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Affiliation(s)
- Shima Abbasihormozi
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Azin Shirin
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Hosseini
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahsa Moayedi
- Department of Genetics, Faculty of Biology Science, Kharazmi University, Karaj, Iran
| | - Ahmad Vosough Taghi Dizaj
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Marjan Afghan
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Azam Kouhkan
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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13
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Mastrovito B, Lardon A, Dubromel A, Nave V, Beny K, Dussart C. Understanding the gap between guidelines and influenza vaccination coverage in people with diabetes: a scoping review. Front Public Health 2024; 12:1360556. [PMID: 38706547 PMCID: PMC11066301 DOI: 10.3389/fpubh.2024.1360556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Diabetes affects millions of people worldwide, making them more vulnerable to infections, including seasonal influenza. It is therefore particularly important for those suffering from diabetes to be vaccinated against influenza each year. However, influenza vaccination coverage remains low in this population. This review primarily aims to identify the determinants of influenza vaccination in people with diabetes (T1D or T2D). Secondly, it aims to assess main recommendations for influenza vaccination, vaccine effectiveness, vaccination coverage, and how education and pharmacists can encourage uptake of the vaccine in the diabetic population. Methods A scoping review was conducted in January 2022 to systematically review evidence on influenza vaccination in people with diabetes using data from PubMed, Science Direct, and EM Premium with terms such as "Diabetes mellitus," "Immunization Programs," "Vaccination," and "Influenza Vaccines." Quality assessment and data extraction were independently conducted by two authors. Disagreements between the authors were resolved through discussion and consensus, and if necessary, by consulting a third author. Results Of the 333 records identified, 55 studies met the eligibility criteria for inclusion in this review. Influenza vaccination was recommended for people ≥6 months. Despite effectiveness evidence showing a reduction in mortality and hospitalizations in people with diabetes vaccinated vs. non-vaccinated ones, very few studies reported a coverage rate ≥ 75%, which is WHO's target objective. Determinants such as advanced age, presence of comorbidities and healthcare givers' advice were associated with increased vaccination uptake. On the contrary, fear of adverse reactions and concerns about vaccine effectiveness were significant barriers. Finally, education and pharmacists' intervention played a key role in promoting vaccination and increasing vaccination uptake. Conclusion Influenza vaccination coverage in people with diabetes remains low despite recommendations and evidence on vaccine effectiveness. Motivators and barriers as well as several socio-demographic and clinical factors have been identified to explain this trend. Efforts are now needed to increase the number of diabetics vaccinated against influenza, mainly through education and the involvement of healthcare givers.
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Affiliation(s)
- Brice Mastrovito
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Alexia Lardon
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Amelie Dubromel
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Viviane Nave
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Karen Beny
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Claude Dussart
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
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Antonelli Incalzi R, Consoli A, Lopalco P, Maggi S, Sesti G, Veronese N, Volpe M. Influenza vaccination for elderly, vulnerable and high-risk subjects: a narrative review and expert opinion. Intern Emerg Med 2024; 19:619-640. [PMID: 37891453 PMCID: PMC11039544 DOI: 10.1007/s11739-023-03456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Influenza is associated with a substantial health burden, especially in high-risk subjects such as older adults, frail individuals and those with underlying chronic diseases. In this review, we summarized clinical findings regarding the impact of influenza in vulnerable populations, highlighted the benefits of influenza vaccination in preventing severe illness and complications and reviewed the main evidence on the efficacy, effectiveness and safety of the vaccines that are best suited to older adults among those available in Italy. The adverse outcomes associated with influenza infection in elderly and frail subjects and those with underlying chronic diseases are well documented in the literature, as are the benefits of vaccination (mostly in older adults and in patients with cardiovascular diseases, diabetes and chronic lung disease). High-dose and adjuvanted inactivated influenza vaccines were specifically developed to provide enhanced immune responses in older adults, who generally have low responses mainly due to immunosenescence, comorbidities and frailty. These vaccines have been evaluated in clinical studies and systematic reviews by international immunization advisory boards, including the European Centre for Disease Prevention and Control. The high-dose vaccine is the only licensed influenza vaccine to have demonstrated greater efficacy versus a standard-dose vaccine in preventing laboratory-confirmed influenza in a randomized controlled trial. Despite global recommendations, the vaccination coverage in high-risk populations is still suboptimal. All healthcare professionals (including specialists) have an important role in increasing vaccination rates.
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Affiliation(s)
- Raffaele Antonelli Incalzi
- Gerontology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Pierluigi Lopalco
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Stefania Maggi
- Institute of Neuroscience-Aging Branch, National Research Council, Padua, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Rome, Italy.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome and IRCCS San Raffaele, Rome, Italy
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15
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Zahhar JA, Salamatullah HK, Almutairi MB, Faidah DE, Afif LM, Banjar TA, Alansari N, Betar M, Alghamdi S, Makkawi S. Influenza vaccine effect on risk of stroke occurrence: a systematic review and meta-analysis. Front Neurol 2024; 14:1324677. [PMID: 38269000 PMCID: PMC10806129 DOI: 10.3389/fneur.2023.1324677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024] Open
Abstract
Background Stroke is a significant global cause of mortality and long-term disability, potentially influenced by infections that heighten systemic inflammation and thrombotic events. The full impact of influenza vaccination on stroke remains uncertain. This systematic review and meta-analysis aimed to investigate the association between influenza immunization and stroke incidence. Methods We searched for randomized controlled trials (RCTs), case-control, and cohort studies published in PubMed/Medline, Cochrane-Central-Register-of-Controlled-Trials (CENTRAL), and Embase until 5 December 2022, and identified articles investigating the effect of influenza vaccine on stroke occurrence. All articles were screened by two independent reviewers. We performed a meta-analysis to investigate the risk of stroke occurrence in vaccinated vs. unvaccinated individuals. The random-effects model was used in all statistical analyses. Results Among the 26 articles meeting our criteria, 10 were retrospective cohort studies, 9 were case-control studies, 3 were prospective cohort studies, 3 were RCTs and 1 case-series. Overall, the studies showed a significant decrease in the risk of stroke incidence/hospitalization among vaccinated patients (OR = 0.81, 95% CI [0.77-0.86], p = 0.00001). Furthermore, studies showed flu vaccine decreases the occurrence of mortality among stroke patients (OR = 0.50, 95% CI [0.37-0.68], p = 0.00001). Sub-group analysis revealed significant protective effect for patients with specific comorbidities including atrial fibrillation (OR = 0.68, 95% CI [0.57-0.81], p = 0.0001), diabetes (OR = 0.76, 95% CI [0.66-0.87], p = 0.0001), Chronic obstructive pulmonary disease (OR = 0.70, 95% CI [0.61-0.81], p = 0.00001), and hypertension (OR = 0.76, 95% CI [0.70-83], p = 0.00001). Conclusion The current meta-analysis further supports prior findings that influenza vaccination reduces stroke risk, particularly in patients with comorbidities. Guidelines should promote vaccination for at-risk individuals.
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Affiliation(s)
- Jalal A. Zahhar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Hassan K. Salamatullah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Maher B. Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Dania E. Faidah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Lena M. Afif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Toka A. Banjar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Nayef Alansari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Manar Betar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
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Koksal I, Al Awaidy S, Assiri AM, Ozudogru O, Khalaf M, Yeşiloğlu C, Badur S. Adult vaccination in three Eastern Mediterranean countries: current status, challenges and the way forward. Expert Rev Vaccines 2024; 23:1068-1084. [PMID: 39539060 DOI: 10.1080/14760584.2024.2428806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 09/25/2024] [Accepted: 11/08/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Changing population demographics places a premium on optimizing older adult health. Vaccine-preventable diseases represent a substantial clinical and economic burden in older adults (≥65 years). AREAS COVERED This narrative review summarizes the adult immunization landscape in three countries; Saudi Arabia, the United Arab Emirates and Türkiye, informed by literature searches; PubMed (23-27 September 2023) supplemented by citation tracking via Google Scholar). Existing vaccination recommendations and published data were reviewed to evaluate vaccine uptake, chiefly focusing on core adult vaccines (seasonal influenza, pneumococcal, and herpes zoster). Barriers to vaccine access and uptake were reviewed, and initiatives to improve recommended vaccine uptake in older (≥65 years) or otherwise high-risk adults are described. EXPERT OPINION Uptake of recommended adult vaccines is low in all three countries. Receipt of annual seasonal influenza vaccine is typically below 50% in both older and at-risk younger adults; pneumococcal vaccination rates are even lower in eligible adults (<15% and often far lower), as is herpes zoster vaccine uptake (typically <5%). Low coverage is driven chiefly by low awareness of vaccine benefits, inconsistent recommendations, and vaccine hesitancy, together with often complex adult vaccine access pathways. Initiatives and remedies aimed at augmenting adult vaccination rates are warranted.
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Affiliation(s)
- Iftihar Koksal
- Department of Infectious Disease and Clinical Microbiology, Acibadem Mehmet Ali Aydinlar University, Atakent Hospital, Istanbul, Türkiye
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Feleke BE, Sacre J, Tomic D, Huynh Q, Shaw JE, Magliano DJ. Hospital admissions among people with diabetes: A systematic review. Diabet Med 2024; 41:e15236. [PMID: 37811704 DOI: 10.1111/dme.15236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To describe the reasons for hospital admission among people with diabetes. METHODS We searched Emcare, Embase, Medline and Google Scholar databases for population-based studies describing the causes of hospitalisation among people with diabetes. We included articles published in English from 1980 to 2022. For each study, we determined the most frequent reasons for admission. Studies were assessed for quality using the Newcastle Ottawa quality assessment tool. RESULTS 6920 research articles were retrieved from the search of all sources. After screening the titles and abstracts of these, we reviewed the full text of 135 papers and finally included data from 42 studies. Admissions among the total diabetes were reported in 25 papers: 5 articles reported type 1 diabetes alone, 10 articles reported type 2 diabetes alone and the remaining 2 articles reported type 1 and type 2 diabetes separately. Among the 25 total and type 2 diabetes studies that reported the distribution of hospitalisations in broad categories, cardiovascular diseases (CVD) were the leading cause of admission in 19/25 (76%) of studies. Among the 19 studies that reported CVD admissions by subcategories, ischaemic or coronary heart disease was the leading subtype of CVD in 58% of studies. The other common causes of admissions were infections, renal disorders, endocrine, nutritional, metabolic and immunity disorders. In people with type 1 diabetes, acute diabetes complications were the leading cause of admission. CONCLUSION CVD are the leading cause of hospital admission for people with diabetes, with ischaemic or coronary heart disease as the predominant subtype.
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Affiliation(s)
- Berhanu Elfu Feleke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Julian Sacre
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dunya Tomic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jonathan E Shaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna J Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Naderalvojoud B, Shah ND, Mutanga JN, Belov A, Staiger R, Chen JH, Whitaker B, Hernandez-Boussard T. Trends in Influenza Vaccination Rates among a Medicaid Population from 2016 to 2021. Vaccines (Basel) 2023; 11:1712. [PMID: 38006044 PMCID: PMC10675465 DOI: 10.3390/vaccines11111712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/28/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Seasonal influenza is a leading cause of death in the U.S., causing significant morbidity, mortality, and economic burden. Despite the proven efficacy of vaccinations, rates remain notably low, especially among Medicaid enrollees. Leveraging Medicaid claims data, this study characterizes influenza vaccination rates among Medicaid enrollees and aims to elucidate factors influencing vaccine uptake, providing insights that might also be applicable to other vaccine-preventable diseases, including COVID-19. This study used Medicaid claims data from nine U.S. states (2016-2021], encompassing three types of claims: fee-for-service, major Medicaid managed care plan, and combined. We included Medicaid enrollees who had an in-person healthcare encounter during an influenza season in this period, excluding those under 6 months of age, over 65 years, or having telehealth-only encounters. Vaccination was the primary outcome, with secondary outcomes involving in-person healthcare encounters. Chi-square tests, multivariable logistic regression, and Fisher's exact test were utilized for statistical analysis. A total of 20,868,910 enrollees with at least one healthcare encounter in at least one influenza season were included in the study population between 2016 and 2021. Overall, 15% (N = 3,050,471) of enrollees received an influenza vaccine between 2016 and 2021. During peri-COVID periods, there was an increase in vaccination rates among enrollees compared to pre-COVID periods, from 14% to 16%. Children had the highest influenza vaccination rates among all age groups at 29%, whereas only 17% were of 5-17 years, and 10% were of the 18-64 years were vaccinated. We observed differences in the likelihood of receiving the influenza vaccine among enrollees based on their health conditions and medical encounters. In a study of Medicaid enrollees across nine states, 15% received an influenza vaccine from July 2016 to June 2021. Vaccination rates rose annually, peaking during peri-COVID seasons. The highest uptake was among children (6 months-4 years), and the lowest was in adults (18-64 years). Female gender, urban residency, and Medicaid-managed care affiliation positively influenced uptake. However, mental health and substance abuse disorders decreased the likelihood. This study, reliant on Medicaid claims data, underscores the need for outreach services.
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Affiliation(s)
- Behzad Naderalvojoud
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; (B.N.); (R.S.)
- Stanford Center for Biomedical Informatics Research, Stanford, CA 94305, USA
| | - Nilpa D. Shah
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; (B.N.); (R.S.)
- Stanford Center for Biomedical Informatics Research, Stanford, CA 94305, USA
| | - Jane N. Mutanga
- Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (J.N.M.)
| | - Artur Belov
- Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (J.N.M.)
| | - Rebecca Staiger
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; (B.N.); (R.S.)
| | - Jonathan H. Chen
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; (B.N.); (R.S.)
- Stanford Center for Biomedical Informatics Research, Stanford, CA 94305, USA
- Division of Hospital Medicine, Stanford, CA 94305, USA
- Clinical Excellence Research Center, Stanford, CA 94304, USA
| | - Barbee Whitaker
- Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (J.N.M.)
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; (B.N.); (R.S.)
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA
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19
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Gigante B, Levy JH, van Gorp E, Bartoloni A, Bochaton-Piallat ML, Bäck M, Ten Cate H, Christersson C, Ferreiro JL, Geisler T, Lutgens E, Schulman S, Storey RF, Thachil J, Vilahur G, Liaw PC, Rocca B. Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis. Eur Heart J 2023; 44:3040-3058. [PMID: 37439553 DOI: 10.1093/eurheartj/ehad388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023] Open
Abstract
Patients with severe infections and a pre-existing indication for antithrombotic therapy, i.e. antiplatelet agents, anticoagulant drugs, or their combinations, require integrated clinical counselling among coagulation, infectious disease, and cardiology specialists, due to sepsis-induced coagulopathy that frequently occurs. Bacterial and viral pathogens constitute an increasing threat to global public health, especially for patients with ongoing antithrombotic treatment who have a high risk of thrombotic recurrences and high susceptibility to severe infections with increased morbidity and mortality. Similarly, sepsis survivors are at increased risk for major vascular events. Coagulopathy, which often complicates severe infections, is associated with a high mortality and obligates clinicians to adjust antithrombotic drug type and dosing to avoid bleeding while preventing thrombotic complications. This clinical consensus statement reviews the best available evidence to provide expert opinion and statements on the management of patients hospitalized for severe bacterial or viral infections with a pre-existing indication for antithrombotic therapy (single or combined), in whom sepsis-induced coagulopathy is often observed. Balancing the risk of thrombosis and bleeding in these patients and preventing infections with vaccines, if available, are crucial to prevent events or improve outcomes and prognosis.
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Affiliation(s)
- Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solnavägen 30. 17164 and Department of Cardiology, Danderyds Hospital, Entrévägen 2, 182 88, Stockholm, Sweden
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, United States; 2301 Erwin Road, Durham, NC 27710, USA
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC, Rotterdam, PO box 2040 [Room Ee1726], 3000 CA Rotterdam, The Netherlands
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious Diseases Unit, University of Florence, Largo Brambilla 3, 50100 Florence, Italy
| | - Marie-Luce Bochaton-Piallat
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, 1 rue Michel-Servet 1, CH-1211 Genève, Switzerland
| | - Magnus Bäck
- Department of Translational Cardiology, Karolinska Institutet and Karolinska University Hospital, CMM L8:01, 171 76 Stockholm, Sweden
- INSERM U1116, University of Lorraine, Nancy University Hospital, 2 rue Jean Lamour, 54505 Vandoeuvre les Nancy Cedex, France
| | - Hugo Ten Cate
- Department of Internal medicine, Thrombosis Expertise Center, Maastricht University Medical Center and CARIM school for cardiovascular diseases, Universiteitsingel 50, PO Box 616, 6200 MD Maastricht, The Netherlands
- Center for Thrombosis and Haemostasis, Gutenberg University Medical Center, Langenbeckstr. 1, Bldg. 403, 55131 Mainz, Germany
| | - Christina Christersson
- Department of Medical Sciences, Cardiology, Uppsala University, Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - José Luis Ferreiro
- Department of Cardiology and Bio-Heart Cardiovascular Diseases Research Group; Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL); CIBERCV; L'Hospitalet de Llobregat, Hospital Duran i Reynals - Edifici Terapèutic - 2a planta Gran Via de l'Hospitalet, 199, 08908 Hospitalet de Llobregat Barcelona -Spain
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Esther Lutgens
- Cardiovascular Medicine, Experimental CardioVascular Immunology Laboratory, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians Universität, München, Germany & German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Pettenkoferstrasse 9, 80336, Munich, Germany
| | - Sam Schulman
- Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada HHS - General Hospital 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 2, стр. 4, Moscow 119435, Russia
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Pegasus House, 463a Glossop Road, Sheffield, S10 2QD, UK
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Oxford road, Manchester, M13 9WL, UK
| | - Gemma Vilahur
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Avda. Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Patricia C Liaw
- Department of Medicine, Thrombosis & Atherosclerosis Research Institute (TaARI), McMaster University, 237 Barton Street East Hamilton, Ontario L8L 2X2, Canada
| | - Bianca Rocca
- Department of Safety and Bioethics, Section on Pharmacology, Catholic University School of Medicine, Largo F. Vito 1, 00168 Rome, Italy
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20
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Maire A, Chapet N, Aguilhon S, Laugier ML, Laffont-Lozes P, Rigoni M, Mathieu B, Audurier Y, Breuker C, de Barry G, Jalabert A, Leclercq F, Pasquié JL, Roubille F, Castet-Nicolas A. Evaluation of vaccination coverage in heart failure patients in a tertiary center. Heliyon 2023; 9:e18080. [PMID: 37519644 PMCID: PMC10372228 DOI: 10.1016/j.heliyon.2023.e18080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Background Despite current recommendation, vaccination coverage (VC) for patients with heart failure (HF) remains far too limited. Aims To evaluate the VC of HF patients followed in our hospital center and investigate the barriers to vaccination and the ways to address them. Methods This was a cross-sectional monocentric descriptive study conducted between December 2019 and January 2021 at the University Hospital of Montpellier, France. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status against influenza and pneumococcus. For non-vaccinated patients, opinion and willingness to be vaccinated were also obtained. Results Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years and the proportion of males was 72%. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p = 0.022) and 22% were up to date with pneumococcal vaccination (11% in CU, 35% in TP, p < 0.001). Among patients not vaccinated, 17% refused vaccination. Among unvaccinated patients who consider vaccination, 69% wanted to be vaccinated by their general practitioner (GP). Conclusions The VC of HF patients remains insufficient. Patients in TP are more vaccinated than patients in CU, which could involve better management. The low rate of vaccinated patients is mainly explained by a lack of awareness. The medical team, including the clinical pharmacist by his dedicated time during medication reconciliation may play a major role in the management of hospitalized patients as well as GP's as local actors.
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Affiliation(s)
- Adrien Maire
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Chapet
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Sylvain Aguilhon
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Lucie Laugier
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | | | - Mélinda Rigoni
- Department of Pharmacy, University Hospital of Nimes, Nimes, France
| | - Betty Mathieu
- Department of Pharmacy, University Hospital of Nimes, Nimes, France
| | | | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Gaëlle de Barry
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Jean-Luc Pasquié
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital of Montpellier, Montpellier, France
- Cancer Research Institute of Montpellier (IRCM), INSERM U1194, ICM, University of Montpellier, Montpellier, France
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21
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Ishak AR, Hsieh YC, Srinivasan H, See KC. Review of Vaccination Recommendations in Guidelines for Non-Communicable Diseases with Highest Global Disease Burden among Adults 75 Years Old and Above. Vaccines (Basel) 2023; 11:1076. [PMID: 37376465 PMCID: PMC10305037 DOI: 10.3390/vaccines11061076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
This scientific review paper explores international and country-specific healthcare guidelines for non-communicable diseases with the highest burden among individuals aged 75 years and above. The study aims to identify the best vaccination practices and standardize healthcare practices to improve vaccination adherence in this vulnerable population. Given that older people are more prone to infectious illnesses and have higher rates of morbidity and mortality, vaccinations are essential for disease prevention. Despite the proven efficacy of vaccinations, adherence has plateaued in recent years, partly due to a lack of accessibility, public education, and variability in disease-specific guidelines. This paper highlights the need for a more robust and standardized international vaccination model to improve quality of life and reduce disability-adjusted life years among the elderly. The findings of this study call for further research to review the guidelines as more implementations are put in place, including non-English guidelines.
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Affiliation(s)
| | - Yu Chun Hsieh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (A.R.I.); (H.S.)
| | | | - Kay Choong See
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (A.R.I.); (H.S.)
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22
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Dicembrini I, Silverii GA, Clerico A, Fornengo R, Gabutti G, Sordi V, Tafuri S, Peruzzi O, Mannucci E. Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2023; 33:1099-1110. [PMID: 37032254 DOI: 10.1016/j.numecd.2023.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
AIMS In order to better define the need for influenza vaccination in people with diabetes (DM), we collected all available evidence on the effect of DM as a risk factor for complications of both seasonal and pandemic influenza, and on the specific effectiveness of vaccines in patients with DM. DATA SYNTHESIS Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and Embase databases were performed, one for each metanalysis, collecting all observational studies and randomized clinical trials performed on humans up to May 31st, 2022. We retrieved 34 observational studies comparing risk for influenza complications in people with or without diabetes, and 13 observational studies assessing vaccine effectiveness on preventing such complications. Mortality for influenza and hospitalization for influenza and pneumonia resulted significantly higher in individuals with versus without DM, both when unadjusted and adjusted data are analyzed. In diabetic individuals vaccinated for influenza overall hospitalization, hospitalization for influenza or pneumonia and overall mortality are significantly lower in comparison with not vaccinated DM subjects, both when unadjusted and adjusted data were analyzed. CONCLUSION This systematic review and meta-analysis shows that: 1) influenza is associated with more severe complications in diabetic versus not diabetic individuals and 2) influenza vaccination is effective in preventing clinically relevant outcomes in adults with DM with a NNT (number needed to treat) of 60, 319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively. The identification of diabetic patients as the target of vaccination campaigns for influenza appears to be justified by available clinical evidence.
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Affiliation(s)
- Ilaria Dicembrini
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy.
| | | | | | | | - Giovanni Gabutti
- Coordinator Working Group Vaccines and Immunization Policies, Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro, University of Bari, Italy
| | - Ottavia Peruzzi
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
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23
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Thomas S, Emara MM, Ouhtit A, Nader JD, Nasrallah GK, Coyle PV, Althani AA, Al Maslamani MA, Yassine HM. Influenza Prevalence and Vaccine Efficacy among Diabetic Patients in Qatar. J Infect Public Health 2023; 16:808-815. [PMID: 36996614 DOI: 10.1016/j.jiph.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023] Open
Abstract
Seasonal influenza viruses may lead to severe illness and mortality in patients with comorbidities, including Diabetes Mellitus (DM). Vaccination against influenza in DM patients may reduce influenza incidence and severity. Before the emergence of the COVID-19 pandemic, influenza infections were the most prevalent respiratory infections in Qatar. Still, reports about influenza prevalence and vaccine efficacy in DM patients have not been reported. This study aimed to analyze influenza prevalence among other respiratory infections and assess influenza vaccine efficacy in DM patients in Qatar. Statistical analysis was performed on data obtained from Hamad Medical Corporation (HMC) database for patients that visited the emergency department (ED) with respiratory-like illnesses. The analysis was done for the period between January 2016 to December 2018. Among 17,525 patients who visited HMC-ED with clinical symptoms of respiratory infections, 2611(14.9%) were reported to have DM. Among DM patients, influenza was the most prevalent respiratory pathogen at 48.9%. Influenza virus A (IVA) was the most circulating type, contributing to 38.4%, followed by IVB contributing to 10.4% of total respiratory infections. Among the typed IVA-positive cases, 33.4% were H1N1, and 7.7% were H3N2. A significant decrease in influenza infections was reported in vaccinated DM patients (14.5%) when compared to non-vaccinated patients (18.9%) (p-value = 0.006). However, there was no significant relaxation in the clinical symptoms among vaccinated DM patients compared to their non-vaccinated counterparts. In conclusion, influenza was the most common etiology for respiratory viral infection among diabetic patients at the leading healthcare provider in Qatar. Although vaccination reduced the incidence rate among DM patients, it was less effective in preventing symptoms. Further studies on a larger cohort and for a more extended period are required to investigate influenza prevalence and vaccine efficacy among DM patients.
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Affiliation(s)
- Swapna Thomas
- Biomedical Research Center, Qatar University, Doha, Qatar; Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Mohamed M Emara
- Basic Medical Science Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Allal Ouhtit
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Joanne D Nader
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Qatar University, Doha, Qatar; College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Peter V Coyle
- Biomedical Research Center, Qatar University, Doha, Qatar; Virology laboratory, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar; College of Health Sciences, QU-Health, Qatar University, Doha, Qatar.
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24
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Tavabe NR, Kheiri S, Dehghani M, Mohammadian-Hafshejani A. A Systematic Review and Meta-Analysis of the Relationship between Receiving the Flu Vaccine with Acute Cerebrovascular Accident and Its Hospitalization in the Elderly. BIOMED RESEARCH INTERNATIONAL 2023; 2023:2606854. [PMID: 36814798 PMCID: PMC9940958 DOI: 10.1155/2023/2606854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 02/15/2023]
Abstract
Background and Aims In recent years, various studies have been conducted worldwide to investigate the relationship between receiving the flu vaccine with acute cerebrovascular accident or stroke and its hospitalization in the elderly; however, the results of these studies are contradictory. Therefore, this study was aimed at investigating the relationship between receiving the flu vaccine with stroke and its hospitalization in the elderly. Methods This study is a systematic review and meta-analysis of studies examining the relationship between receiving the flu vaccine with stroke and its hospitalization in the elderly during the years 1980 to 2021 which have been published in ISI Web of Science, Scopus PubMed, Cochrane, Science Direct, Google Scholar, and Embase. All analyses were performed by Stata 15, and the significance level in this study was considered <0.05. Results In the systematic search, 3088 articles were retrieved, considering the study criteria; finally, 14 studies were included in the meta-analysis. Based on the results of the meta-analysis, the odds ratio (OR) of occurrence and hospitalization of stroke compared to the nonvaccinated group in vaccine recipients is equal to 0.84 (95% confidence interval (CI): 0.78-0.90, P value ≤ 0.001). Publication bias was not observed in this study (P value = 0.101). Conclusion Getting the flu vaccine can reduce the risk of occurrence and hospitalization of stroke in the elderly by 16% (10%-22%). Therefore, receiving this vaccine as a preventive intervention for stroke in the elderly may be promising.
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Affiliation(s)
- Nilay Rezaei Tavabe
- Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Soleiman Kheiri
- Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohsen Dehghani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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25
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Ahmed WS, Abu Farha R, Halboup AM, Alshargabi A, Al-mohamadi A, Abu-rish EY, Zawiah M, Al-Ashbat YK, Al-Jamei S. Knowledge, attitudes, perceptions, and practice toward seasonal influenza and its vaccine: A cross-sectional study from a country of conflict. Front Public Health 2023; 11:1030391. [PMID: 36860400 PMCID: PMC9970292 DOI: 10.3389/fpubh.2023.1030391] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Background The seasonal influenza vaccine is an important preventive measure against influenza and its associated complications. In Yemen, there is no seasonal influenza vaccination policy, and the influenza vaccine is excluded from the national immunization program. Data on vaccination coverage remain scarce with no previous surveillance programs or awareness campaigns implemented in the country. The current study aims to assess the awareness, knowledge, and attitudes of the public in Yemen toward seasonal influenza and their motivators and perceived barriers to receiving its vaccine. Methods A cross-sectional survey was carried out using a self-administered questionnaire that was distributed to eligible participants using convenience sampling. Results A total of 1,396 participants completed the questionnaire. The respondents showed a median knowledge score of influenza of 11.0/15.0, and most of them (70%) were able to recognize its modes of transmission. However, only 11.3% of the participants reported receiving the seasonal influenza vaccine. Physicians were the respondents' most preferred information source for influenza (35.2%), and their recommendation (44.3%) was the most cited reason for taking its vaccine. On the contrary, not knowing about the vaccine's availability (50.1%), concerns regarding the safety of the vaccine (17%), and not considering influenza as a threat (15.9%) were the main reported barriers to getting vaccinated. Conclusion The current study showed a low uptake of influenza vaccines in Yemen. The physician's role in promoting influenza vaccination seems to be essential. Extensive and sustained awareness campaigns would likely increase the awareness of influenza and remove misconceptions and negative attitudes toward its vaccine. Equitable access to the vaccine can be promoted by providing it free of charge to the public.
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Affiliation(s)
- Wesam S. Ahmed
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Rana Abu Farha
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Abdulsalam M. Halboup
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen,Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Ahmed Al-mohamadi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen
| | - Eman Y. Abu-rish
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Mohammed Zawiah
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia,Department of Pharmacy Practice, College of Clinical Pharmacy, Hodeidah University, Al Hodeidah, Yemen
| | - Yousf K. Al-Ashbat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Al-Razi University, Sana'a, Yemen
| | - Sayida Al-Jamei
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Al-Razi University, Sana'a, Yemen,*Correspondence: Sayida Al-Jamei ✉
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26
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Wichtige Impfempfehlungen für Diabetiker. CARDIOVASC 2023. [PMCID: PMC9931443 DOI: 10.1007/s15027-023-2981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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27
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Wichtige Impfempfehlungen für Diabetiker. INFO DIABETOLOGIE 2023; 17. [PMCID: PMC9943583 DOI: 10.1007/s15034-023-4469-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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28
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Lee WC, Ho MC, Leu SW, Chang CC, Lin CK, Lin CM, Fang YH, Huang SY, Lin YC, Chuang MC, Yang TM, Hung MS, Chou YL, Tsai YH, Hsieh MJ. The impacts of bacterial co-infections and secondary bacterial infections on patients with severe influenza pneumonitis admitted to the intensive care units. J Crit Care 2022; 72:154164. [PMID: 36209697 DOI: 10.1016/j.jcrc.2022.154164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/08/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
Abstract
PURPOSES This study investigated the prevalence and clinical outcomes of pulmonary bacterial co-infections and secondary bacterial infections in patients with severe influenza pneumonitis. METHODS We retrospectively analyzed the data of adult patients with severe influenza pneumonitis admitted to medical ICUs. Bacterial co-infections and secondary bacterial infections were identified. The risk factors of bacterial infection were evaluated. The outcomes of patients regarding co-infection or secondary bacterial infection were analyzed. RESULTS We identified 117 critically ill patients with laboratory-confirmed influenza pneumonitis admitted to the medical ICUs. Klebsiella pneumoniae (31.4%) and Staphylococcus aureus (22.8%) were the most identified bacteria in patients with bacterial co-infection. A high proportion of methicillin-resistant Staphylococcus aureus (17.1%) was noted. Liver cirrhosis and diabetes mellitus were the independent risk factors for bacterial co-infection. Acinetobacter baumannii (30.7%) and S. aureus (23.1%) were the most often identified bacteria in patients with secondary bacterial pneumonia. Patients with secondary bacterial infections had a longer duration of mechanical ventilation, and longer ICU and hospital stay. CONCLUSIONS High rates of drug-resistant bacterial co-infections and secondary bacterial infections were identified in patients with severe influenza pneumonitis requiring ICU care and were associated with more morbidity in these patients.
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Affiliation(s)
- Wei-Chun Lee
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Meng-Chin Ho
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Shaw-Woei Leu
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan
| | - Che-Chia Chang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Chin-Kuo Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Chieh-Mo Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Yu-Hung Fang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Shu-Yi Huang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Yu-Ching Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan; Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Min-Chun Chuang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Ming-Szu Hung
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan; Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yen-Li Chou
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Ying-Huang Tsai
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan; Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan; Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan.
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Vora A, Di Pasquale A, Kolhapure S, Agrawal A, Agrawal S. The need for vaccination in adults with chronic (noncommunicable) diseases in India - lessons from around the world. Hum Vaccin Immunother 2022; 18:2052544. [PMID: 35416747 PMCID: PMC9225226 DOI: 10.1080/21645515.2022.2052544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worldwide, chronic diseases (noncommunicable diseases [NCDs]) cause 41 million (71%) deaths annually. They are the leading cause of mortality in India, contributing to 60% of total deaths each year. Individuals with these diseases are more susceptible to vaccine-preventable diseases (VPDs) and have an increased risk of associated disease severity and complications. This poses a substantial burden on healthcare systems and economies, exemplified by the COVID-19 pandemic. Vaccines are an effective strategy to combat these challenges; however, utilization rates are inadequate. With India running one of the world’s largest COVID-19 vaccination programs, this presents an opportunity to improve vaccination coverage for all VPDs. Here we discuss the burden of VPDs in those with NCDs, the benefit of vaccinations, current challenges and possible strategies that may facilitate implementation and accessibility of vaccination programs. Effective vaccination will have a significant impact on the disease burden of both VPDs and NCDs and beyond.
What is already known on this topic?
Annually, chronic or noncommunicable diseases (NCDs) cause >40 million deaths worldwide and 60% of all deaths in India Adults with these diseases are more susceptible to vaccine-preventable diseases (VPDs); however, vaccine utilization is inadequate in this population
What is added by this report?
We highlight the benefits of vaccination in adults with NCDs that extend beyond disease prevention We discuss key challenges in implementing adult vaccination programs and provide practical solutions
What are the implications for public health practice?
Raising awareness about the benefits of vaccinations, particularly for those with NCDs, and providing national guidelines with recommendations from medical societies, will increase vaccine acceptance Adequate vaccine acceptance will reduce the VPD burden in this vulnerable population
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Affiliation(s)
- Agam Vora
- Department of Chest & TB, Dr. R. N. Cooper Municipal General Hospital, Mumbai, India
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Lin CS, Chang CC, Yeh CC, Chang YC, Chen TL, Liao CC. Outcomes following diabetes admission in patients who had influenza vaccination: A population-based cohort study. Diabetes Res Clin Pract 2022; 189:109930. [PMID: 35605799 DOI: 10.1016/j.diabres.2022.109930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The beneficial effect of influenza vaccination (IV) in patients with diabetes was not completely understood. METHODS Using the research data of health insurance, we performed a cohort study of patients aged ≥20 years who were admitted to inpatient care due to diabetes in 2008-2013 in Taiwan. We performed the propensity score matching and the outcomes of complications and mortality following the diabetes admission was compared between patients with and without IV. RESULTS Among 61,002 patients with diabetes admission, IV reduced 30-day in-hospital mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.66-0.84), particularly among patients with prior diabetes hospitalization, inadequate control for diabetes, and diabetes-related comorbidities, such as eye involvement, ketoacidosis, renal manifestations, and coma. Compared with non-IV control group, patients with IV also had decreased risks of pneumonia (OR 0.92, 95% CI 0.87-0.97), septicemia (OR 0.83, 95% CI 0.79-0.88), urinary tract infection (OR 0.94, 95% CI 0.90-0.97), and intensive care (OR 0.29, 95% CI 0.27-0.31). CONCLUSION In patients with diabetes admission, IV was associated with reduced risks of complications and mortality. Our study implicated the urgent need to promote influenza vaccination for this susceptible population with diabetes.
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Affiliation(s)
- Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Yi-Cheng Chang
- Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Lewing B, Sansgiry S, Abughosh SM, Lal LS, Essien EJ, Sansgiry SS. Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States. Postgrad Med 2022; 134:494-506. [PMID: 35379062 DOI: 10.1080/00325481.2022.2061260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. METHODS The most recently available (years 2016 - 2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes related complications, and total days absent from school or work change from baseline. RESULTS 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. CONCLUSION Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.
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Affiliation(s)
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine, Houston, TX, USA
| | | | - Lincy S Lal
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ekere J Essien
- University of Houston, College of Pharmacy Houston, TX, USA
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Thomas S, Ouhtit A, Al Khatib HA, Eid AH, Mathew S, Nasrallah GK, Emara MM, Al Maslamani MA, Yassine HM. Burden and Disease Pathogenesis of Influenza and Other Respiratory Viruses in Diabetic Patients. J Infect Public Health 2022; 15:412-424. [DOI: 10.1016/j.jiph.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023] Open
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Application of a city wide digital population database for outcome analysis in diabetes: SARS-CoV-2, diabetes and hospital admission rate month by month in Greater Manchester, UK. Cardiovasc Endocrinol Metab 2022; 11:e0257. [PMID: 35128337 PMCID: PMC8805797 DOI: 10.1097/xce.0000000000000257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022]
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COVID-19 Vaccine Hesitancy and Associated Factors among Diabetes Patients: A Cross-Sectional Survey in Changzhi, Shanxi, China. Vaccines (Basel) 2022; 10:vaccines10010129. [PMID: 35062790 PMCID: PMC8778010 DOI: 10.3390/vaccines10010129] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with diabetes are more susceptible to severe acute respiratory syndrome-associated coronavirus (SARS-CoV)-2 infection, but vaccine hesitancy is a problem in this population. We investigated the prevalence of SARS-CoV-2 vaccine hesitancy among diabetes patients in China through a cross-sectional survey from April and August 2021 using a questionnaire administered to patients at two hospitals affiliated with Changzhi Medical College (Shanxi, China). The health belief model (HBM) is used examining factors influencing vaccine hesitancy. After adjusting for potential confounders, a multivariate logistic regression model was used to analyze correlations between vaccine hesitancy and associated factors. Of the 483 participants, 56.4% (273/483) had vaccine hesitancy, including 58.2% (159/273) who were unsure of being vaccinated and 41.8% (114/273) who were unwilling. Although patients considered SARS-CoV-2 infection to be serious (adjusted odds ratio [aOR] = 3.90, 95% confidence interval [CI]: 2.36–6.42; p < 0.001), they had concerns about vaccine safety (aOR = 3.05, 95% CI: 1.89–4.91; p < 0.001). Relatives’ vaccination status did not influence participants’ willingness to be vaccinated (aOR = 2.43, 95% CI: 1.39–4.25; p < 0.001). Disagreement with physicians’ view that vaccination can reduce SARS-CoV-2 infection risk was independently correlated with vaccine hesitancy (aOR = 2.25, 95% CI: 1.28–3.95; p < 0.001). Diabetes patients in China need to be educated on SARS-CoV-2 vaccine safety and protective effects to increase the vaccination rate in this population.
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Alsufyani S. Acceptance rate of influenza vaccination among patients with type II diabetes. J Family Med Prim Care 2022; 11:44-52. [PMID: 35309605 PMCID: PMC8930144 DOI: 10.4103/jfmpc.jfmpc_115_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Methodology: Results: Conclusion:
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Low Levels of Influenza Vaccine Uptake among the Diabetic Population in Spain: A Time Trend Study from 2011 to 2020. J Clin Med 2021; 11:jcm11010068. [PMID: 35011809 PMCID: PMC8745480 DOI: 10.3390/jcm11010068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: In this work, we aim to describe influenza vaccine uptake among the diabetic population in Spain to assess the time trend from 2011 to 2020 and identify predictors of vaccine uptake among diabetes patients. (2) Methods: We conducted a descriptive cross-sectional study using the European Health Interview Survey for Spain (2014 and 2020) and the Spanish National Health Surveys (2011 and 2017). The independent variables analysed included socio-demographic characteristics, health-related variables and lifestyle variables. We matched each participant with diabetes with a non-diabetic participant based on age, sex, place of residence and year of survey. (3) Results: The overall coverage among diabetic adults was 52.1% compared to 40.6% for matched participants without diabetes (p < 0.01). The vaccine uptake among adults with diabetes was 52.6% in 2011, 54.38% in 2014 and 53.4% in 2017. The adjusted OR of having been vaccinated in 2020, with respect to 2011, was not significant at 0.87 (95% CI: 0.72–1.06). Factors such as being male, higher age, being affected by respiratory disease or cancer and being physically active were identified as positive predictors for influenza vaccination uptake, while smoking was a negative predictor. (4) Conclusions: The influenza vaccine uptake is below desirable levels among the adult diabetic population in Spain and has not improved from 2011 to 2020. More efforts should be made to increase influenza vaccine uptake in this high-risk group, especially for women, those aged 18–64 years, without other high-risk conditions and smokers.
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Al Awaidy ST, Al Slail F, Al Kathiry DAA, Al Mayahi ZK, Koul PA, Tanriover MD. A Case for Enhancing Coverage of Influenza Vaccination in Gulf Cooperation Council Countries in Patients with Diabetes Mellitus during COVID-19. Oman Med J 2021; 36:e325. [PMID: 34912571 PMCID: PMC8652396 DOI: 10.5001/omj.2021.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/17/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Salah T Al Awaidy
- Communicable Disease Advisor for Health Affairs, Office of HE Undersecretary of Health Affairs, Ministry of Health, Muscat, Oman
| | - Fatima Al Slail
- Directorate of the National Diabetes Prevention and Control Program, Ministry of Health, Riyadh, Saudi Arabia
| | - Dalal Abdul Aziz Al Kathiry
- Directorate of the National Diabetes Prevention and Control Program, Ministry of Health, Riyadh, Saudi Arabia
| | - Zayid K Al Mayahi
- Directorate of Health Services, Ministry of Health, South Batinah Governorate, Oman
| | - Parvaiz A Koul
- Internal and Pulmonary Medicine Department, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Demirci I, Haymana C, Salman S, Tasci I, Corapcioglu D, Kirik A, Yetkin İ, Altay M, Sabuncu T, Bayram F, Satman I, Sonmez A, TEMD Study Group. Rates and associates of influenza and pneumococcus vaccination in diabetes mellitus: A nationwide cross-sectional study (TEMD vaccination study). World J Diabetes 2021; 12:2107-2118. [PMID: 35047124 PMCID: PMC8696642 DOI: 10.4239/wjd.v12.i12.2107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/13/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vaccination against influenza and pneumococcus is effective in reducing morbidity and mortality in patients with diabetes.
AIM To investigate the prevalence of influenza and pneumococcal vaccinations and to search for the independent associates of vaccination in Turkish patients with diabetes.
METHODS In this cross-sectional, nationwide, multicenter study, adult patients with type 1 diabetes (T1DM) (n = 454) and type 2 diabetes (T2DM) (n = 4721), who were under follow-up for at least a year in the outpatient clinics, were consecutively enrolled. Sociodemographic, clinical, and laboratory parameters of patients were recorded. Vaccination histories were documented according to the self-statements of the patients.
RESULTS Patients with T1DM and T2DM had similar vaccination rates for influenza (23.6% vs 21.2%; P = 0.240) and pneumococcus (8% vs 7%; P = 0.451) vaccinations. Longer diabetes duration and older age were the common independent associates of having vaccination for both types of diabetes patients. Higher education level, using statin treatment, and having optimal hemoglobin A1c levels were the common independent associates of influenza and pneumococcal vaccination in patients with T2DM.
CONCLUSION TEMD Vaccination Study shows that patients with T1DM and T2DM had very low influenza and pneumococcal vaccination rates in Turkey. The lower rates of vaccination in certain populations urges the necessity of nationwide vaccination strategies targeting these populations.
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Affiliation(s)
- Ibrahim Demirci
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, Ankara 06190, Turkey
| | - Cem Haymana
- Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital, Ankara 06190, Turkey
| | - Serpil Salman
- Department of Endocrinology and Metabolism, Liv Hospital, Istanbul 34000, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Ankara 06018, Turkey
| | - Demet Corapcioglu
- Department of Endocrinology and Metabolism, Ankara University, Faculty of Medicine, Ankara 06560, Turkey
| | - Ali Kirik
- Department of Internal Medicine, Balıkesir University, Faculty of Medicine, Balikesir 10145, Turkey
| | - İlhan Yetkin
- Department of Endocrinology and Metabolism, Gazi University, Faculty of Medicine, Ankara 06190, Turkey
| | - Mustafa Altay
- Department of Endocrinology and Metabolism, Kecioren Training and Research Hospital, Ankara 06190, Turkey
| | - Tevfik Sabuncu
- Department of Endocrinology and Metabolism, Harran University, Faculty of Medicine, Sanliurfa 63050, Turkey
| | - Fahri Bayram
- Department of Endocrinology and Metabolism, Erciyes University, Faculty of Medicine, Kayseri 38000, Turkey
| | - Ilhan Satman
- Department of Endocrinology and Metabolism, Istanbul University, Faculty of Medicine, Istanbul 34000, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Faculty of Medicine, Ankara 06190, Turkey
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Geerdes-Fenge HF, Klein S, Schuldt HM, Löbermann M, Köller K, Däbritz J, Reisinger EC. Complications of influenza in 272 adult and pediatric patients in a German university hospital during the seasonal epidemic 2017-2018. Wien Med Wochenschr 2021; 172:280-286. [PMID: 34581968 PMCID: PMC8476975 DOI: 10.1007/s10354-021-00884-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
Background The influenza season 2017–2018 of the northern hemisphere was the highest since 2001 and was caused predominantly by influenza B virus. Methods We performed a retrospective analysis of all patients in a university hospital in northern Germany with laboratory-confirmed influenza during the winter season 2017–2018 and analyzed underlying conditions, complications, and outcome. Results A total of 272 cases of influenza were diagnosed: 70 influenza A (25.7%), 201 influenza B (73.9%), and 1 co-infection. Of 182 adults, 145 were hospitalized, 73 developed pneumonia, 11 developed myocardial infarction, two a transient ischemic attack, one a stroke, and one perimyocarditis. Eleven of the 145 hospitalized adult patients (7.6%) died, ten of them because of pneumonia. All of them had preexisting diseases. Pneumonia was associated with a mortality of 13.7%. Underlying cardiac insufficiency was correlated with higher mortality (7/51 with versus 4/126 patients without cardiac insufficiency; p < 0.05). Ninety cases of influenza were diagnosed in 89 children (30 A, 60 B), one child had first influenza B, then influenza A. Twenty-eight children (31%) were hospitalized, 15 children developed one or more complications (lower respiratory tract infections, meningeal irritations, febrile seizures, otitis media, myositis). No child died. Influenza vaccination status was known in 149 adult patients, pneumonia occurred more frequently in non-vaccinated individuals (43/90; 47.8%) than in vaccinated patients (18/59; 30.5%, p < 0.05). Conclusion Patients with influenza should be monitored for secondary pneumonia and myocardial infarction, and vaccination should be enforced especially in patients with coronary heart disease and cardiac insufficiency.
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Affiliation(s)
- Hilte F Geerdes-Fenge
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Saskia Klein
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Hans-Martin Schuldt
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Micha Löbermann
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Kerstin Köller
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre, Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Jan Däbritz
- Department of Paediatrics, Rostock University Medical Centre, Ernst-Heydemann-Str. 8, 18057, Rostock, Germany
| | - Emil Christian Reisinger
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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40
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Lee JL, Foschini L, Kumar S, Juusola J, Liska J, Mercer M, Tai C, Buzzetti R, Clement M, Cos X, Ji L, Kanumilli N, Kerr D, Montanya E, Müller-Wieland D, Ostenson CG, Skolnik N, Woo V, Burlet N, Greenberg M, Samson SI. Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial. NPJ Digit Med 2021; 4:138. [PMID: 34535755 PMCID: PMC8448887 DOI: 10.1038/s41746-021-00508-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.
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Affiliation(s)
- J L Lee
- Evidation Health, San Mateo, CA, USA.,Emory University, Atlanta, GA, USA
| | | | - S Kumar
- Evidation Health, San Mateo, CA, USA
| | - J Juusola
- Evidation Health, San Mateo, CA, USA
| | | | - M Mercer
- Sanofi Pasteur, Swiftwater, PA, USA
| | - C Tai
- Evidation Health, San Mateo, CA, USA
| | - R Buzzetti
- Sapienza University of Rome, Rome, Italy
| | - M Clement
- University of British Columbia, Armstrong, British Columbia, Canada
| | - X Cos
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary and Hospital Innovation Department, Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - L Ji
- Peking University People's Hospital, Beijing, China
| | | | - D Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - E Montanya
- Hospital Universitari Bellvitge-IDIBELL, CIBERDEM and University of Barcelona, Barcelona, Spain
| | | | | | - N Skolnik
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Woo
- University of Manitoba, Winnipeg, Canada
| | - N Burlet
- Sanofi, Paris, France.,Kyowa Kirin International, Marlow, United Kingdom
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Martínez-Baz I, Navascués A, Portillo ME, Casado I, Fresán U, Ezpeleta C, Castilla J. Effect of Influenza Vaccination in Preventing Laboratory-Confirmed Influenza Hospitalization in Patients With Diabetes Mellitus. Clin Infect Dis 2021; 73:107-114. [PMID: 32412600 DOI: 10.1093/cid/ciaa564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with diabetes are at high risk of severe influenza complications. The influenza vaccination effect among diabetic patients remains inconclusive. We estimated the average effect of influenza vaccination status in the current and prior seasons in preventing laboratory-confirmed influenza hospitalization in diabetic patients. METHODS Patients attended in hospitals and primary healthcare centers with influenza-like illness were tested for influenza from the 2013-2014 to 2018-2019 seasons in Navarre, Spain. A test-negative case-control design in diabetic inpatients compared the influenza vaccination status in the current and 5 prior seasons between laboratory-confirmed influenza cases and negative controls. Vaccination status of influenza-confirmed cases was compared between diabetic inpatients and outpatients. Influenza vaccination effect was compared between diabetic patients and older (≥ 60 years) or chronic nondiabetic patients. RESULTS Of 1670 diabetic inpatients tested, 569 (34%) were confirmed for influenza and 1101 were test-negative controls. The average effect in preventing influenza hospitalization was 46% (95% confidence interval [CI], 28%-59%) for current-season vaccination and 44% (95% CI, 20%-61%) for vaccination in prior seasons only in comparison to unvaccinated patients in the current and prior seasons. Among diabetic patients with confirmed influenza, current-season vaccination reduced the probability of hospitalization (adjusted odds ratio, 0.35; 95% CI, .15-.79). In diabetic patients, vaccination effect against influenza hospitalizations was not inferior to that in older or chronic nondiabetic patients. CONCLUSIONS On average, influenza vaccination of diabetic population reduced by around half the risk of influenza hospitalization. Vaccination in prior seasons maintained a notable protective effect. These results reinforce the recommendation of influenza vaccination for diabetic patients.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Navascués
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - María Eugenia Portillo
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Ezpeleta
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Equitable and Holistic Public Health Measures During the Singaporean COVID-19 Pandemic. Ann Glob Health 2021; 87:45. [PMID: 34046308 PMCID: PMC8139311 DOI: 10.5334/aogh.3244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic. The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.
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43
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Mahmood A, Kim H, Kabir U, Kedia S, Ray M. Food Insecurity and Influenza and Pneumonia Vaccines Uptake Among Community-Dwelling Older Adults in the United States. J Community Health 2021; 45:943-953. [PMID: 32219711 DOI: 10.1007/s10900-020-00812-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Influenza and pneumonia vaccines can reduce morbidities and mortality associated with infectious diseases among older adults. Food security, good nutrition, and high-quality diets are critical for the wellbeing of older adults. However, little is known about the relationship between food insecurity and use of preventive health services, such as influenza and pneumonia vaccinations, among older adults. In this study, we analyzed data on 40,555 adults aged ≥ 65 years from the 2014-2018 National Health Interview Survey in the United States. Through multiple hierarchical logistic regression models, we investigated the associations between food insecurity and influenza and pneumonia vaccines uptake in this population. We found that, during 2014-2018, about 12.6 million (5.3%) adults aged ≥ 65 years lived in food-insecure households in the United States. Of those, 60.6% reported getting an influenza vaccine in the past 12 months, and 54.2% reported ever getting a pneumonia vaccine. Compared to food-secure older adults, food-insecure individuals were not significantly different in terms of influenza vaccine uptake. However, they were 25% less likely to have ever gotten a pneumonia vaccine (adjusted odds ratio = 0.75, 95% CI 0.65-0.86, P < .001). Efforts should be made to develop strategies to improve immunization rates among food-insecure older adults. Healthcare providers could routinely assess their vaccination status and screen them for food insecurity. Also, community level screening and intervention programs should target food-insecure older adults, who often face structural disadvantages. Future studies could explore and identify the underlying predictive factors contributing to low pneumonia vaccination rates among food-insecure older adults.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Robison Hall, 3825 E DeSoto Avenue, Office #136C, Memphis, TN, 38152-3530, USA.
| | - Hyunmin Kim
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Robison Hall, 3825 E DeSoto Avenue, Office #136C, Memphis, TN, 38152-3530, USA.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Umar Kabir
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Robison Hall, 3825 E DeSoto Avenue, Office #136C, Memphis, TN, 38152-3530, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Meredith Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
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Almasri L, Holtzclaw BJ. Assessing Vaccine Protection for Older Adults with Diabetes: A Systematic Review. West J Nurs Res 2021; 44:582-597. [PMID: 33845695 DOI: 10.1177/01939459211005710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immunosenescence and comorbidities increase the susceptibility of older adults with diabetes mellitus (DM) to vaccine-preventable diseases, hospitalization, disability, or death. This systematic review synthesizes research on protecting older adults with DM during pandemics, exploring vaccine safety, tolerance, and vaccination uptake by older adults in anticipation of seasonal influenza outbreaks during the current COVID-19 threat. Addressed were: (a) age-related factors influencing the effectiveness of vaccines against infectious disease in older adults; (b) vaccine safety, tolerance, effectiveness for older persons with DM; and (c) issues affecting older adults accepting immunization recommendations. Medline and CINAHL databases yielded 214 studies with 43 meeting inclusion criteria (32 descriptive and 11 controlled trials). Findings show altered glycemic control stimulates proinflammatory mediators, increasing infection risk, vaccines, and annual revaccinations safely reduce hospitalization rates, mortality outcomes, without affecting glycemic control. However, vaccines fail to evoke optimal antibody responses in older adults. Unawareness, fear of side effects, tend to lower vaccination participation.
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Affiliation(s)
- Leena Almasri
- Donald W. Reynolds Center of Geriatric Nursing Excellence, Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barbara J Holtzclaw
- Donald W. Reynolds Center of Geriatric Nursing Excellence, Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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45
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Pérez-Rubio A, San Román JA, Eiros Bouza JM. The impact of influenza vaccination on cardiovascular disease. Med Clin (Barc) 2021; 157:22-32. [PMID: 33832764 DOI: 10.1016/j.medcli.2021.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 01/03/2023]
Abstract
Influenza infection has been identified as a triggering or exacerbating factor for cardiovascular events. To analyse the effect of influenza vaccination on cardiovascular disease, a systematic search of studies published between 2009-2019 was conducted. All the studies that evaluated the effect of vaccination against influenza on cardiovascular events and their outcome were considered. Finally, 30 of the 1147 identified studies were included. These studies show a protective effect of the influenza vaccine on the development of cardiovascular events (myocardial infarction, cerebrovascular accidents, atrial fibrillation, and heart failure) and on the worsening of these conditions. Furthermore, the data showed that vaccinated patients have a lower risk of death from cardiovascular pathologies. Influenza vaccination is therefore an effective measure in the prevention of cardiovascular diseases both in patients with established cardiovascular disease and in the population without previous coronary pathology.
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46
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Palladino R, Marrie RA, Majeed A, Chataway J. Evaluating the Risk of Macrovascular Events and Mortality Among People With Multiple Sclerosis in England. JAMA Neurol 2021; 77:820-828. [PMID: 32364569 DOI: 10.1001/jamaneurol.2020.0664] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance People with multiple sclerosis (MS) are associated with an increased risk of cardiovascular disease and mortality; however, evidence from population-based studies is sparse. Objective To assess whether the risk of macrovascular events and mortality differs among people with MS compared with a matched population without MS in England. Design, Setting, and Participants A population-based retrospective matched cohort study was conducted in general practices registered with the Clinical Practice Research Datalink in England between January 1, 1987, and September 30, 2018, with a mean (SD) follow-up of 11.3 (6.5) years. A total of 12 251 patients with MS were matched with up to 6 people without MS (n = 72 572) by age, sex, and general practice. People with 3 or more diagnoses of MS recorded during the study period were included. The first MS diagnosis was considered as index date. Exposures Multiple sclerosis status. Analyses were also stratified by sex. Main Outcomes and Measures Main outcomes were acute coronary syndrome, cerebrovascular disease, any macrovascular disease (including peripheral arterial disease), and mortality (all-cause mortality and cardiovascular disease-specific mortality). Cox proportional hazards regression and Fine and Gray proportional subhazard regression models were used to assess differences in rates. Results A total of 12 251 people with MS (66.9% women; mean [SD] age, 44.9 [13.3] years) were matched with 72 572 people without MS (69.8% women; mean [SD] age, 44.9 [13.3] years). As compared with people without MS, people with MS were associated with a 28% increased hazard of acute coronary syndrome (hazard ratio [HR], 1.28; 95% CI, 1.09-1.51), 59% increased hazard of cerebrovascular disease (HR, 1.59; 95% CI, 1.32-1.92), 32% increased hazard of any macrovascular disease (HR, 1.32; 95% CI, 1.15-1.52), 3.5-fold increased hazard of all-cause mortality (HR, 3.46; 95% CI, 3.28-3.65), and 1.5-fold increased hazard in cardiovascular disease mortality (HR, 1.47; 95% CI, 1.27-1.71). Differences in macrovascular events were more pronounced among women than men. Mortality risk was also higher for women than men. Treatment with lipid-lowering medications (mainly statins) was associated with lower mortality rates among people with MS. Conclusions and Relevance This study suggests that MS is associated with an increased risk of cardiovascular and cerebrovascular disease that is not completely accounted for by traditional vascular risk factors. Given the adverse effects of these comorbidities on outcomes in patients with MS, further investigation is needed.
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Affiliation(s)
- Raffaele Palladino
- Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, United Kingdom.,Department of Public Health, Federico II University, Naples, Italy
| | - Ruth Ann Marrie
- Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, United Kingdom
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom.,National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, United Kingdom
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47
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Influence of sexual orientation on diabetes management in US adults with diabetes. DIABETES & METABOLISM 2021; 47:101177. [DOI: 10.1016/j.diabet.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 11/23/2022]
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Nakafero G, Grainge MJ, Myles PR, Mallen CD, Zhang W, Doherty M, Nguyen-Van-Tam JS, Abhishek A. Effectiveness of inactivated influenza vaccine in autoimmune rheumatic diseases treated with disease-modifying anti-rheumatic drugs. Rheumatology (Oxford) 2020; 59:3666-3675. [PMID: 32160295 PMCID: PMC7733714 DOI: 10.1093/rheumatology/keaa078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/28/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The effectiveness of inactivated influenza vaccine in people with autoimmune rheumatic disease (AIRDs) is not known. We investigated whether the influenza vaccine is effective in preventing respiratory morbidity, mortality and all-cause mortality in AIRD patients. METHODS Adults with AIRDs treated with DMARDs prior to 1 September of each year between 2006 and 2009, and 2010 and 2015 were identified from the Clinical Practice Research Datalink. Exposure and outcome data were extracted. Data from multiple seasons were pooled. Propensity score (PS) for vaccination was calculated. Cox-proportional hazard ratios (HRs) and 95% CIs were calculated, and were (i) adjusted, (ii) matched for PS for vaccination. RESULTS Data for 30 788 AIRD patients (65.7% female, 75.5% with RA, 61.1% prescribed MTX) contributing 125 034 influenza cycles were included. Vaccination reduced risk of influenza-like illness [adjusted HR (aHR) 0.70], hospitalization for pneumonia (aHR 0.61) and chronic obstructive pulmonary disease exacerbations (aHR 0.67), and death due to pneumonia (aHR 0.56) on PS-adjusted analysis in the influenza active periods (IAPs). The associations were of similar magnitude and remained statistically significant on PS-matched analysis except for protection from influenza-like illness, which became non-significant. Sub-analysis restricted to pre-IAP, IAP and post-IAP did not yield evidence of residual confounding on influenza-like illness and death due to pneumonia. Vaccination reduced risk of all-cause mortality, although IAP-restricted analysis demonstrated residual confounding for this outcome. CONCLUSION Influenza vaccine associates with reduced risk of respiratory morbidity and mortality in people with AIRDs. These findings call for active promotion of seasonal influenza vaccination in immunosuppressed people with AIRDs by healthcare professionals.
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Affiliation(s)
- Georgina Nakafero
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Matthew J Grainge
- Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham
| | - Puja R Myles
- Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham
| | | | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | | | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
- Nottingham NIHR Biomedical Research Centre, Nottingham, UK
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49
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Edoka I, Kohli-Lynch C, Fraser H, Hofman K, Tempia S, McMorrow M, Ramkrishna W, Lambach P, Hutubessy R, Cohen C. A cost-effectiveness analysis of South Africa's seasonal influenza vaccination programme. Vaccine 2020; 39:412-422. [PMID: 33272702 DOI: 10.1016/j.vaccine.2020.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/02/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Seasonal influenza imposes a significant health and economic burden in South Africa, particularly in populations vulnerable to severe consequences of influenza. This study assesses the cost-effectiveness of South Africa's seasonal influenza vaccination strategy, which involves vaccinating vulnerable populations with trivalent inactivated influenza vaccine (TIV) during routine facility visits. Vulnerable populations included in our analysis are persons aged ≥ 65 years; pregnant women; persons living with HIV/AIDS (PLWHA), persons of any age with underlying medical conditions (UMC) and children aged 6-59 months. METHOD We employed the World Health Organisation's (WHO) Cost Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV), a decision tree model, to evaluate the 2018 seasonal influenza vaccination campaign from a public healthcare provider and societal perspective. CETSIV was populated with existing country-specific demographic, epidemiologic and coverage data to estimate incremental cost-effectiveness ratios (ICERs) by comparing costs and benefits of the influenza vaccination programme to no vaccination. RESULTS The highest number of clinical events (influenza cases, outpatient visits, hospitalisation and deaths) were averted in PLWHA and persons with other UMCs. Using a cost-effectiveness threshold of US$ 3400 per quality-adjusted life year (QALY), our findings suggest that the vaccination programme is cost-effective for all vulnerable populations except for children aged 6-59 months. ICERs ranged from ~US$ 1 750 /QALY in PLWHA to ~US$ 7500/QALY in children. In probabilistic sensitivity analyses, the vaccination programme was cost-effective in pregnant women, PLWHA, persons with UMCs and persons aged ≥65 years in >80% of simulations. These findings were robust to changes in many model inputs but were most sensitive to uncertainty in estimates of influenza-associated illness burden. CONCLUSION South Africa's seasonal influenza vaccination strategy of opportunistically targeting vulnerable populations during routine visits is cost-effective. A budget impact analysis will be useful for supporting future expansions of the programme.
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Affiliation(s)
- Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather Fraser
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; MassGenics, Duluth, GA, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; US Public Health Service, Rockville, MD, USA
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, South Africa
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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50
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Protective effect of influenza vaccination on cardiovascular diseases: a systematic review and meta-analysis. Sci Rep 2020; 10:20656. [PMID: 33244069 PMCID: PMC7692477 DOI: 10.1038/s41598-020-77679-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are among the leading causes of mortality and morbidity worldwide. There are many contrasting ideas on the effectiveness of influenza vaccination on CVDs. This study aimed to investigate the association between influenza vaccination and the risk of CVDs. We systematically searched all PubMed/Medline, EMBASE, and the Cochrane library entries up to November 2019 for studies of influenza vs. the CVDs outcomes. We conducted a random-effects meta‐analysis using the inverse variance method for pooled risk ratios (RR) or odds ratios (OR) and evaluated statistical heterogeneity using the I2 statistic. We identified 17 studies (6 randomized controlled trial [RCT], 5 cohorts, and 6 case–control) with a total of 180,043 cases and 276,898 control participants. The pooled RR of developing CVDs after influenza vaccination in RCT studies was 0.55 (95% CI 0.41–0.73), which was significant (P-value = 0.00). The pooled OR of decreasing CVDs after influenza vaccination in cohort studies was 0.89 (95% CI 0.77–1.04). The pooled OR of developing CVDs after influenza vaccination by pooling case–control studies was 0.70 (95% CI 0.57–0.86, (P-value = 0.00). All of these studies suggest decreased risks of CVDs with influenza vaccination. The current study does support the protective role of influenza vaccination on CVDs events. Health authorities may develop evidence-based preventive strategies to offer influenza vaccination in patients with CVDs.
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