Working Paper Article Version 3 This version is not peer-reviewed

Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza During the 2017-2018 Season. A Retrospective Cohort Study in Catalonia (Spain)

Version 1 : Received: 11 December 2020 / Approved: 12 December 2020 / Online: 12 December 2020 (12:00:50 CET)
Version 2 : Received: 11 May 2021 / Approved: 13 May 2021 / Online: 13 May 2021 (13:45:31 CEST)
Version 3 : Received: 14 May 2021 / Approved: 24 May 2021 / Online: 24 May 2021 (15:02:34 CEST)

A peer-reviewed article of this Preprint also exists.

Acosta, L.; Soldevila, N.; Torner, N.; Martínez, A.; Ayneto, X.; Rius, C.; Jané, M.; Domínguez, A.; the Influenza Surveillance Network of Catalonia, PIDIRAC. Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza during the 2017–2018 Season. A Retrospective Cohort Study in Catalonia (Spain). Viruses 2021, 13, 1465. https://doi.org/10.3390/v13081465 Acosta, L.; Soldevila, N.; Torner, N.; Martínez, A.; Ayneto, X.; Rius, C.; Jané, M.; Domínguez, A.; the Influenza Surveillance Network of Catalonia, PIDIRAC. Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza during the 2017–2018 Season. A Retrospective Cohort Study in Catalonia (Spain). Viruses 2021, 13, 1465. https://doi.org/10.3390/v13081465

Journal reference: Viruses 2021
DOI: 10.3390/v13081465

Abstract

Seasonal influenza is a common cause of hospital admission, especially in older people and those with comorbidities. The objective of this study was to determine influenza vaccine effectiveness (VE) in preventing intensive care admissions and shortening the length of stay (LOS) in hospitalized laboratory-confirmed influenza cases (HLCI) in Catalonia (Spain).A retrospective cohort study was carried out during the 2017-2018 season in HLCI aged ≥ 18 years from 14 public hospitals. Differences in means and proportions were assessed using a t-test or a chi-square test as necessary and the differences were quantified using standardized effect measures; Cohen’s d for quantitative and Cohen’s w for categorical variables. Adjusted influenza vaccine effectiveness in preventing severity was estimated by multivariate logistic regression where the adjusted VE = (1-adjusted odds ratio) ·100%; adjustment was also made using the propensity score.We analyzed 1414 HLCI aged ≥ 18 years; 465 (33%) were vaccinated, of whom 437 (94%) were aged ≥ 60 years, 269 (57.8%) were male and 295 (63.4%) were positive for influenza type B. ICU admission was required in 214 (15.1%) cases. There were 141/1118 (12.6%) ICU admissions in patients aged ≥ 60 years and 73/296 (24.7%) in those aged < 60 years (p<0.001). The mean LOS and ICU LOS did not differ significantly between vaccinated and unvaccinated patients. There were 52/465 (11.2%) in vaccinated cases) ICU admissions in vaccinated cases vs. 162/949 (17.1%) in unvaccinated cases. Patients admitted to the ICU had a longer hospital LOS (mean: 22.4 [SD 20.3] days) than those who were not (mean: 11.1 [SD14.4] days); p<0.001. Overall, vaccination was associated with a lower risk of ICU admission. Taking virus types A and B together, the estimated adjusted VE in preventing ICU admission was 31% (95% CI 1-52; p=0.04). When stratified by viral type, the aVE was 40% for type A (95% CI -11-68; p = 0.09) and 25% for type B (95% CI -18-52; p = 0.21). Annual influenza vaccination may prevent ICU admission in cases of HLCI. A non-significantly shorter mean hospital stay was observed in vaccinated cases. Our results support the need to increase vaccination uptake and public perception of the benefits of influenza vaccination in groups at a higher risk of hospitalization and severe outcomes.

Keywords

influenza; intensive care unit; vaccine effectiveness; length of stay

Comments (1)

Comment 1
Received: 24 May 2021
Commenter: Nuria Torner
Commenter's Conflict of Interests: Author
Comment: The title was changed in the main file according to reviewer's suggestion. Abstract was corrected according to reviewer's suggestion
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