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Showing content from https://pubmed.ncbi.nlm.nih.gov/23535212/ below:

Effectiveness of influenza vaccination in working-age adults with diabetes: a population-based cohort study

Affiliations

• ¹ Department of Public Health Sciences, University of Alberta, Edmonton, Canada.

• PMID: 23535212
• PMCID: PMC3711373
• DOI: 10.1136/thoraxjnl-2012-203109

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Darren Lau et al. Thorax. 2013 Jul.

• ¹ Department of Public Health Sciences, University of Alberta, Edmonton, Canada.

• PMID: 23535212
• PMCID: PMC3711373
• DOI: 10.1136/thoraxjnl-2012-203109

Item in Clipboard

Background: Guidelines recommend influenza vaccinations in all diabetic adults, but there is limited evidence to support vaccinating working-age adults (<65 years) with diabetes. We examined the effectiveness of influenza vaccine in this subgroup, compared with elderly adults (≥ 65 years) for whom vaccination recommendations are well accepted.

Methods: We identified all adults with diabetes, along with a sample of age-matched and sex-matched comparison subjects without diabetes, from 2000 to 2008, using administrative data from Manitoba, Canada. With multivariable Poisson regression, we estimated vaccine effectiveness (VE) on influenza-like illnesses (ILIs), pneumonia and influenza (PI) hospitalisations and all-cause (ALL) hospitalisations during periods of known circulating influenza. Analyses were replicated outside of influenza season to rule out residual confounding.

Results: We included 543 367 person-years of follow-up, during which 223 920 ILI, 5422 PI and 94 988 ALL occurred. The majority (58%) of adults with diabetes were working age. In this group, influenza vaccination was associated with relative reductions in PI (43%, 95% CI 28% to 54%) and ALL (28%, 95% CI 24% to 32%) but not ILI (-1%, 95% CI -3% to 1%). VE was similar in elderly adults for ALL (33-34%) and PI (45-55%), although not ILI (12-13%). However, similar estimates of effectiveness were also observed for all three groups during non-influenza control periods.

Conclusions: Working-age adults with diabetes experience similar benefits from vaccination as elderly adults, supporting current diabetes-specific recommendations. However, these benefits were also manifest outside of influenza season, suggesting residual bias. Vaccination recommendations in all high-risk adults would benefit from randomised trial evidence.

Keywords: Clinical Epidemiology; Viral infection.

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Estimates of influenza vaccine effectiveness…

Estimates of influenza vaccine effectiveness during influenza season. Error bars represent 95% CIs.…

Estimates of influenza vaccine effectiveness during influenza season. Error bars represent 95% CIs. 65p, elderly (ie, 65 plus); 65p, DM, elderly adults with diabetes mellitus; 65p, no DM, elderly adults without diabetes mellitus; ALL, all-cause hospitalisations; ILI, outpatient visits and hospitalisations for influenza-like illness; PI, pneumonia and influenza hospitalisations; u65, working age; u65, DM, working-age adults with diabetes mellitus.

Estimates of influenza vaccine effectiveness…

Estimates of influenza vaccine effectiveness during the off-season periods. Error bars represent 95%…

Estimates of influenza vaccine effectiveness during the off-season periods. Error bars represent 95% CIs. 65p, elderly (ie, 65 plus); 65p, DM, elderly adults with diabetes mellitus; ALL, all-cause hospitalisations; ILI, outpatient visits and hospitalisations for influenza-like illness; PI, pneumonia and influenza hospitalisations; u65, working age; u65, DM, working-age adults with diabetes mellitus; 65p, no DM, elderly adults without diabetes mellitus.

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