The Importance of Frailty in the Assessment of Influenza Vaccine Effectiveness Against Influenza-Related Hospitalization in Elderly People

被引：125

作者：

Andrew, Melissa K. ^{[1
,2
]}

Shinde, Vivek ^{[3
,20
]}

Ye, Lingyun ^{[1
,2
]}

Hatchette, Todd ^{[1
,2
]}

Haguinet, Francois ^{[3
]}

Dos Santos, Gael ^{[4
,21
]}

McElhaney, Janet E. ^{[5
]}

Ambrose, Ardith ^{[1
,2
]}

Boivin, Guy ^{[6
]}

Bowie, William ^{[7
]}

Chit, Ayman ^{[8
,9
]}

ElSherif, May ^{[1
,2
]}

Green, Karen ^{[10
]}

Halperin, Scott ^{[1
,2
]}

Ibarguchi, Barbara ^{[11
,22
]}

Johnstone, Jennie ^{[12
]}

Katz, Kevin ^{[13
]}

Langley, Joanne ^{[1
,2
]}

Leblanc, Jason ^{[1
,2
]}

Loeb, Mark ^{[12
]}

MacKinnon-Cameron, Donna ^{[1
,2
]}

McCarthy, Anne ^{[14
]}

McGeer, Allison ^{[10
]}

Powis, Jeff ^{[15
]}

Richardson, David ^{[16
]}

Semret, Makeda ^{[17
]}

Stiver, Grant ^{[7
]}

Trottier, Sylvie ^{[6
]}

Valiquette, Louis ^{[18
]}

Webster, Duncan ^{[19
]}

McNeil, Shelly A. ^{[1
,2
]}

机构：

[1] Dalhousie Univ, Canadian Ctr Vaccinol, IWK Hlth Ctr, Halifax, NS, Canada

[2] Dalhousie Univ, Nova Scotia Hlth Author, Halifax, NS, Canada

[3] GlaxoSmithKline GSK, King Of Prussia, PA USA

[4] Business & Decis Life Sci, Brussels, Belgium

[5] Hlth Sci North Res Inst, Sudbury, ON, Canada

[6] Ctr Hosp Univ Quebec, Quebec City, PQ, Canada

[7] Univ British Columbia, Vancouver, BC, Canada

[8] Sanofi Pasteur, Swiftwater, PA USA

[9] Univ Toronto, Leslie Dan Fac Pharm, Toronto, ON, Canada

[10] Mt Sinai Hosp, Toronto, ON, Canada

[11] GSK Vaccines, Mississauga, ON, Canada

[12] McMaster Univ, Hamilton, ON, Canada

[13] North York Gen Hosp, Toronto, ON, Canada

[14] Ottawa Hosp, Toronto, ON, Canada

[15] Michael Garron Hosp, Toronto, ON, Canada

[16] William Osler Hlth Syst, Brampton, ON, Canada

[17] McGill Univ, Montreal, PQ, Canada

[18] Univ Sherbrooke, Sherbrooke, PQ, Canada

[19] Horizon Hlth, St John, NB, Canada

[20] Novavax Vaccines, Washington, DC USA

[21] GSK, Wavre, Belgium

[22] Bayer Inc, Mississauga, ON, Canada

来源：

JOURNAL OF INFECTIOUS DISEASES | 2017年 / 216卷 / 04期

基金：

加拿大健康研究院;

关键词：

influenza; vaccine effectiveness; elderly; frailty; hospitalization; ADULTS; NETWORK; COHORT;

D O I：

10.1093/infdis/jix282

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

071005 [微生物学]; 100108 [医学免疫学];

摘要：

Background. Influenza is an important cause of morbidity and mortality among older adults. Even so, effectiveness of influenza vaccine for older adults has been reported to be lower than for younger adults, and the impact of frailty on vaccine effectiveness (VE) and outcomes is uncertain. We aimed to study VE against influenza hospitalization in older adults, focusing on the impact of frailty. Methods. We report VE of trivalent influenza vaccine (TIV) in people >= 65 years of age hospitalized during the 2011-2012 influenza season using a multicenter, prospective, test-negative case-control design. A validated frailty index (FI) was used to measure frailty. Results. Three hundred twenty cases and 564 controls (mean age, 80.6 and 78.7 years, respectively) were enrolled. Cases had higher baseline frailty than controls (P =.006). In the fully adjusted model, VE against influenza hospitalization was 58.0% (95% confidence interval [CI], 34.2%-73.2%). The contribution of frailty was important; adjusting for frailty alone yielded a VE estimate of 58.7% (95% CI, 36.2%-73.2%). VE was 77.6% among nonfrail older adults and declined as frailty increased. Conclusions. Despite commonly held views that VE is poor in older adults, we found that TIV provided good protection against influenza hospitalization in older adults who were not frail, though VE diminished as frailty increased.

引用

页码：405 / 414

页数：10

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