Grijalva Carlos G, Zhu Yuwei, Williams Derek J, Self Wesley H, Ampofo Krow, Pavia Andrew T, Stockmann Chris R, McCullers Jonathan, Arnold Sandra R, Wunderink Richard G, Anderson Evan J, Lindstrom Stephen, Fry Alicia M, Foppa Ivo M, Finelli Lyn, Bramley Anna M, Jain Seema, Griffin Marie R, Edwards Kathryn M
Vanderbilt University School of Medicine, Nashville, Tennessee2Geriatric Research Education Clinical Center (GRECC), VA Tennessee Valley, Nashville.
Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA. 2015 Oct 13;314(14):1488-97. doi: 10.1001/jama.2015.12160.
Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection.
To assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia.
DESIGN, SETTING, AND PARTICIPANTS: The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 at 4 US sites. In this case-control study, we used EPIC data from patients 6 months or older with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (case) and influenza-negative (control) patients with pneumonia, controlling for demographics, comorbidities, season, study site, and timing of disease onset. Vaccine effectiveness was estimated as (1 - adjusted odds ratio) × 100%.
Influenza vaccination, verified through record review.
Influenza pneumonia, confirmed by real-time reverse-transcription polymerase chain reaction performed on nasal/oropharyngeal swabs.
Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) had laboratory-confirmed influenza. Twenty-eight of 162 cases (17%) with influenza-associated pneumonia and 766 of 2605 controls (29%) with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI, 0.28-0.68; estimated vaccine effectiveness, 56.7%; 95% CI, 31.9%-72.5%).
Among children and adults hospitalized with community-acquired pneumonia, those with laboratory-confirmed influenza-associated pneumonia, compared with those with pneumonia not associated with influenza, had lower odds of having received influenza vaccination.
很少有研究评估流感疫苗接种与肺炎（流感感染的一种严重并发症）之间的关系。
评估流感疫苗接种状况与社区获得性实验室确诊流感肺炎住院治疗之间的关联。
设计、地点和参与者：社区肺炎病因（EPIC）研究是一项前瞻性观察性多中心研究，于2010年1月至2012年6月在美国4个地点对社区获得性肺炎住院患者进行。在这项病例对照研究中，我们使用了来自6个月及以上实验室确诊流感感染且在流感季节期间疫苗接种状况得到核实的患者的EPIC数据，并排除了近期住院、来自长期护理居住设施以及有严重免疫抑制的患者。采用逻辑回归计算比值比，比较肺炎流感阳性（病例）和流感阴性（对照）患者之间的疫苗接种几率，并对人口统计学、合并症、季节、研究地点和疾病发病时间进行控制。疫苗效力估计为（1 - 调整后的比值比）×100%。
通过记录审查核实的流感疫苗接种情况。
通过对鼻/咽拭子进行实时逆转录聚合酶链反应确诊的流感肺炎。
总体而言，2767名因肺炎住院的患者符合研究条件；162例（5.9%）有实验室确诊的流感。162例流感相关肺炎病例中有28例（17%）以及2605例流感阴性肺炎对照中有766例（29%）接种过疫苗。病例组和对照组之前流感疫苗接种的调整后比值比为0.43（95%可信区间，0.28 - 0.68；估计疫苗效力，56.7%；95%可信区间，31.9% - 72.5%）。
在因社区获得性肺炎住院的儿童和成人中，与非流感相关肺炎患者相比，实验室确诊为流感相关肺炎的患者接种流感疫苗的几率较低。
