Asthma and Influenza Vaccination

Influenza and pneumonia vaccination rates in patients hospitalized with acute respiratory failure

Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded.Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations.Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients.

Prevalence of influenza and pneumococcal vaccine uptake in Saudi type 2 diabetic individuals

INTRODUCTION

Individuals with diabetes are at particularly at high risk for many of the negative health consequences associated with influenza and pneumococcal infections. This study aimed to determine the prevalence of influenza and pneumococcal vaccination among a population of type 2 diabetic patients in Saudi Arabia and to determine the factors associated with vaccine uptake.

METHODS

A cross-sectional survey was conducted among patients with type 2 diabetes at Security Forces Hospital, Riyadh in Saudi Arabia. The survey asked basic demographic questions as well as questions about awareness, vaccination status, and beliefs about the influenza and pneumococcal vaccines.

RESULTS

From a total number of 422 responses, 360 participants were ultimately included in the final sample. The overall prevalence of influenza and pneumococcal vaccination in this population were 47.8% and 2.8%, respectively. In general, there was a very low awareness of the pneumococcal vaccine. Older individuals, unmarried individuals, those with less education, and those living with certain chronic conditions were less likely to have gotten the influenza vaccine. Beliefs in the importance of vaccination for people with diabetes, the efficacy of the influenza vaccine, and not being worried about the side effect of the vaccine were strongly associated with having received the vaccine.

CONCLUSIONS

Attention should be given to increasing awareness of the pneumococcal vaccine among people living with diabetes. Particular consideration should also be paid to increasing access and awareness to both vaccines among those groups that have the lowest prevalence of vaccination and may be at the highest risk for the negative consequences associated with these infections. Finally, education interventions should be used to increase the understanding of the safety and efficacy of the influenza vaccine.

Association between Psychological Flexibility and Health Beliefs in the Uptake of Influenza Vaccination among People with Chronic Respiratory Diseases in Hong Kong

It is common for elderly people and those with such chronic disorders as respiratory diseases to suffer severe complications from influenza, a viral infection. The voluntary uptake of vaccination is vital to the effectiveness of influenza prevention efforts. The Health Belief Model (HBM) is the most commonly used framework in the field of vaccination behavior to explain the decision that people make to accept or refuse vaccination. In addition, psychological flexibility is considered helpful in causing people to be open to adopting new practices that are consistent with their values. This study examined the role of psychological flexibility and health beliefs in predicting the uptake of influenza vaccination among people in Hong Kong. Eligible participants were Hong Kong permanent residents aged 18 years or above with a history of chronic respiratory diseases (CRD). A convenience sample of 255 patients was recruited to participate in a cross-sectional survey in which HBM components and factors of psychological flexibility were assessed. The following variables were found to be significant predictors of vaccination: age, smoking status, comorbidity, previous hospitalization, perceived susceptibility, perceived severity, and psychological flexibility. Enhancing psychological flexibility might be a potential new direction for motivating people to accept influenza vaccination.

Predictors of influenza vaccination in adults with chronic bronchitis

Influenza vaccination is recommended for people with chronic bronchitis (CB) because they have a higher risk of influenza-related complications, hospitalizations, and death during seasonal influenza epidemics. This study sought to evaluate influenza vaccination coverage among adults with CB and analyze the factors (predictors) linked to compliance with vaccination recommendations. Individual data from adults aged > or = 40 years included in the Spanish Health Survey conducted in 2006 were used. Subjects were classified as chronic bronchitis sufferers if they answered affirmatively to the question: "has your doctor told you that you are currently suffering from chronic bronchitis?". To assess influenza vaccination status we used the question, "did you have a flu shot in the latest campaign?". Independent variables analyzed included sociodemographic, health-related variables, self-reported presence of other concomitant chronic diseases, and use of health-care services. The percentage of subjects who were reported to be suffering from CB was 6.6% (N=1320, 95% CI 6.2-6.9%). The influenza vaccination coverage among CB sufferers was 63.6% compared with 48.6% for nonsufferers (p<0.05). The predictors significantly associated with a higher likelihood of receiving the vaccine among adult CB sufferers were: higher age; male gender; nonsmoker or ex-smoker status; doing physical exercise; and suffering from concomitant asthma or diabetes. We conclude that influenza vaccination coverages among Spanish adults suffering from CB are below desirable levels; thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine among such patients.

Respiratory virus induction of alpha-, beta- and lambda-interferons in bronchial epithelial cells and peripheral blood mononuclear cells

BACKGROUND

Respiratory viruses, predominantly rhinoviruses are the major cause of asthma exacerbations. Impaired production of interferon-beta in rhinovirus infected bronchial epithelial cells (BECs) and of the newly discovered interferon-lambdas in both BECs and bronchoalveolar lavage cells, is implicated in asthma exacerbation pathogenesis. Thus replacement of deficient interferon is a candidate new therapy for asthma exacerbations. Rhinoviruses and other respiratory viruses infect both BECs and macrophages, but their relative capacities for alpha-, beta- and lambda-interferon production are unknown.

METHODS

To provide guidance regarding which interferon type is the best candidate for development for treatment/prevention of asthma exacerbations we investigated respiratory virus induction of alpha-, beta- and lambda-interferons in BECs and peripheral blood mononuclear cells (PBMCs) by reverse transferase-polymerase chain reaction and enzyme-linked immunosorbent assay.

RESULTS

Rhinovirus infection of BEAS-2B BECs induced interferon-alpha mRNA expression transiently at 8 h and interferon-beta later at 24 h while induction of interferon-lambda was strongly induced at both time points. At 24 h, interferon-alpha protein was not detected, interferon-beta was weakly induced while interferon-lambda was strongly induced. Similar patterns of mRNA induction were observed in primary BECs, in response to both rhinovirus and influenza A virus infection, though protein levels were below assay detection limits. In PBMCs interferon-alpha, interferon-beta and interferon-lambda mRNAs were all strongly induced by rhinovirus at both 8 and 24 h and proteins were induced: interferon-alpha>-beta>-lambda. Thus respiratory viruses induced expression of alpha-, beta- and lambda-interferons in BECs and PBMCs. In PBMCs interferon-alpha>-beta>-lambda while in BECs, interferon-lambda>-beta>-alpha.

CONCLUSIONS

We conclude that interferon-lambdas are likely the principal interferons produced during innate responses to respiratory viruses in BECs and interferon-alphas in PBMCs, while interferon-beta is produced by both cell types.

Influenza vaccination among Canadians with chronic respiratory disease

BACKGROUND

The purposes of this study were to estimate the prevalence of recent influenza vaccination, to identify sociodemographic risk factors and reasons for non-vaccination, and to examine the association between influenza vaccination and respiratory medication use, among individuals with asthma and COPD in Canada.

METHODS

Data from the 2003 Statistics Canada Canadian Community Health Survey (n=134,072, age 12-80+ years) were analyzed. All data were based on self-report.

RESULTS

An estimated 36.3% and 47.9% of individuals with asthma and COPD, respectively, were immunized for influenza within the last year in 2003. These vaccination rates were relatively lower than those seen with other non-respiratory health conditions. Respondents thinking that influenza vaccination was not necessary was the most frequent reason cited for non-vaccination among individuals with asthma and COPD. Men, non-Ontarians, younger age groups, current smokers, and those without a family doctor were less likely to be vaccinated among individuals with asthma and COPD. After controlling for potential sociodemographic confounders, among individuals with asthma, those vaccinated for influenza had significantly greater odds of using inhalers/nebulizers (OR=1.8, 95% CI=1.3-2.4). No other significant medication use associations were observed among individuals with asthma and COPD.

CONCLUSIONS

Recent self-reported influenza vaccination rates among individuals with asthma and COPD were relatively low. Influenza vaccination was not associated with decreased respiratory medication use among individuals with asthma and COPD, suggesting that vaccination may not help prevent exacerbations. More research is needed to fully clarify the role of influenza vaccination in chronic respiratory disease, particularly asthma, to justify policies of mass-immunization.

School-based health centers: improving access and quality of care for low-income adolescents

OBJECTIVES

We sought to compare visit rates, emergency care use, and markers of quality of care between adolescents who use school-based health centers and those who use other community centers within a safety-net health care system for low-income and uninsured patients.

PATIENTS AND METHODS

In this retrospective cohort study we used Denver Health electronic medical chart data, the Denver Health immunization registry, and Denver Public Schools enrollment data for the period from August 1, 2002, to July 31, 2003. The cohort included all 14- to 17-year-old Denver Public Schools high school enrollees who were active Denver Health patients and were either uninsured or insured by Medicaid or the State Children's Health Insurance Program. "School-based health center users" were those who had used a Denver Health school-based health center; "other users" were those who had used a Denver Health community clinic but not a school-based health center. Markers of quality included having a health maintenance visit and receipt of an influenza vaccine, tetanus booster, and hepatitis B vaccine if indicated. Multiple logistic regression analysis that controlled for gender, race/ethnicity, insurance status, chronic illness, and visit rate was used to compare school-based health center users to other users.

RESULTS

Although school-based health center users (n = 790) were less likely than other users (n = 925) to be insured (37% vs 73%), they were more likely to have made > or = 3 primary care visits (52% vs 34%), less likely to have used emergency care (17% vs 34%), and more likely to have received a health maintenance visit (47% vs 33%), an influenza vaccine (45% vs 18%), a tetanus booster (33% vs 21%), and a hepatitis B vaccine (46% vs 20%).

CONCLUSIONS

These findings suggest that, within a safety-net system, school-based health centers augment access to care and quality of care for underserved adolescents compared with traditional outpatient care sites.

Influenza vaccine in patients with asthma

Influenza virus continues to be a major cause of respiratory infection and is an important contributor to morbidity and mortality in at-risk populations, including those with underlying pulmonary conditions such as asthma. Vaccination with inactivated influenza vaccine remains the most popular method in controlling influenza through prevention. Current guidelines recommend the administration of the influenza vaccine to all patients with asthma. However, a third or fewer of those patients with asthma are currently receiving this vaccine. In this review, the risk-versus-benefit of influenza vaccination in children and adults with asthma is evaluated, based on the current evidence.

Influenza vaccination among cardiovascular disease sufferers in Spain: related factors and trend, 1993-2003

Based on data drawn from the 1993 and 2003 National Health Surveys (NHS), we sought to: estimate influenza vaccination coverages among Spanish cardiovascular disease (CVD) sufferers; study which variables were associated with the likelihood of being vaccinated; analyze the time-trend in coverage for the period 1993-2003. For study purposes, a CVD sufferer was defined as any adult who reported suffering from high blood pressure and/or heart disease. The proportion of vaccinated adult CVD sufferers in 1993 and 2003 totalled 39.96% and 51.73%, respectively. The following variables increased the likelihood of being vaccinated: higher age; male gender; presence of respiratory chronic diseases; non-smoker status. Coverages for CVD sufferers had improved significantly from 1993 to 2003 but still remain below desirable levels. The improvement over time is mainly due to the subgroup aged >64 years. Strategies must be implemented to improve the use of influenza vaccine among CVD sufferers in Spain in general, and among the younger age-groups in particular.

Racial and ethnic disparities in influenza vaccination coverage among adults during the 2004-2005 season

During the 2004-2005 influenza season, the supply of vaccine to the United States was significantly reduced. In response, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices issued interim recommendations for prioritizing vaccination. Given trends in racial/ethnic disparities in vaccination for influenza, the authors assessed the impact of the shortage on those historically less likely to be vaccinated. Using data from the Behavioral Risk Factor Surveillance System, they considered vaccination coverage among those non-Hispanic Whites, non-Hispanic Blacks, and Hispanics who had priority for being vaccinated during the 2004-2005 influenza season. The vaccine shortage had a significant negative effect on coverage among adults aged 65 years or older across the three racial/ethnic groups. Yet, the magnitude of the disparities in coverage did not change significantly from previous seasons. This finding may imply similar patterns of vaccine-seeking behavior during shortage and nonshortage years. No racial/ethnic differences were seen among adults aged 18-64 years, which likely reflects the higher percentage of health-care workers in this age group. Yearly monitoring of influenza vaccine coverage is important to assess the long-term impact of shortages on overall coverage and gaps in coverage between racial/ethnic groups.

Asthma, genes, and air pollution

OBJECTIVE

The objective of this article is to evaluate genetic risks associated with the pulmonary response to air pollutants, including particulates and ozone.

METHODS

A comprehensive review of articles related to the genetics of asthma with particular attention to air pollution was conducted through a search of the National Library of Medicine's PubMed database.

RESULTS

Asthma, which affects over 15 million people in the United States, is characterized by inflammation leading to reversible airflow obstruction. Triggered by exposure to numerous occupational and environmental agents, asthma has long been considered to occur more frequently in families, with upwards of a 50% higher rate in the offspring of parents with asthma. Asthma genetic studies have used two major methods: mapping techniques that pinpoint gene loci and studies that identify genes and polymorphisms associated with various asthma mechanisms such as inflammatory mediators. The most consistently replicated chromosomal regions associated with asthma have been chromosomes 2q, 5q, 6p, 12 q, and 13q. Because the formation of reactive oxygen species is a major aspect of the inflammatory process of asthma, genetic aberrations associated with antioxidants such as glutathione S-transferase (GST) may shed light on reasons why some people with asthma seem more at risk of exacerbations as a result of air pollution. People with a polymorphism at the GSTP 1 locus, which codes for GST, one of a family of pulmonary antioxidants, have higher rates of asthma. Children in Mexico City with the GSTM1 null genotype demonstrated significant ozone-related decrements in lung function. Animal studies support the key role of antioxidants in reducing the inflammatory response associated with exposure to diesel exhaust particles.

CONCLUSIONS

Oxidative stress is a key mechanism underlying the toxic effects of exposure to some types of air pollution. Asthmatics with the null genotype for the antioxidant, GST, seem more at risk of the pulmonary effects of air pollution.

A multiple cause-of-death analysis of asthma mortality in the United States, 1990-2001

OBJECTIVES

Most analyses of asthma mortality in the United States have relied solely on underlying cause-of-death data, which may underestimate the magnitude of asthma-related mortality. We used multiple cause-of-death data to examine asthma-related mortality trends in the United States.

METHODS

Data were selected from the United States Multiple Cause-of-Death Files, 1990-2001. Mortality rates and 95% confidence intervals were computed to examine differences in asthma mortality over time and by age, race/ethnicity, and gender. Location of death and seasonal variations in asthma mortality were also assessed, as well as the impact of seasonal respiratory infections.

RESULTS

We identified 135,668 asthma-related deaths in the United States over the 12-year period, representing an age-adjusted mortality rate of 4.4 per 100,000. Only 45% of the asthma-related deaths had asthma recorded as the underlying cause. Whites and older adults were less likely to have asthma listed as the underlying cause. Asthma mortality rates mirrored underlying cause trends, increasing slightly between 1990 and 1995, declining between 1996 and 1998, and further declining after International Classification of Disease (ICD)-10 implementation in 1999. Mortality was highest among blacks and the elderly and was higher among females than males. Asthma-related deaths peaked in the winter months and were over four times more likely than non-asthma deaths to have acute upper respiratory infections, influenza, or acute bronchitis listed on the death record. The proportion of asthma-related deaths occurring outside a medical setting increased steadily over the period, from 23.3% in 1990 to 29.4% in 2001.

CONCLUSIONS

The burden of asthma may be underestimated by relying solely on underlying cause-of-death data. Further research is needed to determine the reasons for the steady increase in out-of-hospital deaths and the continued demographic disparities in mortality.

Is influenza vaccination in asthma helpful?

PURPOSE OF REVIEW

Influenza infections are frequently involved in asthma exacerbations. During influenza epidemics substantial excess morbidity due to respiratory tract complications is reported in all age categories as well as excess mortality among the elderly. Vaccines are available for protection against influenza. Worldwide, vaccination is advised and considered a quality point for asthma care. However, the protective effect of influenza vaccination in patients with asthma is still disputed. In order to establish the current state of affairs we reviewed the recent literature on the protective effect of influenza vaccination and its usefulness in patients with asthma.

RECENT FINDINGS

Several studies were found addressing influenza and the protective aspects of vaccination. They discussed the incidence, the adverse effects of vaccination, the coverage of influenza vaccination among patients with asthma and the effectiveness of the vaccine.

SUMMARY

Influenza vaccination can safely be used in patients with asthma. Allegations that vaccination could provoke asthma exacerbations are convincingly invalidated by previous and recent research. Although patients with asthma are one of the major target groups for immunization, vaccine coverage in all age categories remains low. So far, no unequivocal beneficial effect of influenza vaccination in patients with asthma was found in observational and experimental studies in the sense of reduction of asthma exacerbations and other complications. Recent studies confirm these negative findings. More long-term randomized, placebo-controlled studies, focusing on influenza- proven illness in patients with asthma, are needed to address the question of how helpful influenza vaccination is in these patients.