住院社区获得性肺炎成人的肺炎球菌和流感疫苗接种状况及其对临床症状的影响。
Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation.
机构信息
a Uludağ University Faculty of Medicine , Department of Pulmonary Diseases , Bursa , Turkey.
b Ege University Faculty of Medicine , Department of Pulmonary Diseases , İzmir , Turkey.
出版信息
Hum Vaccin Immunother. 2017 Sep 2;13(9):2072-2077. doi: 10.1080/21645515.2017.1339851. Epub 2017 Jul 14.
BACKGROUND
Previous reports have shown that vaccination rates of adult at-risk populations are low in Turkey. There are differing reports with regards to the effectiveness of the influenza and the pneumococcal polysaccharide vaccine (PPSV23) on the clinical outcomes of community acquired pneumonia (CAP). The purpose of this study was to analyze the influenza (FV) and pneumococcal vaccination (PV) status, the factors that influence the receipt of influenza/pneumococcal vaccine and the effects of prior vaccination on the clinical outcomes in adults hospitalized with CAP.
PATIENTS AND METHODS
Patients hospitalized with CAP between March 2009 and October 2013 and registered at the web-based Turkish Thoracic Society Pneumonia Database (TURCAP) were included in this multicentric, observational study. Of a total of 787 cases, data were analyzed for 466 patients for whom self-reported information on PV and FV was available.
RESULTS
In this adult population with CAP, the vaccination rate with both the pneumococcal and influenza vaccines was found to be 6%. Prior FV was found to be the sole variable that was associated with the receipt of PV [OR 17.8, 95% CI (25-75:8.56-37.01), p < 0.001]. Conversely, being vaccinated with PPSV23 was the only predictor of receipt of FV [OR 18.1, 95% CI (25 - 75:8.75 - 37.83), p < 0.001]. Compared to the unvaccinated cases, the chest radiograms of the vaccinated patients revealed less consolidation. The latter also reported fatigue, muscle pain and gastrointestinal symptoms less frequently. Although there was a trend for lower 30-day mortality and for lower rates of intensive care unit (ICU) admission, these did not reach statistical significance. A pneumonia severity index (PSI) score ≥ 90, CURB-65 score ≥3 and multilobar involvement, but not the vaccination status, were identified as independent determinants of ICU admission.
CONCLUSIONS
This study showed that, among patients hospitalized with CAP, the FV and/or PV rates are low. Prior vaccination does not appear to significantly affect the clinical outcomes.
背景
先前的报告表明，土耳其的高危成年人群的疫苗接种率较低。关于流感和肺炎球菌多糖疫苗（PPSV23）对社区获得性肺炎（CAP）临床结果的有效性，存在不同的报告。本研究的目的是分析流感（FV）和肺炎球菌疫苗（PV）接种状况、影响流感/肺炎球菌疫苗接种的因素以及既往接种对 CAP 住院成人临床结局的影响。
方法
本多中心、观察性研究纳入了 2009 年 3 月至 2013 年 10 月期间在基于网络的土耳其胸科学会肺炎数据库（TURCAP）登记的 CAP 住院患者。在总共 787 例患者中，对其中 466 例提供了 PV 和 FV 自我报告信息的患者进行了数据分析。
结果
在 CAP 的成年人群中，发现肺炎球菌和流感疫苗的接种率均为 6%。既往 FV 是唯一与 PV 接种相关的变量[比值比（OR）17.8，95%置信区间（CI）（25-75：8.56-37.01），p<0.001]。相反，接种 PPSV23 是接受 FV 的唯一预测因素[OR 18.1，95%CI（25-75：8.75-37.83），p<0.001]。与未接种的病例相比，接种疫苗的患者的胸部 X 光片显示的实变影较少。后者也较少报告疲劳、肌肉疼痛和胃肠道症状。尽管 30 天死亡率和重症监护病房（ICU）入住率有下降趋势，但未达到统计学意义。肺炎严重指数（PSI）评分≥90、CURB-65 评分≥3 和多叶受累，但不是疫苗接种状态，被确定为 ICU 入住的独立决定因素。
结论
本研究表明，在 CAP 住院患者中，FV 和/或 PV 接种率较低。既往接种似乎不会显著影响临床结局。
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