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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
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BMC Pulmonary Medicine

ISSN: 1471-2466

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