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Research

Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: a multicentre case–control study

Itziar Casado, Ángela Domínguez, Diana Toledo, Judith Chamorro, Jenaro Astray, Mikel Egurrola, María Amelia Fernández-Sierra, Vicente Martín, María Morales-Suárez-Varela, Pere Godoy and Jesús Castilla; for the Project PI12/02079 Working Group
CMAJ January 08, 2018 190 (1) E3-E12; DOI: https://doi.org/10.1503/cmaj.170910
Itziar Casado
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Ángela Domínguez
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Diana Toledo
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Judith Chamorro
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Jenaro Astray
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Mikel Egurrola
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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María Amelia Fernández-Sierra
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Vicente Martín
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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María Morales-Suárez-Varela
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Pere Godoy
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Jesús Castilla
Instituto de Salud Pública de Navarra — IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública – CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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  • For correspondence: jcastilc@navarra.es
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    Figure 1:

    Scheme of the study groups and the comparisons made.

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    Figure 2:

    Effectiveness of vaccination for influenza in the current and 3 previous seasons in preventing nonsevere and severe cases of influenza. Estimates were obtained from conditional logistic regression models. The adjusted models included the number of chronic conditions, Barthel Index score, number of visits to primary care and hospital in the previous year, pneumococcal vaccination, diagnosis of pneumonia in the previous 2 years and treatment with corticosteroids administered orally in the previous month. Note: CI = confidence interval. Values > 0 represent the preventive effect of vaccination.

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    Figure 3:

    Effectiveness of vaccination for influenza in the current and any of the 3 previous seasons in preventing nonsevere and severe cases of influenza by season, virus subtype and age group. Estimates were obtained from conditional logistic regression models. The adjusted models included the number of chronic conditions, Barthel Index score, number of visits to primary care and hospital attendance in the previous year, pneumococcal vaccination, diagnosis of pneumonia in the previous 2 years and treatment with corticosteroids administered orally in the previous month. Note: CI = confidence interval. Values > 0 represent the preventive effect of vaccination.

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    Table 1:

    Baseline patient characteristics, and comparison of patients admitted to hospital with nonsevere and severe influenza with patients in the control group

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    Table 2:

    Effects of infuenza vaccination status in the current and 3 previous seasons in reducing severity of illness in patients who were admitted to hospital for influenza

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    Table 3:

    Effectiveness of Influenza vaccination in reducing disease severity in patients with influenza who were admitted to hospital for the current and any previous season

    Table 3:
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Canadian Medical Association Journal: 190 (1)
CMAJ
Vol. 190, Issue 1
8 Jan 2018
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Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: a multicentre case–control study
Itziar Casado, Ángela Domínguez, Diana Toledo, Judith Chamorro, Jenaro Astray, Mikel Egurrola, María Amelia Fernández-Sierra, Vicente Martín, María Morales-Suárez-Varela, Pere Godoy, Jesús Castilla
CMAJ Jan 2018, 190 (1) E3-E12; DOI: 10.1503/cmaj.170910

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Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: a multicentre case–control study
Itziar Casado, Ángela Domínguez, Diana Toledo, Judith Chamorro, Jenaro Astray, Mikel Egurrola, María Amelia Fernández-Sierra, Vicente Martín, María Morales-Suárez-Varela, Pere Godoy, Jesús Castilla
CMAJ Jan 2018, 190 (1) E3-E12; DOI: 10.1503/cmaj.170910
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