Nakafero Georgina, Grainge Matthew J, Myles Puja R, Mallen Christian D, Zhang Weiya, Doherty Michael, Nguyen-Van-Tam Jonathan S, Abhishek Abhishek
Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham.
Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham.
Rheumatology (Oxford). 2020 Dec 1;59(12):3666-3675. doi: 10.1093/rheumatology/keaa078.
The effectiveness of inactivated influenza vaccine in people with autoimmune rheumatic disease (AIRDs) is not known. We investigated whether the influenza vaccine is effective in preventing respiratory morbidity, mortality and all-cause mortality in AIRD patients.
Adults with AIRDs treated with DMARDs prior to 1 September of each year between 2006 and 2009, and 2010 and 2015 were identified from the Clinical Practice Research Datalink. Exposure and outcome data were extracted. Data from multiple seasons were pooled. Propensity score (PS) for vaccination was calculated. Cox-proportional hazard ratios (HRs) and 95% CIs were calculated, and were (i) adjusted, (ii) matched for PS for vaccination.
Data for 30 788 AIRD patients (65.7% female, 75.5% with RA, 61.1% prescribed MTX) contributing 125 034 influenza cycles were included. Vaccination reduced risk of influenza-like illness [adjusted HR (aHR) 0.70], hospitalization for pneumonia (aHR 0.61) and chronic obstructive pulmonary disease exacerbations (aHR 0.67), and death due to pneumonia (aHR 0.56) on PS-adjusted analysis in the influenza active periods (IAPs). The associations were of similar magnitude and remained statistically significant on PS-matched analysis except for protection from influenza-like illness, which became non-significant. Sub-analysis restricted to pre-IAP, IAP and post-IAP did not yield evidence of residual confounding on influenza-like illness and death due to pneumonia. Vaccination reduced risk of all-cause mortality, although IAP-restricted analysis demonstrated residual confounding for this outcome.
Influenza vaccine associates with reduced risk of respiratory morbidity and mortality in people with AIRDs. These findings call for active promotion of seasonal influenza vaccination in immunosuppressed people with AIRDs by healthcare professionals.
灭活流感疫苗对自身免疫性风湿病（AIRD）患者的有效性尚不清楚。我们调查了流感疫苗在预防AIRD患者的呼吸道疾病、死亡率和全因死亡率方面是否有效。
从临床实践研究数据链中识别出2006年至2009年以及2010年至2015年每年9月1日前接受改善病情抗风湿药物（DMARD）治疗的成年AIRD患者。提取暴露和结局数据。汇总多个季节的数据。计算疫苗接种的倾向评分（PS）。计算Cox比例风险比（HR）和95%置信区间（CI），并进行（i）调整，（ii）按疫苗接种的PS进行匹配。
纳入了30788例AIRD患者的数据（65.7%为女性，75.5%患有类风湿关节炎，61.1%开具了甲氨蝶呤），共125034个流感周期。在流感活跃期（IAP）进行PS调整分析时，疫苗接种降低了流感样疾病的风险[调整后HR（aHR）0.70]、肺炎住院风险（aHR 0.61）、慢性阻塞性肺疾病急性加重风险（aHR 0.67）以及肺炎导致的死亡风险（aHR 0.56）。除了预防流感样疾病的保护作用变得不显著外，这些关联在PS匹配分析中的幅度相似且仍具有统计学意义。仅限于IAP前、IAP和IAP后的亚分析未发现流感样疾病和肺炎导致的死亡存在残余混杂的证据。疫苗接种降低了全因死亡率，尽管IAP限制分析表明该结局存在残余混杂。
流感疫苗与降低AIRD患者的呼吸道疾病和死亡风险相关。这些发现呼吁医疗保健专业人员积极推广季节性流感疫苗接种，以惠及免疫抑制的AIRD患者。
