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Lower risk of respiratory-related hospitalization after high-dose influenza vaccination in the elderly

Roshini Claire Anthony
01 Aug 2017

Elderly individuals residing in nursing homes had a lower risk of respiratory-related hospital admissions during the influenza season after receiving a high-dose influenza vaccine compared with a standard-dose vaccine, a recent study found.

Eight hundred and twenty three nursing care facilities in the US participated in the study. Individuals aged ≥65 years (mean age 83.6 years, 72 percent female) who had been living in the nursing homes for ≥90 days were randomized to receive either high-dose (60 µg antigen per virus strain; n=26,639) or standard-dose (15 µg antigen per virus strain; n=26,369) influenza vaccine for the 2013–2014 influenza season.

Hospital admission due to respiratory issues was lower among patients who received the high-dose vaccine compared with the standard-dose vaccine (0.185 vs 0.211 per 1,000 resident-days; adjusted relative risk [adjRR], 0.873, 95 percent confidence interval [CI], 0.776–0.982; p=0.023). [Lancet Respir Med 2017;doi:10.1016/S2213-2600(17)30235-7]

Pneumonia- related hospital admissions were also reduced among individuals receiving the high-dose vaccine compared with the standard dose (0.067 vs 0.084 per 1,000 resident-days; adjRR, 0.791, 95 percent CI, 0.267–0.953; p=0.013), as were all-cause admissions (1.021 vs 1.113 per 1,000 resident-days; adjRR, 0.915, 95 percent CI, 0.863–0.970; p=0.0028), while all-cause mortality rate was not affected by vaccine dose (p=0.57).

The reduction in all-cause admission suggests that the impact of the high-dose vaccine extends beyond that of influenza-related respiratory conditions, said the researchers. 

“Establishing improved vaccine effectiveness in a nursing home population is noteworthy, considering this population typically has a reduced vaccine response because of immune senescence and multiple morbidities, and are at a high risk for being admitted to hospital for multiple reasons, in addition to respiratory illness,” said the researchers.

“[S]tandard-dose inactivated influenza vaccines ... are known to be less immunogenic in older adults than in healthier, younger adults,” commented Drs Marc-Alain Widdowson and Joseph Bresee from the US Centers for Disease Control and Prevention, in Nairobi, Kenya, and Atlanta, Georgia, US, respectively. [Lancet Respir Med 2017;doi:10.1016/S2213-2600(17)30290-4]

“[T]his study presents strong evidence that influenza has a major role in seasonal hospital admissions of older nursing home residents ... it seems that high-dose influenza vaccines can reduce this burden substantially better than a standard-dose vaccine,” they said.

However, the researchers cautioned that the main circulating virus strain during the 2013–2014 influenza season was A(H1N1)pdm09, a strain that is considered less virulent than the A/H3N2 strains, and which may have affected the findings, particularly among the elderly population.

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Most Read Articles
22 May 2017
Chronic obstructive pulmonary disease (COPD) is currently the 10th commonest cause of death in Singapore, with a disease burden of 5.9 percent according to a 2015 population-based survey (EPIC-Asia survey) in Singapore. Pearl Toh spoke with Dr Augustine Tee, chief and senior consultant of the Department of Respiratory and Critical Care Medicine at Changi General Hospital (CGH) in Singapore, on how COPD is often underdetected in the primary care population as symptoms are not specific and diagnosis requires a combination of clinical risk factors, symptoms and spirometry testing.
15 Aug 2017
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04 Aug 2017
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11 May 2016

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