Department of Medicine and Geriatrics, Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, China.
Vaccine. 2011 Oct 13;29(44):7773-8. doi: 10.1016/j.vaccine.2011.07.112. Epub 2011 Aug 5.
The influenza A (H1N1) 2009 pandemic was declared by the WHO in April 2009. In Hong Kong, the vaccination program began in December 2009 in addition to the annual seasonal trivalent influenza vaccination program. The clinical efficacy of dual vaccination was unknown.
From December 2009 to November 2010, a prospective 12-month cohort study on institutionalized elderly of nine nursing homes was conducted. Elderly persons who were followed up by the Hong Kong West Community Geriatric Assessment Team and had been vaccinated by the Department of Health were included. Outcome measures included all cause mortality, all cause hospitalization, hospitalization for fever on admission and hospitalization for pneumonia based on ICD-9-CM.
711 elderly persons were included. 274 received both seasonal influenza vaccine and (H1N1) 2009 vaccine (H1N1-TIV), 368 received seasonal influenza vaccine only (TIV alone) and 69 received no vaccination (unvaccinated). Baseline characteristics were well matched between the groups, except there were fewer females in the TIV alone. The 12-month mortality rates of the H1N1-TIV, TIV alone and unvaccinated were 10.6%, 19.8% and 29%, respectively. Multivariate analysis demonstrated that dual vaccination in the institutionalized elderly significantly reduced all cause mortality by 54% (Hazard Ratio [HR] 0.46; 95% confidence interval [CI] 0.29-0.72; p<0.001) and 74% (HR 0.26; CI 0.13-0.49; p<0.001), compared with vaccination of seasonal vaccination alone and no vaccination, respectively. Dual vaccination also reduced all cause hospitalization, hospitalization for fever on admission and hospitalization for pneumonia compared with seasonal vaccination alone and the unvaccinated group.
Dual vaccination with both H1N1 and seasonal vaccinations provided additional protection to institutionalized elderly in reducing mortality and hospitalization.
世界卫生组织于 2009 年 4 月宣布甲型 H1N1 流感大流行。在香港，除了每年的季节性三价流感疫苗接种计划外，还于 2009 年 12 月开始了疫苗接种计划。双重疫苗接种的临床效果尚不清楚。
2009 年 12 月至 2010 年 11 月，对 9 家养老院的机构老年人进行了为期 12 个月的前瞻性队列研究。该研究纳入了由香港西区社区老年评估小组进行随访且接受卫生署疫苗接种的老年人。结局指标包括全因死亡率、全因住院率、入院时发热住院率和基于 ICD-9-CM 的肺炎住院率。
共纳入 711 名老年人。其中 274 人同时接种了季节性流感疫苗和（H1N1）2009 疫苗（H1N1-TIV），368 人仅接种了季节性流感疫苗（TIV 组），69 人未接种疫苗（未接种组）。除 TIV 组女性人数较少外，各组的基线特征差异无统计学意义。H1N1-TIV、TIV 组和未接种组的 12 个月死亡率分别为 10.6%、19.8%和 29%。多变量分析表明，与单独接种季节性疫苗相比，机构老年人双重疫苗接种可使全因死亡率分别降低 54%（风险比[HR]0.46；95%置信区间[CI]0.29-0.72；p<0.001）和 74%（HR 0.26；CI 0.13-0.49；p<0.001）；与未接种疫苗相比，双重疫苗接种也降低了全因住院率、入院时发热住院率和肺炎住院率。
同时接种 H1N1 和季节性疫苗可为机构老年人提供额外的保护，降低死亡率和住院率。
