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Girerd N, Chapet N, Roubille C, Roncalli J, Salvat M, Mouquet F, Lamblin N, Gueffet JP, Damy T, Galinier M, Tartiere JM, Janssen C, Berthelot E, Aguilhon S, Escamilla R, Roubille F. Vaccination for Respiratory Infections in Patients with Heart Failure. J Clin Med 2021; 10:jcm10194311. [PMID: 34640328 PMCID: PMC8509310 DOI: 10.3390/jcm10194311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
Bronchopulmonary infections are a major trigger of cardiac decompensation and are frequently associated with hospitalizations in patients with heart failure (HF). Adverse cardiac effects associated with respiratory infections, more specifically Streptococcus pneumoniae and influenza infections, are the consequence of inflammatory processes and thrombotic events. For both influenza and pneumococcal vaccinations, large multicenter randomized clinical trials are needed to evaluate their efficacy in preventing cardiovascular events, especially in HF patients. No study to date has evaluated the protective effect of the COVID-19 vaccine in patients with HF. Different guidelines recommend annual influenza vaccination for patients with established cardiovascular disease and also recommend pneumococcal vaccination in patients with HF. The Heart Failure group of the French Society of Cardiology recently strongly recommended vaccination against COVID-19 in HF patients. Nevertheless, the implementation of vaccination recommendations against respiratory infections in HF patients remains suboptimal. This suggests that a national health policy is needed to improve vaccination coverage, involving not only the general practitioner, but also other health providers, such as cardiologists, nurses, and pharmacists. This review first summarizes the pathophysiology of the interrelationships between inflammation, infection, and HF. Then, we describe the current clinical knowledge concerning the protective effect of vaccines against respiratory diseases (influenza, pneumococcal infection, and COVID-19) in patients with HF and finally we propose how vaccination coverage could be improved in these patients.
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Affiliation(s)
- Nicolas Girerd
- Centre d’Investigations Cliniques—INSERM CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France;
| | - Nicolas Chapet
- Department of Clinical Pharmacy, CHU de Montpellier, 34295 Montpellier, France;
| | - Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, PhyMedExp, 34295 Montpellier, France;
| | - Jérôme Roncalli
- Service de Cardiologie, CHU de Toulouse-Rangueil, Université Paul Sabatier–Toulouse III, 31400 Toulouse, France;
| | | | - Frédéric Mouquet
- Department of Cardiology, Hôpital Privé Le Bois, 59000 Lille, France;
| | - Nicolas Lamblin
- Institut Pasteur, Université Lille, Inserm, CHU Lille, U1167 Lille, France;
| | | | - Thibaud Damy
- Referral Center for Cardiac Amyloidoisis, Department of Cardiology, GHU Henri Mondor-APHP, IMRB 955, 94000 Créteil, France;
| | - Michel Galinier
- Fédération des Services de Cardiologie, CHU Toulouse-Rangueil, Faculté de Médecine, Toulouse, Université Paul Sabatier-Toulouse III, 31400 Toulouse, France;
| | | | - Cécile Janssen
- Centre Hospitalier Annecy Genevois, Infectious Diseases Unit, 74370 Annecy, France;
| | - Emmanuelle Berthelot
- Service de Cardiologie, Hôpital Bicêtre, AP-HP, University of Paris Sud, 94270 Le Kremlin-Bicêtre, France;
| | - Sylvain Aguilhon
- Cardiology Department, CHU de Montpellier, 34295 Montpellier, France;
| | - Roger Escamilla
- Service de Pneumologie, Hôpital Larrey, 31400 Toulouse, France;
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France
- Correspondence:
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The macro-epidemiology of influenza vaccination in 56 countries, 1997--2003. Vaccine 2006; 23:5133-43. [PMID: 16039762 DOI: 10.1016/j.vaccine.2005.06.010] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 06/09/2005] [Accepted: 06/17/2005] [Indexed: 11/20/2022]
Abstract
The WHO Global Agenda on Influenza calls for measuring the progress of national influenza vaccination programs. In response, the Macro-epidemiology of Influenza Vaccination (MIV) Study Group has gathered information on influenza vaccination in 56 countries. During the period 1997--2003, influenza vaccine distribution increased considerably in almost all countries. In 2003, the countries with the highest levels of vaccination (doses distributed/1000 population) were Canada (344), the Republic of Korea (311), the United States (286) and Japan (230). Most countries recommended influenza vaccination for elderly persons and those with high-risk medical conditions, including immuno-compromise. Fewer countries provided public reimbursement for vaccination through national or social health insurance. Higher levels of vaccination were not closely related to higher levels of economic development, but in many instances public reimbursement for vaccination seemed to be associated with greater vaccine use. From 1994 to 2003, the global use of influenza vaccines increased more than two-fold. In 2003, the 56 MIV Study Group countries accounted for approximately 95% of the 292 million doses of influenza vaccine distributed worldwide, and 62% of these doses were distributed within nine vaccine-producing countries in North America, Western Europe, Japan and Australia. However, influenza vaccination was increasing rapidly in many non vaccine-producing countries, and this change has important implications for pandemic vaccination.
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Lin JT, Yu XZ, Cui DJ, Chen XY, Zhu JH, Wang YZ, Wu XD. A multicentre, randomized, controlled trial of oseltamivir in the treatment of influenza in a high-risk Chinese population. Curr Med Res Opin 2006; 22:75-82. [PMID: 16393433 DOI: 10.1185/030079906x80297] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of oseltamivir treatment in a population at high risk for influenza. RESEARCH DESIGN AND METHODS This was a randomized, open-label, controlled trial involving Chinese patients with chronic respiratory diseases (chronic bronchitis, obstructive emphysema, bronchial asthma or bronchiectasis) or chronic cardiac disease. Patients showing symptoms of influenza were randomly assigned to receive oral oseltamivir 75 mg twice daily for 5 days (oseltamivir group), or symptomatic treatment (control group) within 48 h after symptom onset. MAIN OUTCOME MEASURES The main outcome measures were duration and severity of illness in influenza-infected patients. Other outcome measures included incidence of complications, antibiotic use, hospitalization and total medical cost. RESULTS Of the 118 recruited patients, 56 were identified as influenza-infected through laboratory tests (oseltamivir, N = 27; control, N = 29). Relative to symptomatic treatment, oseltamivir significantly reduced the duration of influenza symptoms by 36.8% (p = 0.0479), and the severity by 43.1% (p = 0.0002). In addition, oseltamivir significantly reduced the duration of fever by 45.2% (p = 0.0051), and the time to return to baseline health status by 5 days (p = 0.0011). The incidence of complications (11% vs. 45%, p = 0.0053) and antibiotic use (37% vs. 69%, p = 0.0167) were also significantly lower in the oseltamivir group compared with the control group. The cost of treating influenza and its complications was comparable between the two groups (p = 0.2462). CONCLUSIONS Oseltamivir is effective and well tolerated in high-risk patients with chronic respiratory or cardiac diseases. It can reduce the duration and severity of influenza symptoms and decrease the incidence of secondary complications and antibiotic use, without increasing the total medical cost.
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Yap FHY, Ho PL, Lam KF, Chan PKS, Cheng YH, Peiris JSM. Excess hospital admissions for pneumonia, chronic obstructive pulmonary disease, and heart failure during influenza seasons in Hong Kong. J Med Virol 2004; 73:617-23. [PMID: 15221909 DOI: 10.1002/jmv.20135] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is widely held that Southern China is a hypothetical influenza epicentre for the emergence of pandemic influenza viruses. However, influenza is perceived as a relatively unimportant infection in this part of the world compared with western countries. Hong Kong is situated within the hypothetical epicentre and serves as a sentinel post for the region. In a retrospective study, the influenza-associated excess hospitalisations in a regional hospital for pneumonia, chronic obstructive pulmonary disease (COPD), heart failure, and asthma in persons aged > or = 65 years from 1998 to 2001 were each estimated by a model taking into consideration the confounding effect of other respiratory viral infections, seasonal factors, time trends, and weather and pollution indices. In the regression models, influenza activity is an independent significant factor affecting admission rates for pneumonia, COPD, and heart failure but not that for asthma. The variations in hospital admissions for pneumonia, COPD, and heart failure explained by influenza activity were 38.9, 7.5, and 45.6%, respectively. The adjusted rates of excess influenza-associated hospital admissions for the three diagnoses combined amounted to 58.5, 20.0, 29.2, and 13.4 per 10,000 populations aged > or = 65 years in 1998, 1999, 2000, and 2001, respectively. In conclusion, influenza activity is associated significant excess hospital admissions among elderly aged 65 or above in Hong Kong, comparable to the data reported in Western countries. The findings support a wider application of annual influenza vaccination in this region.
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Affiliation(s)
- Florence H Y Yap
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
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Martínez-Sellés M, García Robles JA, Muñoz R, Serrano JA, Frades E, Domínguez Muñoa M, Almendral J. Pharmacological treatment in patients with heart failure: patients knowledge and occurrence of polypharmacy, alternative medicine and immunizations. Eur J Heart Fail 2004; 6:219-26. [PMID: 14984730 DOI: 10.1016/j.ejheart.2003.09.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2003] [Revised: 06/06/2003] [Accepted: 09/15/2003] [Indexed: 11/19/2022] Open
Abstract
AIMS To evaluate in patients with heart failure (HF) due to systolic dysfunction the occurrence of polypharmacy, alternative medicine, immunization against influenza, and patients' knowledge about their medication. METHODS AND RESULTS Sixty-five patients, 49 men, mean age 60.5+/-12.0 years answered a confidential questionnaire during 2002. Polypharmacy was frequent, 48 (74%) were taking six or more pills per day and 18 (28%) 11 or more. Fifteen patients (23%) used over-the-counter analgesics. Eight patients (12%) used alternative medicine [five women (31%) vs. three men (6%), P=0.02]. Forty-four patients (68%) received immunization against influenza (18 patients <65 years (54%) vs. 25 patients > or =65 years (79%), P=0.03). Half the patients knew that beta-blockers and vasodilators decreased blood pressure, 31 patients receiving diuretics (88%) knew that this drugs help to eliminate liquids, 12 patients (38%) recognized this effect with low dose spironolactone and 23% or less with other drugs. Only 12 patients (42%) treated with acenocoumarol and 13 of those treated with aspirin (32%) recognized the action of these drugs. CONCLUSION Patients with HF and systolic dysfunction have a poor knowledge about the medication they receive. Polypharmacy, over-the-counter, homeopathic and alternative medicine use is frequent whereas the rate of immunization against influenza is low.
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Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007 Madrid, Spain.
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