2012 - 2013年及2013 - 2014年期间，高剂量与标准剂量流感疫苗在美国医疗保险受益人群中预防流感后死亡的比较效果

Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012-2013 and 2013-2014.

作者信息

Shay David K, Chillarige Yoganand, Kelman Jeffrey, Forshee Richard A, Foppa Ivo M, Wernecke Michael, Lu Yun, Ferdinands Jill M, Iyengar Arjun, Fry Alicia M, Worrall Chris, Izurieta Hector S

机构信息

Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Acumen LLC, Burlingame, California, USA.

出版信息

J Infect Dis. 2017 Feb 15;215(4):510-517. doi: 10.1093/infdis/jiw641.

DOI:10.1093/infdis/jiw641

PMID:28329311

Abstract

BACKGROUND

Recipients of high-dose vs standard-dose influenza vaccines have fewer influenza illnesses. We evaluated the comparative effectiveness of high-dose vaccine in preventing postinfluenza deaths during 2012-2013 and 2013-2014, when influenza viruses and vaccines were similar.

METHODS

We identified Medicare beneficiaries aged ≥65 years who received high-dose or standard-dose vaccines in community-located pharmacies offering both vaccines. The primary outcome was death in the 30 days following an inpatient or emergency department encounter listing an influenza International of Classification of Diseases, Ninth Revision, Clinical Modification code. Effectiveness was estimated by using multivariate Poisson regression models; effectiveness was allowed to vary by season.

RESULTS

We studied 1039645 recipients of high-dose and 1683264 recipients of standard-dose vaccines during 2012-2013, and 1508176 high-dose and 1877327 standard-dose recipients during 2013-2014. Vaccinees were well-balanced for medical conditions and indicators of frail health. Rates of postinfluenza death were 0.028 and 0.038/10000 person-weeks in high-dose and standard-dose recipients, respectively. Comparative effectiveness was 24.0% (95% confidence interval [CI], .6%-42%); there was evidence of variation by season (P = .12). In 2012-2013, high-dose was 36.4% (95% CI, 9.0%-56%) more effective in reducing mortality; in 2013-2014, it was 2.5% (95% CI, -47% to 35%).

CONCLUSIONS

High-dose vaccine was significantly more effective in preventing postinfluenza deaths in 2012-2013, when A(H3N2) circulation was common, but not in 2013-2014.

摘要

背景

与标准剂量流感疫苗的接种者相比，高剂量流感疫苗的接种者患流感疾病的情况较少。我们评估了在2012 - 2013年和2013 - 2014年（当时流感病毒和疫苗相似）期间，高剂量疫苗预防流感后死亡的相对有效性。

方法

我们确定了年龄≥65岁且在同时提供两种疫苗的社区药房接种高剂量或标准剂量疫苗的医疗保险受益人。主要结局是在列出国际疾病分类第九版临床修订本流感代码的住院或急诊科就诊后30天内的死亡情况。通过使用多变量泊松回归模型估计有效性；有效性允许因季节而异。

结果

在2012 - 2013年期间，我们研究了1039645名高剂量疫苗接种者和1683264名标准剂量疫苗接种者，在2013 - 2014年期间，研究了1508176名高剂量疫苗接种者和1877327名标准剂量疫苗接种者。疫苗接种者在医疗状况和健康脆弱指标方面均衡良好。高剂量和标准剂量接种者的流感后死亡率分别为0.028和0.038/10000人周。相对有效性为24.0%（95%置信区间[CI]，0.6% - 42%）；有证据表明存在季节差异（P = 0.12）。在2012 - 2013年，高剂量疫苗在降低死亡率方面的有效性高36.4%（95%CI，9.0% - 56%）；在2013 - 2014年，为2.5%（95%CI， - 47%至35%）。