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Table 4 Effectiveness outcomes, mortality and hospitalisation, after seasonal influenza vaccination in COPD patients

From: Seasonal influenza vaccination in patients with COPD: a systematic literature review

Reference
(Country)
Study design Influenza season n Subgroup analysis Effectiveness outcome Comment
      Mortality  
Schembri et al., 2009 [42]
(UK)
Database study 1988–2006a 40,741   RR (95% CI) all-cause
0.59 (0.57–0.61)
Mortality rates were higher in years when the influenza vaccine did not include all strains circulating during that season (RR 1.19, 95% CI 1.13–1.25).
  RR (95% CI) death associated with respiratory event
0.63 (0.58–0.68)
  RR (95% CI) with respiratory event recorded as cause of death
0.63 (0.55–0.77)
Vila-Córcoles et al., 2008 [41]
(Spain)
Prospective cohort study     HR (95% CI) all-cause Mild-moderate influenza activity during the study. Mixed circulation of influenza A and B, with generally good matches with vaccine strains
2002 1,298   0.48 (0.22–1.04)
2003 1,233   0.79 (0.37–1.60)
2004 1,149   0.95 (0.48–2.03)
2005 1,050   0.87 (0.43–1.77)
All seasons -   0.76 (0.52–1.06)
Wang et al., [12]
(Taiwan)
Retrospective population-based cohort study 2001 102,698 elderly   RR (95% CI) with COPD recorded as cause of death Good match between epidemic strains and vaccine strains [55]
High-riskb 0.45 (0.32–0.63)
Low-risk 0.47 (0.26–0.83)
      Hospitalisation  
Chen et al., 2013c [45]
(Taiwan)
Retrospective, Database study 2000–2007a   Gender HR (95% CI) due to heart failure Good match between epidemic strains and vaccine strains except for 2001–02 (B mismatch), 2003–04 (A/H3N2 mismatch) [55]
11,749 Female 0.48 (0.33–0.68)
13,860 Male 0.42 (0.32–0.57)
  Age groups HR (95% CI) due to heart failure
13,218 ≤44 years 3.96 (0.50–31.11)
4,669 45–54 years 2.67 (0.95–7.50)
3,455 55–64 years 0.65 (0.38–1.10)
2,854 65–74 years 0.37 (0.26–0.52)
1,413 ≥75 years 0.38 (0.26–0.55)
25,609 All subjects 0.44 (0.35–0.55)
Sung et al., 2014c [46]
(Taiwan)
Retrospective, Database study 2000–2007a 7,722 ≥ 55 years HR (95% CI) due to acute coronary syndrome As above
Influenza season 0.45 (0.35–0.57)
Non-influenza season 0.48 (0.37–0.62)
All seasons 0.46 (0.39–0.55)
Menon et al., 2008 [43]
(India, New Delhi)
Self-controlled case series 2004–2006   COPD severity RR (p-value) post-vaccination year compared to pre-vaccination year
Hospitalisation
Poorly matched seasons in 2005 and 2006 for influenza A strains (data for Kolkata) [56].
32 Mild 0.33 (0.31)
17 Moderate 0.5 (0.41)
38 Severe 0.14 (0.15)
87 Total 0.28 (0.02)
   ARI
32 Mild 0.4 (0.26)
17 Moderate 0.4 (0.21)
38 Severe 0.25 (0.02)
87 Total 0.33 (0.005)
Montserrat-Capdevila et al., 2014 [44]
(Spain)
Retrospective cohort study 2011–2012   COPD severity OR (95% CI) due to COPD exacerbations Moderately severe influenza season. Moderate-to good matches for predominant circulating A/H1N1 and A/H3N2 viruses. Poor match for type B [14]
1,099 Mild 0.083 (0.042–0.163)
108 Moderate 0.133 (0.021–0.844)
62 Severe 0.305 (0.024–3.813)
54 Very severe 0.067 (0.009–0.505)
1,323 Total 0.092 (0.052–0.165)
  1. CI confidence interval, COPD chronic obstructive disease, HR hazard ratio, n number of subjects, OR odds ratio, RR relative risk, UK United Kingdom
  2. Disease severity by Menon et al., 2008: mild: FEV1 > 70% predicted; moderate: FEV1 = 50–69% predicted; severe: FEV1 < 50% predicted. Disease severity by Montserrat-Capdevila et al., 2014: mild: FEV1 > 80% predicted; moderate: FEV1 = 50–80% predicted; severe: FEV130–50% predicted; very severe: FEV1 < 30% predicated
  3. aData from different influenza seasons were not separately analysed
  4. bHigh risk defined as recent hospital admission or chronic disease
  5. cIn the study of Sung et al., 2014 a subpopulation of Chen et al., 2014 is used