NoviSci, LLC, Durham, NC, United States.
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States; RTI Health Solutions, Research Triangle Park, NC, United States.
Vaccine. 2018 Oct 1;36(41):6087-6094. doi: 10.1016/j.vaccine.2018.08.079. Epub 2018 Sep 6.
Standard influenza vaccines may be of limited benefit to patients with end-stage renal disease (ESRD). These patients may benefit from high-dose influenza vaccine, currently indicated for patients aged ≥65 years. Studies in other populations have demonstrated that high-dose vaccine elicits a stronger immunological response. We compared vaccine uptake in the United States and predictors of receipt for high-dose and standard influenza vaccines.
Using data from the United States Renal Data System (2010-2013), we conducted a cohort study of 421,482 adult patients on hemodialysis. We examined temporal trends in uptake of high-dose or standard trivalent influenza vaccine each influenza season, and used multivariate logistic regression to assess the association between individual-level variables (e.g., demographics, comorbidities) and facility-level variables (e.g., facility size and type) with vaccine receipt.
The proportion of patients with ESRD who were vaccinated with any influenza vaccine increased from 68.3% in 2010 to 72.4% in 2013. High-dose vaccines were administered to 0.9% of patients during the study period, and 16.7% of high-dose vaccines were administered to patients <65 years of age. Among patients aged ≥65 years, older patients (>79 vs. 65-69 years: OR, 1.29; 95% CI, 1.19-1.41) and patients at hospital-based versus free-standing dialysis facilities (OR, 2.31; 95% CI, 2.13-2.45) were more likely to receive high-dose vaccine, while blacks (vs. whites [OR, 0.66; 95% CI, 0.61-0.71]) and patients with longer duration of ESRD (>9 vs. 0 years: OR, 0.66; 95% CI, 0.55-0.78) were less likely to receive the high-dose vaccine.
While the overall influenza vaccination rate has increased, use of high-dose vaccine among patients with ESRD was very low. Being an older patient, living in the Midwest, and receiving care at hospital-based facilities were the strongest predictors of receiving high-dose vaccine.
标准流感疫苗对终末期肾病（ESRD）患者的效果可能有限。这些患者可能受益于高剂量流感疫苗，目前适用于≥65 岁的患者。其他人群的研究表明，高剂量疫苗会引发更强的免疫反应。我们比较了美国的疫苗接种率以及高剂量和标准流感疫苗接种的预测因素。
我们使用美国肾脏数据系统（2010-2013 年）的数据，对 421482 名接受血液透析的成年患者进行了队列研究。我们检查了每个流感季节高剂量或标准三价流感疫苗接种率的时间趋势，并使用多变量逻辑回归来评估个体水平变量（例如，人口统计学，合并症）和设施水平变量（例如，设施规模和类型）与疫苗接种率之间的关联。
患有 ESRD 的患者中接受任何流感疫苗接种的比例从 2010 年的 68.3%增加到 2013 年的 72.4%。在研究期间，为 0.9%的患者接种了高剂量疫苗，而 16.7%的高剂量疫苗接种给了<65 岁的患者。在≥65 岁的患者中，年龄较大的患者（>79 岁与 65-69 岁：比值比，1.29；95%置信区间，1.19-1.41）和在医院为基础的透析设施中接受治疗的患者（比值比，2.31；95%置信区间，2.13-2.45）更有可能接种高剂量疫苗，而黑人（与白人[比值比，0.66；95%置信区间，0.61-0.71]）和 ESRD 持续时间较长的患者（>9 年与 0 年：比值比，0.66；95%置信区间，0.55-0.78）接种高剂量疫苗的可能性较低。
尽管总体流感疫苗接种率有所提高，但 ESRD 患者使用高剂量疫苗的比例非常低。年龄较大的患者、居住在中西部地区以及在医院为基础的设施中接受治疗是接种高剂量疫苗的最强预测因素。
