Huang Po-Han, Nowalk Mary Patricia, Zimmerman Richard K, Olson Samantha M, Talbot H Keipp, Zhu Yuwei, Gaglani Manjusha, Murthy Kempapura, Monto Arnold S, Martin Emily T, Silveira Fernanda P, Balasubramani G K
Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Hum Vaccin Immunother. 2025 Dec;21(1):2457205. doi: 10.1080/21645515.2025.2457205. Epub 2025 Jan 28.
Influenza causes 100,000-710,000 hospitalizations annually in the U.S. Patients with liver disease are at higher risk of severe outcomes following influenza infection. This study evaluated influenza vaccine effectiveness (VE) against influenza-associated hospitalization among adults with liver disease. Data from the U.S. Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN), a test-negative case-control study, from 2015 to 2020 were used to estimate VE among adults ≥18 years admitted for acute respiratory illness. VE was calculated as (1-adjusted odds ratio)*100%, comparing the odds of vaccine receipt between laboratory-confirmed influenza cases and test-negative controls using multiple logistic regression with inverse probability of treatment weighting (IPTW). In total, 1,622 (12.8%) of 12,704 adults had ≥1 liver disease(s). Compared with those without liver disease, adults with liver disease were more likely to be admitted to the intensive care unit (15.7% vs 12.8%, = .001) or to die in hospital (3.0% vs 1.4%, < .001). The IPTW-adjusted VE against influenza-associated hospitalization was 27% (95% confidence interval [CI], 22-32%) among patients without liver disease, but the VE of 11% (95% CI, -8-26%) was not significant among those with liver disease. Significant effect modification of VE by the presence of liver disease was found ( < .05 for interaction term). While influenza vaccination significantly reduced the risk of influenza-associated hospitalization among adults without liver disease, the protective effect was not significant among those with liver disease. Further studies are warranted to evaluate influenza VE in patients with different types of liver disease and with specific vaccine formulations.
在美国，流感每年导致10万至71万人住院。肝病患者在感染流感后出现严重后果的风险更高。本研究评估了流感疫苗对肝病成人患者流感相关住院治疗的有效性（VE）。美国住院成人流感疫苗有效性网络（HAIVEN）的数据来自一项检测呈阴性的病例对照研究，研究时间为2015年至2020年，用于估计18岁及以上因急性呼吸道疾病入院的成年人的VE。VE计算为（1 - 调整后的比值比）×100%，使用多因素逻辑回归和治疗权重逆概率（IPTW）比较实验室确诊的流感病例和检测呈阴性的对照之间接种疫苗的几率。在12704名成年人中，共有1622人（12.8%）患有≥1种肝病。与没有肝病的成年人相比，患有肝病的成年人更有可能入住重症监护病房（15.7%对12.8%，P = 0.001）或在医院死亡（3.0%对1.4%，P < 0.001）。在没有肝病的患者中，IPTW调整后的流感相关住院治疗的VE为27%（95%置信区间[CI]，22 - 32%），但在患有肝病的患者中，VE为11%（95% CI，-8 - 26%），差异无统计学意义。发现肝病的存在对VE有显著的效应修饰作用（交互项P < 0.05）。虽然流感疫苗接种显著降低了无肝病成年人流感相关住院的风险，但对患有肝病的成年人的保护作用并不显著。有必要进一步开展研究，以评估不同类型肝病患者以及使用特定疫苗制剂时的流感VE。
