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Bang JY, Kim YJ, Seo YJ, Hong SH. Reduced cell-mediated immune response in hyperglycemic NOD mice following influenza vaccination. Vaccine 2024:S0264-410X(24)00757-6. [PMID: 38981742 DOI: 10.1016/j.vaccine.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
Due to the higher risk of medical complications posed by influenza infection, patients with type 1 diabetes (T1D) are strongly recommended to receive the influenza vaccine. However, it remains unclear if hyperglycemia in patients with T1D affects vaccine-induced immune responses. In this study, we investigated the humoral and cellular immune responses of prediabetic and diabetic, nonobese diabetic (NOD) mice following influenza vaccination to determine the effects of hyperglycemia on influenza vaccine-induced responses. In diabetic NOD mice, vaccine-specific IgG and IgM levels, as well as IgG-producing cells, were comparable to those in prediabetic NOD mice. However, the diabetic NOD mice exhibited reduced percentages of memory T cells and activated T cells in the spleen, along with reduced number of vaccine-specific interferon (IFN)-γ-secreting cells. Thus, these findings suggest that in patients with T1D, hyperglycemia could lead to impaired cell-mediated immune responses following influenza vaccination.
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Affiliation(s)
- Ji Young Bang
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yun Ji Kim
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Young-Jin Seo
- Department of Life Science, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea
| | - So-Hee Hong
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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2
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Mastrovito B, Lardon A, Dubromel A, Nave V, Beny K, Dussart C. Understanding the gap between guidelines and influenza vaccination coverage in people with diabetes: a scoping review. Front Public Health 2024; 12:1360556. [PMID: 38706547 PMCID: PMC11066301 DOI: 10.3389/fpubh.2024.1360556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Diabetes affects millions of people worldwide, making them more vulnerable to infections, including seasonal influenza. It is therefore particularly important for those suffering from diabetes to be vaccinated against influenza each year. However, influenza vaccination coverage remains low in this population. This review primarily aims to identify the determinants of influenza vaccination in people with diabetes (T1D or T2D). Secondly, it aims to assess main recommendations for influenza vaccination, vaccine effectiveness, vaccination coverage, and how education and pharmacists can encourage uptake of the vaccine in the diabetic population. Methods A scoping review was conducted in January 2022 to systematically review evidence on influenza vaccination in people with diabetes using data from PubMed, Science Direct, and EM Premium with terms such as "Diabetes mellitus," "Immunization Programs," "Vaccination," and "Influenza Vaccines." Quality assessment and data extraction were independently conducted by two authors. Disagreements between the authors were resolved through discussion and consensus, and if necessary, by consulting a third author. Results Of the 333 records identified, 55 studies met the eligibility criteria for inclusion in this review. Influenza vaccination was recommended for people ≥6 months. Despite effectiveness evidence showing a reduction in mortality and hospitalizations in people with diabetes vaccinated vs. non-vaccinated ones, very few studies reported a coverage rate ≥ 75%, which is WHO's target objective. Determinants such as advanced age, presence of comorbidities and healthcare givers' advice were associated with increased vaccination uptake. On the contrary, fear of adverse reactions and concerns about vaccine effectiveness were significant barriers. Finally, education and pharmacists' intervention played a key role in promoting vaccination and increasing vaccination uptake. Conclusion Influenza vaccination coverage in people with diabetes remains low despite recommendations and evidence on vaccine effectiveness. Motivators and barriers as well as several socio-demographic and clinical factors have been identified to explain this trend. Efforts are now needed to increase the number of diabetics vaccinated against influenza, mainly through education and the involvement of healthcare givers.
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Affiliation(s)
- Brice Mastrovito
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Alexia Lardon
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Amelie Dubromel
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Viviane Nave
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Karen Beny
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
| | - Claude Dussart
- Hospices Civils de Lyon, Pharmacie et Stérilisation Centrales, Pharmacie centrale, Saint-Genis-Laval, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
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Lee TH, Chen JJ, Wu CY, Lin TY, Hung SC, Yang HY. Immunosenescence, gut dysbiosis, and chronic kidney disease: Interplay and implications for clinical management. Biomed J 2024; 47:100638. [PMID: 37524304 PMCID: PMC10979181 DOI: 10.1016/j.bj.2023.100638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
Immunosenescence refers to the immune system changes observed in individuals over 50 years old, characterized by diminished immune response and chronic inflammation. Recent investigations have highlighted similar immune alterations in patients with reduced kidney function. The immune system and kidney function have been found to be closely interconnected. Studies have shown that as kidney function declines, both innate and adaptive immunity are affected. Chronic kidney disease (CKD) patients exhibit decreased levels of naive and regular T cells, as well as naive and memory B cells, while memory T cell counts increase. Furthermore, research suggests that CKD and end-stage kidney disease (ESKD) patients experience early thymic dysfunction and heightened homeostatic proliferation of naive T cells. In addition to reduced thymic T cell production, CKD patients display shorter telomeres in both CD4+ and CD8+ T cells. Declining kidney function induces uremic conditions, which alter the intestinal metabolic environment and promote pathogen overgrowth while reducing diversity. This dysbiosis-driven imbalance in the gut microbiota can result in elevated production of uremic toxins, which, in turn, enter the systemic circulation due to compromised gut barrier function under uremic conditions. The accumulation of gut-derived uremic toxins exacerbates local and systemic kidney inflammation. Immune-mediated kidney damage occurs due to the activation of immune cells in the intestine as a consequence of dysbiosis, leading to the production of cytokines and soluble urokinase-type plasminogen activator receptor (suPAR), thereby contributing to kidney inflammation. In this review, we delve into the fundamental mechanisms of immunosenescence in CKD, encompassing alterations in adaptive immunity, gut dysbiosis, and an overview of the clinical findings pertaining to immunosenescence.
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Affiliation(s)
- Tao Han Lee
- Nephrology Department, Chansn Hospital, Taoyuan, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, And Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yun Lin
- Division of Nephrology, Taipei Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Taipei, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Taipei, Taiwan.
| | - Huang-Yu Yang
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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4
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Antonelli Incalzi R, Consoli A, Lopalco P, Maggi S, Sesti G, Veronese N, Volpe M. Influenza vaccination for elderly, vulnerable and high-risk subjects: a narrative review and expert opinion. Intern Emerg Med 2024; 19:619-640. [PMID: 37891453 PMCID: PMC11039544 DOI: 10.1007/s11739-023-03456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Influenza is associated with a substantial health burden, especially in high-risk subjects such as older adults, frail individuals and those with underlying chronic diseases. In this review, we summarized clinical findings regarding the impact of influenza in vulnerable populations, highlighted the benefits of influenza vaccination in preventing severe illness and complications and reviewed the main evidence on the efficacy, effectiveness and safety of the vaccines that are best suited to older adults among those available in Italy. The adverse outcomes associated with influenza infection in elderly and frail subjects and those with underlying chronic diseases are well documented in the literature, as are the benefits of vaccination (mostly in older adults and in patients with cardiovascular diseases, diabetes and chronic lung disease). High-dose and adjuvanted inactivated influenza vaccines were specifically developed to provide enhanced immune responses in older adults, who generally have low responses mainly due to immunosenescence, comorbidities and frailty. These vaccines have been evaluated in clinical studies and systematic reviews by international immunization advisory boards, including the European Centre for Disease Prevention and Control. The high-dose vaccine is the only licensed influenza vaccine to have demonstrated greater efficacy versus a standard-dose vaccine in preventing laboratory-confirmed influenza in a randomized controlled trial. Despite global recommendations, the vaccination coverage in high-risk populations is still suboptimal. All healthcare professionals (including specialists) have an important role in increasing vaccination rates.
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Affiliation(s)
- Raffaele Antonelli Incalzi
- Gerontology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Pierluigi Lopalco
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Stefania Maggi
- Institute of Neuroscience-Aging Branch, National Research Council, Padua, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Rome, Italy.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome and IRCCS San Raffaele, Rome, Italy
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5
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Yuan S, He W, Liu B, Liu Z. Research Progress on the Weak Immune Response to the COVID-19 Vaccine in Patients with Type 2 Diabetes. Viral Immunol 2024; 37:79-88. [PMID: 38498797 DOI: 10.1089/vim.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is generally susceptible to the population, highly infectious, rapidly transmitted, and highly fatal. There is a lack of specific drugs against the virus at present and vaccination is the most effective strategy to prevent infection. However, studies have found that some groups, particularly patients with diabetes, show varying degrees of weak immune reactivity to various COVID-19 vaccines, resulting in poor preventive efficacy against the novel coronavirus in patients with diabetes. Therefore, in this study, patients with type 2 diabetes mellitus (T2DM) who had weak immune response to the COVID-19 vaccine in recent years were analyzed. This article reviews the phenomenon, preliminary mechanism, and related factors affecting weak vaccine response in patients with T2DM, which is expected to help in the development of new vaccines for high-risk groups for COVID-19.
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Affiliation(s)
- Shiqi Yuan
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Wenwen He
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Bin Liu
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Zhuoran Liu
- Department of Laboratory Medicine, Hengyang Medical School, The Second Affiliated Hospital, University of South China, Hengyang, China
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Kumar Y, Sundaram S, Yadav D. Current Vaccination Practice in Diabetic (Diabetes I) Patients. Curr Diabetes Rev 2024; 20:e061023221816. [PMID: 37859318 DOI: 10.2174/0115733998260361230927002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023]
Abstract
The worldwide prevalence of diabetes, an endocrine condition, is rising quickly. The alarming rise of diabetes in recent years has emerged as a major contributor to premature death and illness among persons of working age. The potential use of immunomodulatory drugs to prevent diabetes has been a source of worry in light of recent advances in our understanding of the role of autoimmune responses in the development of diabetes. Vaccines can work in a variety of ways, including by eliminating autoreactive T-cells or by blocking the connections between immune cells. Most diabetes vaccines that have been created so far have only been evaluated in animal models, with just a small number having undergone successful human trials. In this article, the authors also look at the clinical trial research that are currently being conducted to create a prototype diabetes vaccine.
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Affiliation(s)
- Yati Kumar
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Sonali Sundaram
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Deepika Yadav
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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Sengupta A, Al-Otaibi N, Hinkula J. Sex-Specific Immune Responses to Seasonal Influenza Vaccination in Diabetic Individuals: Implications for Vaccine Efficacy. J Immunol Res 2023; 2023:3111351. [PMID: 37881338 PMCID: PMC10597737 DOI: 10.1155/2023/3111351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 10/27/2023] Open
Abstract
Seasonal influenza vaccination has different implications on the immune response depending on the comorbidities. Diabetes is one such critical disease that increases the patient's susceptibility to influenza and suppresses vaccine efficacy and immunity. The sex of the individuals also plays a definitive role in the immune responses to both the vaccine and the infection. This study aims to understand the efficacy of the seasonal vaccine against influenza in diabetic groups and undergoing immune mechanisms in different sexes (females and males). In this study, we are reporting about a switching of the immune response of the infected and vaccinated diabetic females towards stronger Th1/Th17 responses with suppressed humoral immunity. They show increased cDC1, enhanced proinflammatory activities within T cells, CD8T activation, Th17 proliferation, and the majority of IgG2 antibody subtypes with reduced neutralization potential. Males with diabetes exhibit enhanced humoral Th2-immunity than the nondiabetic group. They exhibit higher cDC2, and DEC205 levels within them with an increase in plasma B lymphocytes, higher IgG1 subtypes in plasma cells, and influenza-hemagglutinin-specific IgG titer with stronger virus neutralization potential. Males with diabetes recovered better than the females as observed from the changes in their body weight. This study highlights the critical immune mechanisms and sex-specific swapping of their preferred immune response pathways against influenza after vaccination during diabetes. We propose a need for a sex-specific customized vaccine regimen to be implemented against influenza for individuals having diabetes to exploit the manifested strength and weakness in their protective immunity.
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Affiliation(s)
- Anirban Sengupta
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping 58185, Sweden
| | - Noha Al-Otaibi
- King Abdulaziz City for Science and Technology (KACST), Riyad 11442, Saudi Arabia
| | - Jorma Hinkula
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping 58185, Sweden
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8
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Dicembrini I, Silverii GA, Clerico A, Fornengo R, Gabutti G, Sordi V, Tafuri S, Peruzzi O, Mannucci E. Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2023; 33:1099-1110. [PMID: 37032254 DOI: 10.1016/j.numecd.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
AIMS In order to better define the need for influenza vaccination in people with diabetes (DM), we collected all available evidence on the effect of DM as a risk factor for complications of both seasonal and pandemic influenza, and on the specific effectiveness of vaccines in patients with DM. DATA SYNTHESIS Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and Embase databases were performed, one for each metanalysis, collecting all observational studies and randomized clinical trials performed on humans up to May 31st, 2022. We retrieved 34 observational studies comparing risk for influenza complications in people with or without diabetes, and 13 observational studies assessing vaccine effectiveness on preventing such complications. Mortality for influenza and hospitalization for influenza and pneumonia resulted significantly higher in individuals with versus without DM, both when unadjusted and adjusted data are analyzed. In diabetic individuals vaccinated for influenza overall hospitalization, hospitalization for influenza or pneumonia and overall mortality are significantly lower in comparison with not vaccinated DM subjects, both when unadjusted and adjusted data were analyzed. CONCLUSION This systematic review and meta-analysis shows that: 1) influenza is associated with more severe complications in diabetic versus not diabetic individuals and 2) influenza vaccination is effective in preventing clinically relevant outcomes in adults with DM with a NNT (number needed to treat) of 60, 319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively. The identification of diabetic patients as the target of vaccination campaigns for influenza appears to be justified by available clinical evidence.
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Affiliation(s)
- Ilaria Dicembrini
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy.
| | | | | | | | - Giovanni Gabutti
- Coordinator Working Group Vaccines and Immunization Policies, Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro, University of Bari, Italy
| | - Ottavia Peruzzi
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
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Lee DH, Yang B, Gu S, Kim EG, Kim Y, Kang HK, Choe YH, Jeon HJ, Park S, Lee H. Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database. Front Endocrinol (Lausanne) 2023; 14:1077846. [PMID: 36817596 PMCID: PMC9935563 DOI: 10.3389/fendo.2023.1077846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subjects with diabetes are at higher risk of serious influenza-related complications. We aimed to investigate the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza in subjects with diabetes using a nationwide observational study performed within the recent decade. METHODS Among 105,732 subjects from the Korea National Health and Nutrition Examination Survey between 2007 and 2019, 8,632 with diabetes were included. We investigated the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza. RESULTS During the study period, the prevalence of influenza vaccination in subjects with diabetes showed a tendency to increase every year, reaching almost 60% in 2019, which was higher than the rate in subjects without diabetes. Younger age (adjusted hazard ratio (aHR) [95% CI] 11.29 [8.63-14.75] for < 50 years; 6.16 [5.21-7.29] for 50-65 years), male (aHR 1.67 [1.52-1.87]), current smoker (aHR 1.31 [1.00-1.72], lower-income status (aHR 1.46 [1.17, 1.84]), and high education level (aHR 1.30 [1.01-1.67]) were associated with being unvaccinated. Also, a poorer glycemic control with HbA1c ≥ 9% was found to be correlated with unvaccinated status (aHR 1.48 [1.15-1.90]). CONCLUSION The influenza vaccination rate is still unsatisfactory in subjects with diabetes. Young age, males, low-income level, high education level, and poor glycemic control were associated with unvaccinated status. Considering the risk-benefits of influenza vaccination in patients with diabetes, physicians should make an effort to increase vaccination rates, especially in low vaccination rate groups.
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Affiliation(s)
- Dong-Hwa Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seonhye Gu
- Department of Epidemiology and Health Informatics, Korea University, Seoul, Republic of Korea
| | - Eung-Gook Kim
- Department of Biochemistry, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Yeong Hun Choe
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyun Jeong Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Seungyong Park
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Szőllősi GJ, Minh NC, Pataki J, Santoso CM, Nagy AC, Kardos L. Influenza Vaccination Coverage and Its Predictors among Self-Reported Diabetic Patients-Findings from the Hungarian Implementation of the European Health Interview Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16289. [PMID: 36498357 PMCID: PMC9736192 DOI: 10.3390/ijerph192316289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
In high-risk populations, such as the elderly or those with serious medical issues, for instance, people with cardiovascular diseases or diabetes, influenza can have devastating effects because it might contribute to severe complications or even death. This makes vaccination against influenza an essential component of public health. The primary objective of our research was to identify the characteristics that influenced whether an individual chose to become vaccinated against influenza, with an emphasis on whether they reported having diabetes. The data were obtained from the Hungarian implementation of the European Health Interview Surveys, which were conducted in 2009, 2014, and 2019. The total sample size was 15,874 people. To determine the variables that were related to vaccination, a multivariate logistic regression analysis that included interactions was performed. The overall vaccination coverage was 13% in 2009 and 12% in 2014 and 2019 among non-diabetic respondents; the coverage was 26% in 2009, 28% in 2014, and 25% in 2019 among diabetic respondents. Despite vaccination coverage in both groups being below the optimal level of 75%, we were able to identify factors influencing vaccination coverage. Among diabetic respondents, younger age, lower education level, sex, and co-morbidities were factors that influenced vaccination status. It is important for authorities managing healthcare and medical practitioners to be aware of the potential effects that influenza can have on diabetic patients; therefore, more efforts need to be made to increase the number of diabetic people receiving a vaccination against influenza.
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[Evidence syntheses in public health: An overview]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 175:17-28. [PMID: 36335008 PMCID: PMC9630138 DOI: 10.1016/j.zefq.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since the beginning of the COVID-19 pandemic, there has been a high demand for rapid evidence syntheses to answer urgent public health questions. This article provides an overview of different types of reviews for public health questions and a synthesis of existing recommendations for the preparation of reviews. The aim is to support the planning of one's own review and the critical evaluation of published reviews. METHODS The basis of this summary is an extensive search for guidelines and recommendations for different review types. Furthermore, internal journal clubs were held to determine knowledge needs and to critically discuss the various review types. Relating to the dissemination of results, fact sheets were developed for the individual review types including the most important information, prerequisites and work steps, as well as a decision tree for identifying the appropriate review type for the respective question. RESULTS Of the review types identified, Systematic, Rapid, Scoping, Umbrella, and Narrative Reviews were considered in more detail because they are particularly relevant to public health issues. Together with scoping and umbrella reviews, systematic reviews have the highest resource requirements due to the demands for extensive, systematic evidence synthesis and reproducibility. Rapid methods can accelerate the review process, for example by a very narrowly formulated question, a limited literature search, or the execution of certain steps by one instead of two persons. DISCUSSION Systematic Reviews may be considered as the gold standard, but they were developed primarily for clinical questions relating to interventions. This article, however, focusses on review types that consider the diversity of questions as well as the predominant use of quantitative methods in the field of public health. The fact sheets developed and the decision tree should enable low-threshold access to reviews while linking the perspectives of research and resource planning. They complement existing guidelines and recommendations. CONCLUSION To answer the diverse spectrum of public health questions, various types of reviews with various requirements and approaches are available. Given this diversity, a systematic introduction can be helpful for researchers planning or assessing a review.
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 152] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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13
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Okoli GN, Reddy VK, Lam OLT, Racovitan F, Al-Yousif Y, Askin N. Characteristics and methodological standards across systematic reviews with Meta-analysis of efficacy and/or effectiveness of influenza vaccines: an overview of reviews. Infect Dis (Lond) 2022; 54:861-880. [PMID: 36000220 DOI: 10.1080/23744235.2022.2114537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND While systematic reviews (SR) generally suggest that vaccination is an effective way to prevent influenza infection, it is not clear if these conclusions are based on high quality SR methods. As such, we systematically identified, critically appraised, and summarised the characteristics and adherence to methodological standards in SRs with meta-analysis of efficacy/effectiveness of influenza vaccines. METHODS We searched MEDLINE, Embase, Scopus, CINAHL, Global Health, and CDSR for English-language SR publications up to July 11, 2022. We summarised the characteristics, adherence to methodological standards and SR quality (AMSTAR 2). RESULTS From 11,193 retrieved citations, we included 48 publications (47 SRs). Seventy-five percent were of a critically low quality, 19% of a low quality, 2% of a moderate quality, and 4% of a high quality. Thirteen percent were industry-funded, about 13% co-authored by industry employee(s), and 4% commissioned by an organisation or authority. Only 45% percent reported protocol registration, 6% reported collaboration with a knowledge synthesis librarian/information specialist, and 60% utilised a reporting checklist (e.g. PRISMA). CONCLUSIONS AND RELEVANCE SRs with meta-analysis of efficacy/effectiveness of influenza vaccines are mostly of critically low quality and even the more recent reviews did not follow current best SR practices. These findings are significant in view of the controversies that surround influenza vaccines, and the use of SRs in informed decision-making. However, the findings do not justify curtailment or cessation of influenza vaccine use as vaccines continue to offer substantial net public health benefit.HighlightsWe systematically identified, critically appraised, and summarised the characteristics and adherence to methodological standards in 47 systematic reviews with meta-analysis of efficacy/effectiveness of influenza vaccines.13% of the reviews were industry-funded.About 13% of the reviews were co-authored by industry employee(s).4% of the reviews were commissioned by an organisation/authority.45% of the reviews reported protocol registration.6% of the reviews reported collaborating with a knowledge synthesis librarian/information specialist to prepare the search strategy.60% of the reviews reported using the PRISMA (or similar) checklist.75% of the reviews were judged to be of critically low quality; 19% of low quality; 2% of moderate quality; 4% of high quality.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Viraj K Reddy
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Otto L T Lam
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Florentin Racovitan
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Yahya Al-Yousif
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
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14
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Sung LC, Chen CC, Liu SH, Chiu CC, Yang TY, Lin CH, Fan YA, Jian W, Lei MH, Yeh HT, Hsu MH, Hao WR, Liu JC. Effect of Influenza Vaccination on the Reduction of the Incidence of Chronic Kidney Disease and Dialysis in Patients with Type 2 Diabetes Mellitus. J Clin Med 2022; 11:jcm11154520. [PMID: 35956134 PMCID: PMC9369464 DOI: 10.3390/jcm11154520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) have a higher risk of chronic kidney disease (CKD) due to vascular complications and chronic inflammation. T2DM contributes to a higher risk of mortality and morbidity related to influenza. In Taiwan, influenza vaccination is recommended for patients with T2DM. A previous meta-analysis reported the efficacy of influenza vaccination in reducing hospitalization and mortality in patients with diabetes; however, the renal protective effect of the vaccine remains unclear. This study evaluated whether influenza vaccination could reduce the incidence of CKD and dialysis in patients with T2DM. The study cohort included all patients aged ≥55 years who were diagnosed as having T2DM between 1 January 2000 and 31 December 2012, by using data from Taiwan’s National Health Insurance Research Database. Each patient was followed up with to assess factors associated with CKD. A time-dependent Cox proportional hazard regression model after adjustment for potential confounders was used to calculate the hazard ratio (HR) of CKD in the vaccinated and unvaccinated patients. The study population comprised 48,017 eligible patients with DM; 23,839 (49.7%) received influenza vaccination and the remaining 24,178 (50.3%) did not. The adjusted HRs (aHRs) for CKD/dialysis decreased in the vaccinated patients compared with the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs: 0.47/0.47, 0.48/0.49, and 0.48/0.48, respectively, all p < 0.0001). We observed similar protective effects against CKD during the influenza and noninfluenza seasons. Regardless of comorbidities or drug use, influenza vaccination was an independent protective factor. Furthermore, aHRs for CKD/dialysis were 0.71 (0.65−0.77)/0.77 (0.68−0.87), 0.57 (0.52−0.61)/0.69 (0.56−0.70), and 0.30 (0.28−0.33)/0.28 (0.24−0.31) in the patients who received 1, 2−3, and ≥4 vaccinations during the follow-up period, respectively. This population-based cohort study demonstrated that influenza vaccination exerts a dose-dependent and synergistic protective effect against CKD in the patients with T2DM with associated risk factors.
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Affiliation(s)
- Li-Chin Sung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
| | - Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Hao Liu
- Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
| | - Tsung-Yeh Yang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
| | - Cheng-Hsin Lin
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yu-Ann Fan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
| | - William Jian
- Department of Emergency, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Meng-Huan Lei
- Cardiovascular Center, Lo-Hsu Medical Foundation Luodong Poh-Ai Hospital, Yilan 265, Taiwan;
| | - Hsien-Tang Yeh
- Department of Surgery, Lotung Poh-Ai Hospital, Luodong 265, Taiwan;
| | - Min-Huei Hsu
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 110, Taiwan;
- Department of Neurosurgery, Wan-Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Wen-Rui Hao
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (W.-R.H.); (J.-C.L.)
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (L.-C.S.); (C.-C.C.); (C.-C.C.); (T.-Y.Y.); (Y.-A.F.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan;
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (W.-R.H.); (J.-C.L.)
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15
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D'Addio F, Sabiu G, Usuelli V, Assi E, Abdelsalam A, Maestroni A, Seelam AJ, Ben Nasr M, Loretelli C, Mileto D, Rossi G, Pastore I, Montefusco L, Morpurgo PS, Plebani L, Rossi A, Chebat E, Bolla AM, Lunati ME, Mameli C, Macedoni M, Antinori S, Rusconi S, Gallieni M, Berra C, Folli F, Galli M, Gismondo MR, Zuccotti G, Fiorina P. Immunogenicity and Safety of SARS-CoV-2 mRNA Vaccines in a Cohort of Patients With Type 1 Diabetes. Diabetes 2022; 71:1800-1806. [PMID: 35551366 DOI: 10.2337/db22-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/30/2022] [Indexed: 11/13/2022]
Abstract
Patients with type 1 diabetes (T1D) may develop severe outcomes during coronavirus disease 2019 (COVID-19), but their ability to generate an immune response against the SARS-CoV-2 mRNA vaccines remains to be established. We evaluated the safety, immunogenicity, and glycometabolic effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in patients with T1D. A total of 375 patients (326 with T1D and 49 subjects without diabetes) who received two doses of the SARS-CoV-2 mRNA vaccines (mRNA-1273, BNT162b2) between March and April 2021 at ASST Fatebenefratelli Sacco were included in this monocentric observational study. Local and systemic adverse events were reported in both groups after SARS-CoV-2 mRNA vaccination, without statistical differences between them. While both patients with T1D and subjects without diabetes exhibited a parallel increase in anti-SARS-CoV-2 spike titers after vaccination, the majority of patients with T1D (70% and 78%, respectively) did not show any increase in the SARS-CoV-2-specific cytotoxic response compared with the robust increase observed in all subjects without diabetes. A reduced secretion of the T-cell-related cytokines interleukin-2 and tumor necrosis factor-α in vaccinated patients with T1D was also observed. No glycometabolic alterations were evident in patients with T1D using continuous glucose monitoring during follow-up. Administration of the SARS-CoV-2 mRNA vaccine is associated with an impaired cellular SARS-CoV-2-specific cytotoxic immune response in patients with T1D.
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Affiliation(s)
- Francesca D'Addio
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Gianmarco Sabiu
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Vera Usuelli
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Emma Assi
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Ahmed Abdelsalam
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Anna Maestroni
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Andy Joe Seelam
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Moufida Ben Nasr
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Cristian Loretelli
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Davide Mileto
- Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Giada Rossi
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Ida Pastore
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Paola S Morpurgo
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Laura Plebani
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Enrica Chebat
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea M Bolla
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Chiara Mameli
- Pediatric Department, Buzzi Children's Hospital, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Maddalena Macedoni
- Pediatric Department, Buzzi Children's Hospital, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Stefano Rusconi
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Cesare Berra
- Metabolic Diseases and Diabetes, Multimedica IRCCS, Sesto San Giovanni, Milan, Italy
| | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, Università di Milano, ASST Santi Paolo e Carlo, Milan, Italy
| | - Massimo Galli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Maria Rita Gismondo
- Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, and Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
| | - Paolo Fiorina
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, Milan, Italy
- Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA
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16
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Al-Sayyar A, Hulme KD, Thibaut R, Bayry J, Sheedy FJ, Short KR, Alzaid F. Respiratory Tract Infections in Diabetes - Lessons From Tuberculosis and Influenza to Guide Understanding of COVID-19 Severity. Front Endocrinol (Lausanne) 2022; 13:919223. [PMID: 35957811 PMCID: PMC9363013 DOI: 10.3389/fendo.2022.919223] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with type-2 diabetes (T2D) are more likely to develop severe respiratory tract infections. Such susceptibility has gained increasing attention since the global spread of Coronavirus Disease 2019 (COVID-19) in early 2020. The earliest reports marked T2D as an important risk-factor for severe forms of disease and mortality across all adult age groups. Several mechanisms have been proposed for this increased susceptibility, including pre-existing immune dysfunction, a lack of metabolic flexibility due to insulin resistance, inadequate dietary quality or adverse interactions with antidiabetic treatments or common comorbidities. Some mechanisms that predispose patients with T2D to severe COVID-19 may indeed be shared with other previously characterized respiratory tract infections. Accordingly, in this review, we give an overview of response to Influenza A virus and to Mycobacterium tuberculosis (Mtb) infections. Similar risk factors and mechanisms are discussed between the two conditions and in the case of COVID-19. Lastly, we address emerging approaches to address research needs in infection and metabolic disease, and perspectives with regards to deployment or repositioning of metabolically active therapeutics.
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Affiliation(s)
| | - Katina D. Hulme
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
| | - Ronan Thibaut
- Institut Necker Enfants Malades (INEM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1151/CNRS UMRS8253, Immunity and Metabolism of Diabetes (IMMEDIAB), Université de Paris Cité, Paris, France
| | - Jagadeesh Bayry
- Department of Biological Sciences & Engineering, Indian Institute of Technology Palakkad, Palakkad, India
| | | | - Kirsty R. Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, QLD, Australia
| | - Fawaz Alzaid
- Dasman Diabetes Institute, Dasman, Kuwait
- Institut Necker Enfants Malades (INEM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1151/CNRS UMRS8253, Immunity and Metabolism of Diabetes (IMMEDIAB), Université de Paris Cité, Paris, France
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17
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Aberrant Cellular Glycosylation May Increase the Ability of Influenza Viruses to Escape Host Immune Responses through Modification of the Viral Glycome. mBio 2022; 13:e0298321. [PMID: 35285699 PMCID: PMC9040841 DOI: 10.1128/mbio.02983-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Individuals with metabolic dysregulation of cellular glycosylation often experience severe influenza disease, with a poor immune response to the virus and low vaccine efficacy. Here, we investigate the consequences of aberrant cellular glycosylation for the glycome and the biology of influenza virus. We transiently induced aberrant N-linked glycosylation in cultured cells with an oligosaccharyltransferase inhibitor, NGI-1. Cells treated with NGI-1 produced morphologically unaltered viable influenza virus with sequence-neutral glycosylation changes (primarily reduced site occupancy) in the hemagglutinin and neuraminidase proteins. Hemagglutinin with reduced glycan occupancy required a higher concentration of surfactant protein D (an important innate immunity respiratory tract collectin) for inhibition compared to that with normal glycan occupancy. Immunization of mice with NGI-1-treated virus significantly reduced antihemagglutinin and antineuraminidase titers of total serum antibody and reduced hemagglutinin protective antibody responses. Our data suggest that aberrant cellular glycosylation may increase the risk of severe influenza as a result of the increased ability of glycome-modified influenza viruses to evade the immune response.
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18
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Umasabor-Bubu OQ, Bubu OM, Mbah AK, Nakeshbandi M, Taylor TN. Association between Influenza Vaccination and severe COVID-19 outcomes at a designated COVID-only hospital in Brooklyn. Am J Infect Control 2021; 49:1327-1330. [PMID: 33891988 PMCID: PMC8056988 DOI: 10.1016/j.ajic.2021.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022]
Abstract
Maintaining influenza vaccination at high coverage has the potential to prevent a proportion of COVID-19 morbidity and mortality. We examined whether flu-vaccination is associated with severe corona virus disease 2019 (COVID-19) disease, as measured by intensive care unit (ICU)-admission, ventilator-use, and mortality. Other outcome measures included hospital length of stay and total ICU days. Our findings showed that flu-vaccination was associated with a significantly reduced likelihood of an ICU admission especially among aged <65 and non-obese patients. Public health promotion of flu-vaccination may help mitigate the overwhelming demand for critical COVID-19 care pending the large-scale availability of COVID-19 vaccines.
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19
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Esposito S, Mariotti Zani E, Torelli L, Scavone S, Petraroli M, Patianna V, Predieri B, Iughetti L, Principi N. Childhood Vaccinations and Type 1 Diabetes. Front Immunol 2021; 12:667889. [PMID: 34512622 PMCID: PMC8427438 DOI: 10.3389/fimmu.2021.667889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Type 1 diabetes (T1D) is the most common paediatric endocrine disease, and its frequency has been found to increase worldwide. Similar to all conditions associated with poorly regulated glucose metabolism, T1D carries an increased risk of infection. Consequently, careful compliance by T1D children with schedules officially approved for child immunization is strongly recommended. However, because patients with T1D show persistent and profound limitations in immune function, vaccines may evoke a less efficient immune response, with corresponding lower protection. Moreover, T1D is an autoimmune condition that develops in genetically susceptible individuals and some data regarding T1D triggering factors appear to indicate that infections, mainly those due to viruses, play a major role. Accordingly, the use of viral live attenuated vaccines is being debated. In this narrative review, we discussed the most effective and safe use of vaccines in patients at risk of or with overt T1D. Literature analysis showed that several problems related to the use of vaccines in children with T1D have not been completely resolved. There are few studies regarding the immunogenicity and efficacy of vaccines in T1D children, and the need for different immunization schedules has not been precisely established. Fortunately, the previous presumed relationship between vaccine administration and T1D appears to have been debunked, though some doubts regarding rotavirus vaccines remain. Further studies are needed to completely resolve the problems related to vaccine administration in T1D patients. In the meantime, the use of vaccines remains extensively recommended in children with this disease.
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Affiliation(s)
- Susanna Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Elena Mariotti Zani
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Lisa Torelli
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Sara Scavone
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Maddalena Petraroli
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Viviana Patianna
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Principi
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
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20
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Liprandi ÁS, Liprandi MIS, Zaidel EJ, Aisenberg GM, Baranchuk A, Barbosa ECD, Sánchez GB, Alexander B, Zanetti FTL, Santi RL, Múnera-Echeverri AG, Perel P, Piskorz D, Ruiz-Mori CE, Saucedo J, Valdez O, Juanatey JRG, Piñeiro DJ, Pinto FJ, Quintana FSW. Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the Word Heart Federation. Glob Heart 2021; 16:55. [PMID: 34381676 PMCID: PMC8344961 DOI: 10.5334/gh.1069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 02/01/2023] Open
Abstract
Background Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America. Objective The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease. Methods A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of statements. The modified RAND/UCLA methodology was used. This document was supported by a grant from the WHF. Results An extensive literature search was divided into seven questions, and a total of 23 conclusions and 29 recommendations were achieved. There was no disagreement among experts in the conclusions or recommendations. Conclusions There is a strong correlation between influenza and cardiovascular events. Influenza vaccination is not only safe and a proven strategy to reduce cardiovascular events, but it is also cost saving. We found several barriers for its global implementation and potential strategies to overcome them.
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Affiliation(s)
- Álvaro Sosa Liprandi
- School of Medicine, University of Buenos Aires, AR
- Cardiology Department, Sanatorio Güemes, Buenos Aires, AR
- InterAmerican Society of Cardiology, AR
| | | | - Ezequiel José Zaidel
- Cardiology Department, Sanatorio Güemes, Buenos Aires, AR
- Pharmacology Department, School of Medicine, University of Buenos Aires, AR
| | - Gabriel M. Aisenberg
- University of Texas John P and Kathrine G McGovern School of Medicine, Houston, Texas, US
| | - Adrián Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Ontario, CA
| | - Eduardo Costa Duarte Barbosa
- Cardiology Department, Hospital Sao Francisco-Santa Casa, Porto Alegre, BR
- Artery LatAm, LatinAmerican Society of Hypertension, BR
| | - Gabriela Borrayo Sánchez
- Cardiology Department, Mexican Social Security Institute, Mexican National Association of Cardiologists, MX
| | - Bryce Alexander
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Ontario, CA
| | | | - Ricardo López Santi
- Cardiology Department, Hospital Italiano de La Plata, Buenos Aires, AR
- Argentine Federation of Cardiology, AR
| | | | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, GB
- World Heart Federation, Geneva, CH
| | - Daniel Piskorz
- Argentine Federation of Cardiology, AR
- Cardiology Department, British Hospital of Rosario, Santa Fe, AR
| | | | - Jorge Saucedo
- Cardiology Department, Froedtert Hospital and Medical College, Milwaukee, US
| | - Osiris Valdez
- Cardiology Department, Centro Médico Central Romana, La Romana, DO
- Central America Society of Hypertension, DO
| | - José Ramón González Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Spanish Society of Cardiology, ES
| | | | - Fausto J. Pinto
- World Heart Federation, Geneva, CH
- Cardiology Department, Hospital Santa María, PT
- University of Lisbon, PT
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21
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Han AL. Factors associated with influenza vaccine coverage among patients with diabetes: Korea National Health and Nutrition Examination Survey 2016-2018. Int J Diabetes Dev Ctries 2021; 42:297-304. [PMID: 34334977 PMCID: PMC8313670 DOI: 10.1007/s13410-021-00977-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although the influenza vaccine has been proven to be effective, this common disease has high morbidity and mortality rates. Moreover, adults with diabetes are at a high risk of influenza-mediated morbidity and mortality. Purpose of the study With the increasing prevalence of diabetes, influenza is more lethal in diabetics; thus, we aimed to investigate the factors associated with influenza vaccination coverage in patients with diabetes. Methods Cross-sectional data were obtained from the Korea National Health and Nutrition Examination Survey (2016–2018). We retrospectively analyzed whether sociodemographic, health-related, and medical factors are associated with influenza vaccination coverage in patients with diabetes. We performed a complex sample logistic regression analysis and estimated the odds ratios (ORs) by adjusting for statistically significant factors. Results The number of survey subjects was 18,553. The vaccine coverage rate among patients with diabetes was 60.6%. In the univariate analysis, sex, educational level, smoking, exercise, drinking, marital status, private health insurance, activity limit, economic activity, age, and EuroQol-5 Dimension scores, which were used to assess health-related quality of life, were associated with vaccination coverage. In the multivariate analysis, only age and economic activity were associated with vaccination coverage. The vaccination coverage rate was higher for people who did not undertake economic activities and who were older (OR 1.512 (1.087–2.105), OR 2.212 (1.822–2.686), respectively, p < 0.001). Conclusion National interventions involving public health centers are necessary to encourage influenza immunization for patients with diabetes, especially younger patients and those who work or undertake economic activities.
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Affiliation(s)
- A. Lum Han
- Department of Family Medicine, Wonkwang University Hospital, Sinyong-dong 344-2, Iksan, Jeollabuk-do 54538 South Korea
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22
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Martínez-Baz I, Navascués A, Portillo ME, Casado I, Fresán U, Ezpeleta C, Castilla J. Effect of Influenza Vaccination in Preventing Laboratory-Confirmed Influenza Hospitalization in Patients With Diabetes Mellitus. Clin Infect Dis 2021; 73:107-114. [PMID: 32412600 DOI: 10.1093/cid/ciaa564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with diabetes are at high risk of severe influenza complications. The influenza vaccination effect among diabetic patients remains inconclusive. We estimated the average effect of influenza vaccination status in the current and prior seasons in preventing laboratory-confirmed influenza hospitalization in diabetic patients. METHODS Patients attended in hospitals and primary healthcare centers with influenza-like illness were tested for influenza from the 2013-2014 to 2018-2019 seasons in Navarre, Spain. A test-negative case-control design in diabetic inpatients compared the influenza vaccination status in the current and 5 prior seasons between laboratory-confirmed influenza cases and negative controls. Vaccination status of influenza-confirmed cases was compared between diabetic inpatients and outpatients. Influenza vaccination effect was compared between diabetic patients and older (≥ 60 years) or chronic nondiabetic patients. RESULTS Of 1670 diabetic inpatients tested, 569 (34%) were confirmed for influenza and 1101 were test-negative controls. The average effect in preventing influenza hospitalization was 46% (95% confidence interval [CI], 28%-59%) for current-season vaccination and 44% (95% CI, 20%-61%) for vaccination in prior seasons only in comparison to unvaccinated patients in the current and prior seasons. Among diabetic patients with confirmed influenza, current-season vaccination reduced the probability of hospitalization (adjusted odds ratio, 0.35; 95% CI, .15-.79). In diabetic patients, vaccination effect against influenza hospitalizations was not inferior to that in older or chronic nondiabetic patients. CONCLUSIONS On average, influenza vaccination of diabetic population reduced by around half the risk of influenza hospitalization. Vaccination in prior seasons maintained a notable protective effect. These results reinforce the recommendation of influenza vaccination for diabetic patients.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Navascués
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - María Eugenia Portillo
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Ezpeleta
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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23
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Machado A, Leite A, Larrauri A, Gomez V, Rodrigues AP, Kislaya I, Nunes B. No effect modification of influenza virus vaccine effectiveness by age or chronic condition was observed in the 2010/11 to 2017/18 seasons. Pharmacoepidemiol Drug Saf 2021; 30:1411-1419. [PMID: 34096151 DOI: 10.1002/pds.5302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Most European influenza vaccine strategies target individuals at higher risk of complications, which include, among others, individuals aged ≥65 years and with chronic conditions. These individuals not only have a high-risk of post-infection complications but also could have lower capacity of acquiring adequate vaccine-induced protection. As such, chronic conditions and age could modify the effect of vaccines. This study aimed at assessing the potential effect modification of influenza vaccine effectiveness (IVE) by age and chronic conditions. METHODS We used eight-season data from the Portuguese vaccine effectiveness study. Every season, physicians at primary care units recruited patients with influenza-like illness. Clinical data and swabs were collected for Reverse Transverse Polymerase Chain Reaction (RT-PCR) detection of influenza. Trivalent inactivated IVE was estimated as 1 - odds ratio (OR) of being vaccinated in cases (RT-PCR positive for influenza) versus negative controls. ORs were obtained using a multivariable conditional logistic regression model, paired by week of onset within each season. Confounders were assessed by designing a specific causal diagram. Age (< 65 or ≥65 years) and chronic conditions (diabetes, cardiovascular disease, chronic renal disease, chronic hepatic disease, obesity, chronic respiratory disease, and congenital or acquired immunodeficiency) were studied as effect modifiers by including an interaction term in the regression models. Significance was established at 5%. RESULTS Point estimates indicate a higher IVE in the chronic condition strata compared to that in the no chronic condition strata. Regarding age, different results were obtained considering the virus type and (sub)type. When comparing the ≥65 years with the <65 years of age strata, we observed a higher IVE against A(H1N1)pdm09, an equal IVE against A(H3N2) and a lower IVE against B virus. However, all interaction terms were statistically insignificant, and this may be due to a small sample size. CONCLUSION The potential effect modification of age or chronic condition was not observed within our study.
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Affiliation(s)
- Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Unidade de Saúde Pública, Agrupamento de Centros de Saúde Amadora, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Verónica Gomez
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ana Paula Rodrigues
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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24
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Sözen M, Karatoprak AP, Demirhan Y, Nasırlıer GÇ, Selek A, Gezer E, Çetinarslan B, Cantürk Z, Tarkun İ, Köksalan D, Azak E. Awareness of influenza and pneumococcal vaccines in diabetic patients. J Diabetes Metab Disord 2021; 20:757-763. [PMID: 33996650 PMCID: PMC8104465 DOI: 10.1007/s40200-021-00812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
Purpose In our study, it was aimed to evaluate the awareness of diabetic patients about vaccination status and vaccines. Methods This cross-sectional study was conducted between January 2019 and February 2019. A survey questioning the level of knowledge about and vaccination status for influenza and pneumonia vaccines was applied by face-to-face interviews with patients with diabetes mellitus who admitted to the diabetes outpatient clinic. All results were evaluated with SPSS-20.0. Results A total of 202 patients [66 male (32.7%) and 136 female (67.3%) patients; with a mean age of 57.7 ± 11.3 years and mean duration of diabetes 10.7 ± 7.9 years] were recruited in the study. Majority of the patients (92.6%) were type 2 DM patients. 59.4% of the patients had never been vaccinated. The rate of those who had pneumonia vaccine was very low, only 14.7%. The vast majority of the patients had knowledge about vaccines and their most common source of information was nurses. 53% of patients believed that diabetic patients should be vaccinated regularly. 16.8% of the patients were reluctant to have the recommended vaccine. The factor with greatest impact on this was that they did not consider the vaccine necessary. 52.5% of the patients recommended to be vaccinated had the recommended vaccine. 26.4% of the patients who were not enthusiastic about the recommended vaccine had pneumococcal vaccine after being informed about the vaccine. Conclusion It was observed that the information given about vaccines positively affected the vaccination rate. The main barrier to vaccination was the lack of information about the need for influenza vaccination. Designing strategies and training programs for healthcare professionals and patients should be the main goal to improve vaccination coverage and vaccination rates.
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Affiliation(s)
- Mehmet Sözen
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Yeliz Demirhan
- Diabetes Outpatient Clinic, Kocaeli University Research and Application Hospital, Kocaeli, Turkey
| | - Gülten Çevik Nasırlıer
- Department of History of Medicine and Ethics, Kocaeli University Institute of Health Sciences, Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Emre Gezer
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - İlhan Tarkun
- Department of Endocrinology and Metabolism, Anadolu Medical Center, Kocaeli, Turkey
| | - Damla Köksalan
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Emel Azak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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25
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Ferretti F, Cannatelli R, Benucci M, Carmagnola S, Clementi E, Danelli P, Dilillo D, Fiorina P, Galli M, Gallieni M, Genovese G, Giorgi V, Invernizzi A, Maconi G, Maier JA, Marzano AV, Morpurgo PS, Nebuloni M, Radovanovic D, Riva A, Rizzardini G, Sabiu G, Santus P, Staurenghi G, Zuccotti G, Sarzi-Puttini PC, Ardizzone S. How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group. Front Immunol 2021; 12:656362. [PMID: 33936084 PMCID: PMC8082137 DOI: 10.3389/fimmu.2021.656362] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Since March 2020, the outbreak of Sars-CoV-2 pandemic has changed medical practice and daily routine around the world. Huge efforts from pharmacological industries have led to the development of COVID-19 vaccines. In particular two mRNA vaccines, namely the BNT162b2 (Pfizer-BioNTech) and the mRNA-1273 (Moderna), and a viral-vectored vaccine, i.e. ChAdOx1 nCoV-19 (AstraZeneca), have recently been approved in Europe. Clinical trials on these vaccines have been published on the general population showing a high efficacy with minor adverse events. However, specific data about the efficacy and safety of these vaccines in patients with immune-mediated inflammatory diseases (IMIDs) are still lacking. Moreover, the limited availability of these vaccines requires prioritizing some vulnerable categories of patients compared to others. In this position paper, we propose the point of view about the management of COVID-19 vaccination from Italian experts on IMIDs and the identification of high-risk groups according to the different diseases and their chronic therapy.
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Affiliation(s)
- Francesca Ferretti
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Rosanna Cannatelli
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Stefania Carmagnola
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Scientific Institute IRCCS E. Medea, Lecco, Italy
| | - Piergiorgio Danelli
- Surgery Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Ospedale dei Bambini, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli - Sacco, Milan, Italy.,International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università Degli Studi di Milano, Milan, Italy.,Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, III Infectious Diseases unit, University Hospital "Luigi Sacco", Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Nephrology and Dialysis Unit, "L. Sacco" Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Giovanni Genovese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, NSW, Australia
| | - Giovanni Maconi
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Jeanette A Maier
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Angelo V Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Paola S Morpurgo
- Division of Endocrinology, ASST Fatebenefratelli - Sacco, Milan, Italy
| | - Manuela Nebuloni
- Pathology Unit, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Milan, Italy.,School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Gianmarco Sabiu
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Nephrology and Dialysis Unit, "L. Sacco" Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy.,Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Ospedale dei Bambini, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Pier Carlo Sarzi-Puttini
- Rheumatology Unit, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Università degli Studi di Milano, Milan, Italy
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26
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Luk AOY, Wu H, Lau ESH, Yang A, So WY, Chow E, Kong APS, Hui DSC, Ma RCW, Chan JCN. Temporal trends in rates of infection-related hospitalisations in Hong Kong people with and without diabetes, 2001-2016: a retrospective study. Diabetologia 2021; 64:109-118. [PMID: 32986145 PMCID: PMC7520551 DOI: 10.1007/s00125-020-05286-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS Infection is an under-recognised but important complication in people with diabetes. Studies on temporal trends in incidence of infection in this population are limited. We report the trends in infection-related hospitalisation in people with diabetes and compared hospitalisation rates between people with and without diabetes in Hong Kong. METHODS Hospital admissions with infection, including pneumonia, influenza, tuberculosis, kidney infection, urinary tract infection, cellulitis, osteomyelitis, foot infection and sepsis, listed as principal diagnosis occurring between 2001 and 2016 were identified from people with diabetes in the electronic medical record system of the Hong Kong Hospital Authority. Data on hospitalisation for a subset of these infections in the general population between 2007 and 2016 were obtained from the Department of Health. The number of people with diabetes ranged between 117,322 in 2001 and 570,929 in 2016, and the number without diabetes ranged between 5,242,614 in 2007 and 5,593,153 in 2016. Joinpoint regression was used to describe the trends. RESULTS In people with diabetes, over a period of 16 years, the age-standardised annual rates of hospitalisation decreased for tuberculosis but increased for influenza; rates of hospitalisation for pneumonia increased up until 2004/2005 and declined in men and stabilised in women. The rates of hospitalisation for most infection types were unchanged or increased in the 20-44 year and 45-64 year age groups and decreased in those aged 65 years or above. Trends for most of the infections were similar when comparing sexes. Between 2007 and 2016, the rate ratios of hospitalisation for most infection types between people with and without diabetes were stable, and the rate ratios remained higher in people with diabetes, ranging from 1.3-1.4 for pneumonia to 3.2-4.9 for kidney infections in 2016 compared with non-diabetic individuals. CONCLUSIONS/INTERPRETATION Despite advances in medical care, hospitalisation due to infections remains a major healthcare burden in people with diabetes. Graphical abstract.
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Affiliation(s)
- Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Wing-Yee So
- Hong Kong Hospital Authority, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - David S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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27
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Chee YJ, Tan SK, Yeoh E. Dissecting the interaction between COVID-19 and diabetes mellitus. J Diabetes Investig 2020; 11:1104-1114. [PMID: 32558211 PMCID: PMC7323255 DOI: 10.1111/jdi.13326] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic that is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus-2. Data from several countries have shown higher morbidity and mortality among individuals with chronic metabolic diseases, such as diabetes mellitus. In this review, we explore the contributing factors for poorer prognosis in these individuals. As a significant proportion of patients with COVID-19 also have diabetes mellitus, this adds another layer of complexity to their management. We explore potential interactions between antidiabetic medications and renin-angiotensin-aldosterone system inhibitors with COVID-19. Suggested recommendations for the use of antidiabetic medications for COVID-19 patients with diabetes mellitus are provided. We also review pertinent clinical considerations in the management of diabetic ketoacidosis in COVID-19 patients. In addition, we aim to increase clinicians' awareness of the metabolic effects of promising drug therapies for COVID-19. Finally, we highlight the importance of timely vaccinations for patients with diabetes mellitus.
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Affiliation(s)
- Ying Jie Chee
- Division of EndocrinologyDepartment of MedicineKhoo Teck Puat HospitalSingapore
| | - Seng Kiong Tan
- Division of EndocrinologyDepartment of MedicineKhoo Teck Puat HospitalSingapore
- Diabetes CenterAdmiralty Medical CenterSingapore
| | - Ester Yeoh
- Division of EndocrinologyDepartment of MedicineKhoo Teck Puat HospitalSingapore
- Diabetes CenterAdmiralty Medical CenterSingapore
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28
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Modin D, Claggett B, Køber L, Schou M, Jensen JUS, Solomon SD, Vardeny O, Knop FK, Nielsen SD, Fralick M, Torp-Pedersen C, Gislason G, Biering-Sørensen T. Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study. Diabetes Care 2020; 43:2226-2233. [PMID: 32647052 DOI: 10.2337/dc20-0229] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/28/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent influenza infection is associated with an increased risk of atherothrombotic events, including acute myocardial infarction (AMI) and stroke. Little is known about the association between influenza vaccination and cardiovascular outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS We used nationwide register data to identify patients with diabetes in Denmark during nine consecutive influenza seasons in the period 2007-2016. Diabetes was defined as use of glucose-lowering medication. Patients who were not 18-100 years old or had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease were excluded. Patient exposure to influenza vaccination was assessed before each influenza season. We considered the outcomes of death from all causes, death from cardiovascular causes, and death from AMI or stroke. For each season, patients were monitored from December 1 until April 1 the next year. RESULTS A total of 241,551 patients were monitored for a median of four seasons (interquartile range two to eight seasons) for a total follow-up of 425,318 person-years. The vaccine coverage during study seasons ranged from 24% to 36%. During follow-up, 8,207 patients died of all causes (3.4%), 4,127 patients died of cardiovascular causes (1.7%), and 1,439 patients died of AMI/stroke (0.6%). After adjustment for confounders, vaccination was significantly associated with reduced risks of all-cause death (hazard ratio [HR] 0.83, P < 0.001), cardiovascular death (HR 0.84, P < 0.001), and death from AMI or stroke (HR 0.85, P = 0.028) and a reduced risk of being admitted to hospital with acute complications associated with diabetes (diabetic ketoacidosis, hypoglycemia, or coma) (HR 0.89, P = 0.006). CONCLUSIONS In patients with diabetes, influenza vaccination was associated with a reduced risk of all-cause death, cardiovascular death, and death from AMI or stroke. Influenza vaccination may improve outcome in patients with diabetes.
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Affiliation(s)
- Daniel Modin
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Brian Claggett
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Respiratory Medicine Section, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Scott D Solomon
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Orly Vardeny
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis, MN
| | - Filip Krag Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Fralick
- Sinai Health System and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian Torp-Pedersen
- Department of Health Science and Technology, Aalborg University, and Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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29
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Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS One 2020; 15:e0238215. [PMID: 32845926 PMCID: PMC7449476 DOI: 10.1371/journal.pone.0238215] [Citation(s) in RCA: 323] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Estimating the risk of pre-existing comorbidities on coronavirus disease 2019 (COVID-19) mortality may promote the importance of targeting populations at risk to improve survival. This systematic review and meta-analysis aimed to estimate the association of pre-existing comorbidities with COVID-19 mortality. METHODS We searched MEDLINE, SCOPUS, OVID, and Cochrane Library databases, and medrxiv.org from December 1st, 2019, to July 9th, 2020. The outcome of interest was the risk of COVID-19 mortality in patients with and without pre-existing comorbidities. We analyzed 11 comorbidities: cardiovascular diseases, hypertension, diabetes, congestive heart failure, cerebrovascular disease, chronic kidney disease, chronic liver disease, cancer, chronic obstructive pulmonary disease, asthma, and HIV/AIDS. Two reviewers independently extracted data and assessed the risk of bias. All analyses were performed using random-effects models and heterogeneity was quantified. RESULTS Eleven pre-existing comorbidities from 25 studies were included in the meta-analysis (n = 65, 484 patients with COVID-19; mean age; 61 years; 57% male). Overall, the between-study heterogeneity was medium, and studies had low publication bias and high quality. Cardiovascular disease (risk ratio (RR) 2.25, 95% CI = 1.60-3.17, number of studies (n) = 14), hypertension (1.82 [1.43 to 2.32], n = 13), diabetes (1.48 [1.02 to 2.15], n = 16), congestive heart failure (2.03 [1.28 to 3.21], n = 3), chronic kidney disease (3.25 [1.13 to 9.28)], n = 9) and cancer (1.47 [1.01 to 2.14), n = 10) were associated with a significantly greater risk of mortality from COVID-19. CONCLUSIONS Patients with COVID-19 with cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease and cancer have a greater risk of mortality compared to patients with COVID-19 without these comorbidities. Tailored infection prevention and treatment strategies targeting this high-risk population might improve survival.
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Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Emily S. Heilbrunn
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
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30
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Moreno-Fernández J, García-Seco JA, Rodrigo EMO, Segura AMS, García-Seco F, Muñoz-Rodríguez JR. Vaccination adherence to influenza, pneumococcal and hepatitis B virus in adult type 1 diabetes mellitus patients. Prim Care Diabetes 2020; 14:343-348. [PMID: 31582202 DOI: 10.1016/j.pcd.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022]
Abstract
AIM To document adherence to influenza, pneumococcal and hepatitis B virus (HBV) vaccination programme in adult type 1 diabetes mellitus (T1DM) patients. MATERIALS AND METHODS Observational retrospective study using data obtained from computerized clinical records. We contacted all adult T1DM registered in our database from a tertiary diabetes care hospital. Primary efficacy outcome was to describe influenza, pneumococcal and HBV vaccination status. RESULTS Three hundred patients were analyzed (male 53%). Mean age was 40.0±14.4years and T1DM duration was 19.7±11.8years. Thirty-five percent of the patients had complementary indications for studied vaccines. Adherence to vaccination program for influenza, pneumococcal and HBV was achieved by 55%, 18% and 17% of the patients, respectively. Only 3% of the subjects were vaccinated against the three microorganisms. Predictor of correct vaccination were: age, shorter diabetes duration, insulin pump treatment, better diabetes control and being a health professional. We detected 17 sick leaves, 127 lost working days and 3 hospitalizations due to flue during the follow-up. CONCLUSIONS The uptake of recommended vaccinations against influenza, pneumococcal and HBV in adult T1DM patients was below desirable levels. A special effort is required to all health professionals to implement immunization among adult people with T1DM. Clinical Trials NCT03478254.
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Affiliation(s)
- Jesús Moreno-Fernández
- Endocrinology and Nutrition Department, Ciudad Real University Hospital, Ciudad Real, Spain.
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31
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Boey L, Bosmans E, Ferreira LB, Heyvaert N, Nelen M, Smans L, Tuerlinckx H, Roelants M, Claes K, Derdelinckx I, Janssens W, Mathieu C, Van Cleemput J, Vos R, Vandermeulen C. Vaccination coverage of recommended vaccines and determinants of vaccination in at-risk groups. Hum Vaccin Immunother 2020; 16:2136-2143. [PMID: 32614656 PMCID: PMC7553698 DOI: 10.1080/21645515.2020.1763739] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Upon exposure to vaccine-preventable diseases, certain individuals are at increased risk for complications due to preexisting diseases, age or immunosuppressive treatment. Vaccination against influenza, pneumococcal disease and hepatitis B (for some groups) is advised in addition to standard vaccination against diphtheria, tetanus and pertussis. We estimated the vaccination coverage and determinants of recommended vaccinations in patients with diabetes mellitus type 1 (n = 173) and type 2 (n = 177), chronic kidney disease (CKD) (n = 138), heart failure (n = 200), chronic obstructive pulmonary disease (COPD) (n = 187), HIV (n = 201) or solid organ transplantation (SOT) (n = 201) in a monocentric study. Vaccination data were retrieved from documents provided by patients and general practitioners, and from the Flemish vaccination register. Less than 10% had received all recommended vaccines. Overall, 29% of subjects were vaccinated against diphtheria-tetanus, 10% against pertussis, 44% against influenza, 32% against pneumococcal disease and 24% of HIV patients and 31% of CKD patients against hepatitis B. Age was positively associated with vaccination against influenza (OR:2.0, p < .01) and pneumococcal disease (OR:2.6, p < .001). Patients with COPD, HIV and SOT were more likely to be vaccinated against influenza (OR:2.8, p < .001, OR:1.8, p < .05; OR:2.0, p < .001, respectively) and pneumococcal disease (OR:2.9, p < .001, OR:25.0, p < .001; OR:2.6, p < .001, respectively) than patients with heart failure. Reason for non-vaccination were concerns about effectiveness, necessity and side effects of influenza vaccines, and not being aware of the recommendation for pneumococcal disease. Initiatives to monitor the vaccination status of vulnerable patients are needed, which is why we advocate systematic vaccination registration and frequent communication about vaccination.
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Affiliation(s)
- Lise Boey
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Eline Bosmans
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Liane Braz Ferreira
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nathalie Heyvaert
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Melissa Nelen
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lisa Smans
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Hanne Tuerlinckx
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven , Leuven, Belgium
| | - Kathleen Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven , Leuven, Belgium
| | - Inge Derdelinckx
- Department of General Internal Medicine, University Hospitals of Leuven , Leuven, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, University Hospitals of Leuven , Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals of Leuven , Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, University Hospitals of Leuven , Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases - Lung Transplantation Unit, University Hospitals of Leuven , Leuven, Belgium
| | - Corinne Vandermeulen
- Leuven University Vaccinology Center , Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Environment and Health, Department of Public Health and Primary Care, KU Leuven , Leuven, Belgium
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32
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Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes 2019. Diabetol Int 2020; 11:165-223. [PMID: 32802702 PMCID: PMC7387396 DOI: 10.1007/s13340-020-00439-5] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Tatsuya Kondo
- Department of Diabetes, Metabolism and Endocrinology, Kumamoto University Hospital, Kumamoto, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Ichikawa, Japan
| | - Hiroshi Noto
- Division of Endocrinology and Metabolism, St. Luke’s International Hospital, Tokyo, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akihiko Taguchi
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yukio Tanizawa
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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33
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Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes 2019. J Diabetes Investig 2020; 11:1020-1076. [PMID: 33021749 PMCID: PMC7378414 DOI: 10.1111/jdi.13306] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Eiichi Araki
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Atsushi Goto
- Department of Health Data ScienceGraduate School of Data ScienceYokohama City UniversityYokohamaJapan
| | - Tatsuya Kondo
- Department of Diabetes, Metabolism and EndocrinologyKumamoto University HospitalKumamotoJapan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and EndocrinologyIchikawa HospitalInternational University of Health and WelfareIchikawaJapan
| | - Hiroshi Noto
- Division of Endocrinology and MetabolismSt. Luke's International HospitalTokyoJapan
| | - Hideki Origasa
- Department of Biostatistics and Clinical EpidemiologyGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular GeneticsEhime University Graduate School of MedicineToonJapan
| | - Akihiko Taguchi
- Department of Endocrinology, Metabolism, Hematological Science and TherapeuticsGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Yukio Tanizawa
- Department of Endocrinology, Metabolism, Hematological Science and TherapeuticsGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Kazuyuki Tobe
- First Department of Internal MedicineGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
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34
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Thewjitcharoen Y, Butadej S, Malidaeng A, Yenseung N, Nakasatien S, Lekpittaya N, Kittipoom W, Krittiyawong S, Himathongkam T. Trends in influenza and pneumococcal vaccine coverage in Thai patients with type 2 diabetes mellitus 2010-2018: Experience from a tertiary diabetes center in Bangkok. J Clin Transl Endocrinol 2020; 20:100227. [PMID: 32395432 PMCID: PMC7212954 DOI: 10.1016/j.jcte.2020.100227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Trends in influenza and pneumococcal vaccine coverage in Thai patients with type 2 diabetes mellitus 2010-2018: Experience from a tertiary diabetes center in Bangkok. BACKGROUND Routine vaccination is an important part of preventive services in treating patients with type 2 diabetes (T2DM). There are no available data in temporal trends of vaccination coverage rates in both influenza and pneumococcal vaccines among Thai patients with T2DM. AIM This study aimed to elucidate influenza and pneumococcal vaccination trends and to identify factors that affect vaccination rates in those patients. METHOD A retrospective study of randomly medical records stratified by 13 diabetologists was conducted in patients with T2DM from 2010 to 2018 at Theptarin Hospital, a private multi-disciplinary diabetes center in Bangkok. Adherence to influenza and pneumococcal vaccinations according to current guidance on adult immunization in Thailand had been studied. The rate of both vaccinations from each diabetologist had also been recorded. RESULTS A total of 2114 medical records (female 51.7%, mean age 65.2 ± 12.8 years, BMI 26.5 ± 4.6 kg/m2, A1C 7.1 ± 1.3%, median duration of diabetes 13 years) were retrospectively reviewed covering a 9-year period. We audited 3554 selected outpatient visits for influenza and pneumococcal vaccinations rates as key performance index in each year. The overall vaccination rate was 39.6% for influenza, 17.4% for the pneumococcal vaccine, and only 13.7%, for both vaccines. The trends of influenza vaccination rates increased from 32.9% in 2010 to 52.2% in 2018 but the trends of pneumococcal vaccination rates were relatively stable at less than 20%. The rate of both vaccinations varied considerably from 0 to 44% among our diabetologists. Age ≥ 65 years, duration of DM ≥ 15 years, the presence of chronic respiratory disease, and moderate to severe Charlson Comorbidity Index (CCI) score were positively associated with both received vaccinations. CONCLUSIONS The completeness and timeliness of influenza and pneumococcal vaccinations were unsatisfactory in Thai patients with T2DM. More efforts are needed to increase both influenza and pneumococcal vaccination rates.
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Affiliation(s)
| | - Siriwan Butadej
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
| | - Areeya Malidaeng
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
| | - Nalin Yenseung
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
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35
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Bechini A, Ninci A, Del Riccio M, Biondi I, Bianchi J, Bonanni P, Mannucci E, Monami M. Impact of Influenza Vaccination on All-Cause Mortality and Hospitalization for Pneumonia in Adults and the Elderly with Diabetes: A Meta-Analysis of Observational Studies. Vaccines (Basel) 2020; 8:vaccines8020263. [PMID: 32486233 PMCID: PMC7349976 DOI: 10.3390/vaccines8020263] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Diabetes is a chronic condition that can be worsened by complications such as seasonal influenza virus infections. The aim of the present meta-analysis is the systematic retrieval and analysis of all available evidence on the effects of an influenza vaccine on diabetic patients. We conducted a systematic review and meta-analysis by searching MEDLINE, Embase and the Cochrane databases from inception until April 2019. We included all types of studies reporting on the effectiveness of influenza vaccination in adult and elderly patients with type 1 and type 2 diabetes. The Newcastle-Ottawa scale was used to assess risk of bias, the GRADE methodology was used to assess the evidence for each outcome. A total of 2261 studies were identified, of those, 6 studies completely fulfilled the inclusion criteria. In the 6 studies included in the analysis, influenza vaccination was associated with a lower mortality rate (Mantel Haenszel Odds Ratio (MH-OR), 95% CI: 0.54 (0.40; 0.74), p < 0.001). Patients who received influenza vaccination showed a lower risk of hospitalization for pneumonia (MH-OR, 95% CI: 0.89; (0.80; 0.98), p = 0.18). A sensitivity analysis using fixed effect model confirmed the results (MH-OR, 95% CI: 0.91; (0.87; 0.96); p = 0.001). The results of this meta-analysis are clinically relevant and support the recommendation for all persons with diabetes to receive influenza vaccination.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (A.N.); (I.B.); (J.B.); (P.B.)
| | - Alessandra Ninci
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (A.N.); (I.B.); (J.B.); (P.B.)
| | - Marco Del Riccio
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (A.N.); (I.B.); (J.B.); (P.B.)
- Correspondence:
| | - Ilaria Biondi
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (A.N.); (I.B.); (J.B.); (P.B.)
| | - Jacopo Bianchi
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (A.N.); (I.B.); (J.B.); (P.B.)
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (A.N.); (I.B.); (J.B.); (P.B.)
| | - Edoardo Mannucci
- Diabetology, Careggi Hospital and University of Florence, 50134 Florence, Italy; (E.M.); (M.M.)
| | - Matteo Monami
- Diabetology, Careggi Hospital and University of Florence, 50134 Florence, Italy; (E.M.); (M.M.)
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36
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Nikiphorou E, de Lusignan S, Mallen C, Khavandi K, Roberts J, Buckley CD, Galloway J, Raza K. Haematological abnormalities in new-onset rheumatoid arthritis and risk of common infections: a population-based study. Rheumatology (Oxford) 2020; 59:997-1005. [PMID: 31501866 PMCID: PMC7849938 DOI: 10.1093/rheumatology/kez344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/23/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the prevalence of haematological abnormalities in individuals with RA at the point of diagnosis in primary care and the associations between haematological abnormalities, vaccinations and subsequent risk of common infections. METHODS We studied 6591 individuals with newly diagnosed RA between 2004 and 2016 inclusive using the UK Royal College of General Practitioners Research and Surveillance Centre primary care database. The prevalence of haematological abnormalities at diagnosis (anaemia, neutropenia and lymphopenia) was established. Cox proportional hazards models were used to evaluate the association between each haematological abnormality and time to common infections and the influence of vaccination status (influenza and pneumococcal vaccine) on time to common infections in individuals with RA compared with a matched cohort of individuals without RA. RESULTS Anaemia was common at RA diagnosis (16.1% of individuals), with neutropenia (0.6%) and lymphopenia (1.4%) less so. Lymphopenia and anaemia were associated with increased infection risk [hazard ratio (HR) 1.18 (95% CI 1.08, 1.29) and HR 1.37 (95% CI 1.08, 1.73), respectively]. There was no evidence of an association between neutropenia and infection risk [HR 0.94 (95% CI 0.60, 1.47)]. Pneumonia was much more common in individuals with early RA compared with controls. Influenza vaccination was associated with reduced risk of influenza-like illness only for individuals with RA [HR 0.58 (95% CI 0.37, 0.90)]. CONCLUSION At diagnosis, anaemia and lymphopenia, but not neutropenia, increase the risk of common infections in individuals with RA. Our data support the effectiveness of the influenza vaccination in individuals with RA.
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Affiliation(s)
- Elena Nikiphorou
- Department of Inflammation Biology, King’s College London & Department of Rheumatology, King’s College Hospital, London
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele
| | - Kaivan Khavandi
- Pfizer Medical Affairs, Inflammation & Immunology, Pfizer Innovative Health, Tadworth, Surrey
| | - Jacqueline Roberts
- Pfizer Medical Affairs, Inflammation & Immunology, Pfizer Innovative Health, Tadworth, Surrey
| | - Christopher D Buckley
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham
- Kennedy Institute of Rheumatology, University of Oxford, Oxford
- Research into Inflammatory Arthritis Centre Versus Arthritis, and the MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham
| | - James Galloway
- Centre for Rheumatic Diseases, King’s College London, Denmark Hill, London
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham
- Research into Inflammatory Arthritis Centre Versus Arthritis, and the MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Rose AMC, Kissling E, Gherasim A, Casado I, Bella A, Launay O, Lazăr M, Marbus S, Kuliese M, Syrjänen R, Machado A, Kurečić Filipović S, Larrauri A, Castilla J, Alfonsi V, Galtier F, Ivanciuc A, Meijer A, Mickiene A, Ikonen N, Gómez V, Lovrić Makarić Z, Moren A, Valenciano M. Vaccine effectiveness against influenza A(H3N2) and B among laboratory-confirmed, hospitalised older adults, Europe, 2017-18: A season of B lineage mismatched to the trivalent vaccine. Influenza Other Respir Viruses 2020; 14:302-310. [PMID: 32022450 PMCID: PMC7182608 DOI: 10.1111/irv.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/22/2023] Open
Abstract
Background Influenza A(H3N2), A(H1N1)pdm09 and B viruses co‐circulated in Europe in 2017‐18, predominated by influenza B. WHO‐recommended, trivalent vaccine components were lineage‐mismatched for B. The I‐MOVE hospital network measured 2017‐18 seasonal influenza vaccine effectiveness (IVE) against influenza A(H3N2) and B among hospitalised patients (≥65 years) in Europe. Methods Following the same generic protocol for test‐negative design, hospital teams in nine countries swabbed patients ≥65 years with recent onset (≤7 days) severe acute respiratory infection (SARI), collecting information on demographics, vaccination status and underlying conditions. Cases were RT‐PCR positive for influenza A(H3N2) or B; controls: negative for any influenza. “Vaccinated” patients had SARI onset >14 days after vaccination. We measured pooled IVE against influenza, adjusted for study site, age, sex, onset date and chronic conditions. Results We included 3483 patients: 376 influenza A(H3N2) and 928 B cases, and 2028 controls. Most (>99%) vaccinated patients received the B lineage‐mismatched trivalent vaccine. IVE against influenza A(H3N2) was 24% (95% CI: 2 to 40); 35% (95% CI: 6 to 55) in 65‐ to 79‐year‐olds and 14% (95% CI: −22 to 39) in ≥80‐year‐olds. Against influenza B, IVE was 30% (95% CI: 16 to 41); 37% (95% CI: 19 to 51) in 65‐ to 79‐year‐olds and 19% (95% CI: −7 to 38) in ≥80‐year‐olds. Conclusions IVE against influenza B was similar to A(H3N2) in hospitalised older adults, despite trivalent vaccine and circulating B lineage mismatch, suggesting some cross‐protection. IVE was lower in those ≥80 than 65‐79 years. We reinforce the importance of influenza vaccination in older adults as, even with a poorly matched vaccine, it still protects one in three to four of this population from severe influenza.
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Affiliation(s)
| | | | - Alin Gherasim
- National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain
| | - Itziar Casado
- Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC Cochin Pasteur, université Paris Descartes, Sorbonne Paris Cité, hôpital Cochin, AP-HP, Paris, France
| | - Mihaela Lazăr
- National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Sierk Marbus
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Monika Kuliese
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ritva Syrjänen
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Ausenda Machado
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sanja Kurečić Filipović
- Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain
| | - Jesús Castilla
- Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain
| | - Valeria Alfonsi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Florence Galtier
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CHU de Montpellier, Inserm CIC 1411, Hôpital Saint-Eloi, Montpellier, France
| | - Alina Ivanciuc
- National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Adam Meijer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aukse Mickiene
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Niina Ikonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Verónica Gómez
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Zvjezdana Lovrić Makarić
- Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia
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Dhar R, Ghoshal AG, Guleria R, Sharma S, Kulkarni T, Swarnakar R, Samaria JK, Chaudhary S, Gaur SN, Christopher DJ, Singh V, Abraham G, Sarkar A, Mukhopadhyay A, Panda J, Swaminathan S, Nene A, Krishnan S, Shahi PK, Sarangdhar N, Mishra N, Chowdury SR, Halder I, Katiyar SK, Jain VK, Chawla R, Koul PA. Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults. Lung India 2020; 37:S4-S18. [PMID: 32830789 PMCID: PMC7703812 DOI: 10.4103/lungindia.lungindia_270_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, Fortis Hospital, Kolkata, West Bengal, India
| | - Aloke Gopal Ghoshal
- Department of Pulmonary Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shubham Sharma
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Tarang Kulkarni
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care and Sleep Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - J K Samaria
- Department of TB and Chest Diseases, Centre for Research and Treatment of Allergy, Asthma and Bronchitis, Varanasi, Uttar Pradesh, India
| | - Sudhir Chaudhary
- Department of Pulmonology, Kulwanti Hospitals and Research Center, Kanpur, Uttar Pradesh, India
| | - S N Gaur
- Department of Respiratory Medicine and Tuberculosis, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Asthma Bhawan, Shastri Nagar, Jaipur, Rajasthan, India
| | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Anirban Sarkar
- Department of Pulmonology, Zenith Superspeciality Hospital, Kolkata, West Bengal, India
| | - Ansuman Mukhopadhyay
- Department of Pulmonology, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Jayant Panda
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | | | - Amita Nene
- Department of Chest Medicine, Bombay Hospital, Mumbai, Maharashtra, India
| | - Shyam Krishnan
- Department of Chest Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar Shahi
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, Lung Clinica, Andheri West Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, MKCG Medical College, Berhampur, Odisha, India
| | | | - Indranil Halder
- Department of Pulmonary Medicine, College Of Medicine & JNM Hospital, Kalyani, Nadia, Uttar Pradesh, India
| | - S K Katiyar
- Chest Care Center, Kanpur, Uttar Pradesh, India
| | - V K Jain
- Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Rakesh Chawla
- Dr Rakesh Chawla's Chest, Asthma Allergy and Sleep Clinic, Delhi, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Tao L, Lu M, Wang X, Han X, Li S, Wang H. The influence of a community intervention on influenza vaccination knowledge and behavior among diabetic patients. BMC Public Health 2019; 19:1747. [PMID: 31881877 PMCID: PMC6935125 DOI: 10.1186/s12889-019-8101-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate the impact of a comprehensive community intervention on cognition and inoculation behaviors of diabetic patients immunized with influenza vaccine. METHODS A total of 1538 diabetic patients aged 35 years and above for outpatient visits and follow-up treatments were selected from six community health service centers (three for the experimental group, and the other three for the control group) in Chaoyang District, Beijing. Comprehensive interventions applied to the experimental group include patient intervention and community climate interventions. We compared the total awareness of influenza vaccine knowledge and influenza vaccination rates between the two groups before and after the intervention. RESULTS Before the intervention, the total awareness rate of influenza vaccine in the experimental group and the control group was similar (50.6 and 50.2%, respectively. P = 0.171). After the intervention, the awareness rate of influenza vaccine in the experimental group and the control group increased. The amplitude of the increase was similar (70.3 and 70.1%, respectively. P = 0.822,). Before the intervention, there was no significant difference in the influenza vaccination rate between the experimental group and the control group (29.0 and 26.8%, respectively. P = 0.334). After the intervention, the vaccination rate of the experimental group was higher than that of the control group. The difference was statistically significant (The vaccination rate 45.8 and 27.4% for the experimental group and the control group, respectively. P < 0.001). CONCLUSION Comprehensive community interventions had a positive effect on vaccination in diabetic patients. TRIAL REGISTRATION ChiCTR1900025194, registered in Aug,16th, 2019. Retrospectively registered.
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Affiliation(s)
- Lili Tao
- Department of Chronic Diseases Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, No. 25 Panjiayuan Huaweili, Chaoyang District, Beijing, China
| | - Ming Lu
- Peking Union Medical College, Cancer hospital, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Xiaoning Wang
- Department of Chronic Diseases Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, No. 25 Panjiayuan Huaweili, Chaoyang District, Beijing, China
| | - Xiaoyan Han
- Department of Chronic Diseases Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, No. 25 Panjiayuan Huaweili, Chaoyang District, Beijing, China
| | - Shuming Li
- Department of Chronic Diseases Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, No. 25 Panjiayuan Huaweili, Chaoyang District, Beijing, China
| | - Haiyan Wang
- Beijing Friendship Hospital affiliated to Capital Medical University, Beijing, China
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40
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Lam F, Chen TL, Shih CC, Lin CS, Yeh CC, Lee YJ, Hu CJ, Chiou HY, Liao CC. Protective effect of influenza vaccination on outcomes in geriatric stroke patients: A nationwide matched cohort study. Atherosclerosis 2019; 282:85-90. [PMID: 30711633 DOI: 10.1016/j.atherosclerosis.2019.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/14/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS The effects of influenza vaccination (IV) on stroke outcomes are unclear. The purpose of this study is to evaluate the outcomes after stroke in elderly individuals who have received an IV. METHODS We used Taiwan's National Health Insurance Research Database 2000-2009 claims data to conduct a nested stroke cohort study including 148,909 hospitalized stroke patients aged 66 years and older. Using a matching procedure by propensity score, we selected 25,248 stroke patients with IV and 25,248 stroke patients without IV for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs of post-stroke complications and in-hospital mortality associated with IV. RESULTS Stroke patients with IV had significantly lower risks of post-stroke pneumonia (OR = 0.79; 95% CI, 0.74-0.83), septicemia (OR = 0.78; 95% CI, 0.70-0.86), urinary tract infection (OR = 0.87; 95% CI, 0.83-0.92), and 30-day in-hospital mortality (OR = 0.60; 95% CI, 0.54-0.67) compared with non-IV stroke patients. Vaccinated stroke patients also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of post-stroke adverse events in patients with IV were noted in both sexes of all age groups with various types of stroke. CONCLUSIONS Stroke patients with IV showed fewer complications and lower mortality compared with non-IV patients. These findings suggest the urgent need to promote IV for this susceptible population of stroke patients.
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Affiliation(s)
- Fai Lam
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chuan Shih
- The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Yuarn-Jang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Fica A, Sotomayor V, Fasce R, Dabanch J, Soto A, Charpentier P, Guerrero G, Olivares F, Triantafilo V, Omeiri NE, Gaínza-Lein M. Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital. Rev Panam Salud Publica 2019; 43:e1. [PMID: 31093225 PMCID: PMC6393720 DOI: 10.26633/rpsp.2019.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 06/16/2018] [Indexed: 12/16/2022] Open
Abstract
Objective To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet). Methods Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. Results A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn–winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0–164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44–55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02–33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20–24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021–0.90). Conclusions Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.
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Affiliation(s)
- Alberto Fica
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | | | - Rodrigo Fasce
- Viral Hepatitis and Emerging Diseases Section, Viral Diseases Subdepartment, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Jeannette Dabanch
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Andrés Soto
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Paulo Charpentier
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Gonzalo Guerrero
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Felipe Olivares
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | | | - Nathalie El Omeiri
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, D.C., United States of America
| | - Marina Gaínza-Lein
- School of Medicine, Universidad Austral de Chile-Campus Isla Teja, Valdivia, Chile
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Chen CM, Chen HJ, Chen WS, Lin CC, Hsu CC, Hsu YH. Clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis. Int J Rheum Dis 2018; 21:1246-1253. [PMID: 29879317 DOI: 10.1111/1756-185x.13322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis (RA). METHODS The present study was conducted by using the Taiwan National Health Insurance Research Database. In this retrospective nationwide study, we included 3748 RA patients who received influenza vaccinations in 2008, 2009 and 2010, and 3748 matched RA patients who did not receive influenza vaccinations. We followed the patients from 4 weeks after influenza vaccination to the end of the influenza season in each year. After adjustment for potential confounding factors, including disease-modifying anti-rheumatic drugs, we used the Cox proportional hazards regression model to analyze the clinical effectiveness of influenza vaccination. RESULTS The influenza vaccination rate in RA patients was 14.8% in 2008, 19.8% in 2009 and 9.50% in 2010. Receiving influenza vaccine was associated with reduced risk of hospitalization for septicemia, bacteremia or viremia (hazards ratio [HR] = 0.65, 95% CI = 0.45-0.94), and lower risk of mortality (HR = 0.62, 95% CI = 0.39-0.97). The effectiveness was particularly significant in elderly patients. CONCLUSIONS RA patients receiving influenza vaccine have significantly lower morbidity and mortality, particularly in elderly patients. Further studies are needed to explore effective policies to increase the vaccination rate in elderly RA patients.
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Affiliation(s)
- Chun-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Shan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Healthcare Service Research Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yueh-Han Hsu
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan
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43
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Verhees RAF, Dondorp W, Thijs C, Dinant GJ, Knottnerus JA. Influenza vaccination in the elderly: Is a trial on mortality ethically acceptable? Vaccine 2018; 36:2991-2997. [PMID: 29691101 DOI: 10.1016/j.vaccine.2018.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022]
Abstract
The effectiveness of influenza vaccination in the elderly has long been a topic of debate, fueled by the absence of direct evidence from randomized trials on its effect on mortality and the methodological limitations of observational studies pointing this direction. It is argued that new placebo-controlled trials should be undertaken to resolve this uncertainty. However, such trials may be ethically questionable. To bring this discussion forward, we provide a comprehensive overview of the ethical challenges of an influenza vaccine efficacy trial designed to evaluate mortality in the elderly. An important condition in the justification of a trial is the existence of genuine uncertainty in regard to the answer to a research question. Therefore an extensive analysis of the existing levels of knowledge is needed to support the conclusion that an effect of vaccination on mortality is uncertain. Even if a so called "clinical equipoise" status applies, denying a control group vaccination would be problematic because vaccination is considered "competent care" and withholding vaccination could substantially increase patients' risk for influenza and its complications. Given the high burden of disease and already proven benefits of vaccination, such a trial is unlikely to meet the Declaration of Helsinki stating that the importance of a trial must outweigh the risk patients are exposed to. While a placebo-controlled trial in vaccine refusers may be considered, such a trial is unlikely to meet substantial methodological barriers regarding trial size and generalizability. We conclude that a new trial is unlikely to provide for a direct answer, let alone change current policy. At the same time, given the lack of consensus on the ethical acceptability of a placebo-controlled trial on the effect of influenza vaccination on mortality in the elderly, we invite researchers considering such trials to address the ethical challenges discussed in this manuscript.
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Affiliation(s)
- Ruud Andreas Fritz Verhees
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Wybo Dondorp
- Department of Health, Ethics and Society, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Carel Thijs
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Geert Jan Dinant
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Johannes Andreas Knottnerus
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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44
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Affiliation(s)
- Jennifer E Isenor
- College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Centre for Health Care of the Elderly (Bowles), Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Susan K Bowles
- College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Centre for Health Care of the Elderly (Bowles), Nova Scotia Health Authority, Halifax, Nova Scotia
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Shibata M, Iwane T, Higuchi R, Suwa K, Nakajima K. Potential common factors associated with predisposition to common cold in middle-aged and elderly Japanese: A community-based cross-sectional study. Medicine (Baltimore) 2018; 97:e10729. [PMID: 29768343 PMCID: PMC5976333 DOI: 10.1097/md.0000000000010729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/23/2018] [Indexed: 02/05/2023] Open
Abstract
People worldwide frequently catch a common cold, which occasionally develops into secondary severe conditions such as pneumonia. However, it is unclear whether predisposition to the common cold is associated with the individual's characteristics including age, body weight, lifestyles, diets, and intestinal functions, besides exposure to a responsible pathogen. We addressed this issue epidemiologically considering many relevant clinical factors.We reviewed data from a cross-sectional study consisting of 39,524 apparently healthy Japanese aged 40 to 79 years (26,975 men and 12,549 women) who underwent a checkup in 2007. Self-reported predisposition to common cold (SPCC) and relevant clinical conditions and parameters were considered.We observed no significant difference in most clinical parameters including age, body mass index (BMI), glycated hemoglobin (HbA1c), and prevalence of men and current smokers between subjects with and without SPCC. In univariate analysis, circulating white blood cell (WBC) count and serum alanine-aminotransferase (ALT) were significantly higher in subjects with SPCC than in those without, whereas serum high-density lipoprotein cholesterol (HDL-C) and duration of sleep were lower. In logistic regression analysis after full adjustment for relevant confounding factors, BMI categories except BMI of ≥27.0 kg/m were significantly associated with SPCC compared with BMI of 23.0 to 24.9 kg/m. Short duration of sleep (≤5 hours), occasional alcohol drinking, and no-exercise were significantly associated with SPCC compared with 7 hours sleep duration, no-drinking alcohol, and low frequent exercise (twice per month), respectively. All gastrointestinal disorders (gastric complaints, constipation, and diarrhea) were independently associated with SPCC. Imbalanced diet and taking a snack were also associated with SPCC in a degree dependent manner. Furthermore, WBC count, serum ALT, and HDL-C (as continuous variables) were associated with SPCC (HDL-C was inversely), whereas no significant association was observed between SPCC and age, smoking, HbA1c, and pharmacotherapy for diabetes, hypertension, and dyslipidemia.Our results demonstrated that multifactorial conditions and parameters might be simultaneously associated with the predisposition to common cold. Prospective studies including detailed common cold questionnaire and measurements are needed to confirm currently suspected causative and protective factors.
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Affiliation(s)
- Michi Shibata
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services
- Department of Nutrition, St. Marianna University School of Medicine Hospital, Kawasaki, Kanagawa
| | - Taizo Iwane
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services
| | - Ryoko Higuchi
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services
| | - Kaname Suwa
- Saitama Health Promotion Corporation, Yoshimimachi, Hikigun
| | - Kei Nakajima
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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46
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Abstract
Life-long primary prevention interventions beginning and continuing throughout an individual's lifetime are increasingly seen as key to meeting the global healthcare challenges that accompany demographic changes - a concept referred to as "Healthy aging". In this perspective, vaccination is seen as part of a triad, together with healthy diet and exercise. Current adult vaccine coverage is lower than target vaccination rates in most developed countries, and so vaccine preventable diseases continue to present a substantial burden on health and healthcare resources, especially in older individuals. In part, this is due to lack of knowledge and understanding of the benefits of vaccination, inconsistent recommendations by providers and uncertainties about cost benefits. However, lower vaccine effectiveness in older adults plays a part, and new vaccines with novel characteristics to improve effectiveness in older adults are required. A life-course immunization approach to ensure optimal vaccine uptake across adults of all ages can be expected to reduce morbidity and mortality in later life. To achieve this, greater emphasis on public and healthcare provider education is necessary, based on appropriate economic analyses that demonstrate the overall value of vaccination. This article introduces the technical, economic, political and demographic issues that make establishing effective adult vaccination programs such a difficult, but pressing issue, and outlines some of the steps that are now being taken to address them. Key messages Life-long preventive activities that start and continue throughout life are essential, especially as the world's population is "getting older". This "Healthy aging" approach includes not only healthy diet and physical exercise; vaccination is critical in reducing some infectious diseases and their complications. Many adults, especially older adults (who have lower immunity than younger people) develop infections such as influenza and shingles that could potentially be prevented through vaccination. This review provides a perspective on the challenges in delivering a life-course immunization program. While some vaccines are less effective in older people, newer vaccines have been developed which provide stronger and longer protection in older patients than standard existing vaccines. However, the benefits of vaccination can only be realized if the vaccines are recommended and used. For that purpose, greater education of patients and their healthcare providers is necessary. Better knowledge of vaccines and making sure that all adults are up to date with all their recommended vaccines is an essential part of "Healthy aging". This should prevent not only vaccine-preventable diseases but also reduce the risk of complications in later life.
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Affiliation(s)
| | | | - T Mark Doherty
- c Department of Medical Affairs , GlaxoSmithKline , Wavre , Belgium
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47
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Dos Santos G, Tahrat H, Bekkat-Berkani R. Immunogenicity, safety, and effectiveness of seasonal influenza vaccination in patients with diabetes mellitus: A systematic review. Hum Vaccin Immunother 2018. [PMID: 29517396 PMCID: PMC6149986 DOI: 10.1080/21645515.2018.1446719] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Influenza is associated with an increased risk of complications, especially in diabetic mellitus patients who are more susceptible to influenza infection. Despite recommendations of the WHO and public health authorities, vaccination uptake in this population remains suboptimal. This systematic review identified 15 studies published between January 2000-March 2017 in PubMed, Embase and Cochrane Library, which provided data on immunogenicity, safety, effectiveness, and/or cost-effectiveness of seasonal influenza vaccination in diabetic patients. Immunogenicity of seasonal influenza vaccination in diabetic patients was generally comparable to that of healthy participants. One month after vaccination of diabetic patients, seroconversion rates and seroprotection ranged from 24.0-58.0% and 29.0-99.0%, respectively. Seasonal influenza vaccination reduced the risk of hospitalization and mortality in diabetic patients, particularly those aged ≥65 years. These review results demonstrate and reinforce the need and value of annual influenza vaccination in diabetic patients, particularly in alleviating severe complications such as hospitalization or death.
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48
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Rondy M, Larrauri A, Casado I, Alfonsi V, Pitigoi D, Launay O, Syrjänen RK, Gefenaite G, Machado A, Vučina VV, Horváth JK, Paradowska-Stankiewicz I, Marbus SD, Gherasim A, Díaz-González JA, Rizzo C, Ivanciuc AE, Galtier F, Ikonen N, Mickiene A, Gomez V, Kurečić Filipović S, Ferenczi A, Korcinska MR, van Gageldonk-Lafeber R, Valenciano M. 2015/16 seasonal vaccine effectiveness against hospitalisation with influenza A(H1N1)pdm09 and B among elderly people in Europe: results from the I-MOVE+ project. ACTA ACUST UNITED AC 2018; 22:30580. [PMID: 28797322 PMCID: PMC5553054 DOI: 10.2807/1560-7917.es.2017.22.30.30580] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/08/2017] [Indexed: 11/20/2022]
Abstract
We conducted a multicentre test-negative case-control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged ≥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases.
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Affiliation(s)
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain.,CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain
| | - Itziar Casado
- CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | | | | | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, APHP, CIC Cochin-Pasteur, Paris, France
| | - Ritva K Syrjänen
- Impact Assessment Unit, National Institute for Health and Welfare, Tampere, Finland
| | - Giedre Gefenaite
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ausenda Machado
- Epidemiology Research Unit, Epidemiology Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Sierk D Marbus
- Centre for Epidemiology and surveillance of infectious diseases, Centre for infectious disease control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Alin Gherasim
- National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain.,CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain
| | | | | | | | - Florence Galtier
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC de Montpellier, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Niina Ikonen
- Viral Infections Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Aukse Mickiene
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Veronica Gomez
- Epidemiology Research Unit, Epidemiology Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | - Monika R Korcinska
- National institute of Public Health - National Institute of Hygiene, Department of Epidemiology, Warsaw, Poland
| | - Rianne van Gageldonk-Lafeber
- Centre for Epidemiology and surveillance of infectious diseases, Centre for infectious disease control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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- The I-MOVE+ hospital working group is listed at the end of the article
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49
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Affiliation(s)
- Graham Pawelec
- Second Department of Internal Medicine, University of Tübingen, Tübingen, Germany; Health Sciences North Research Institute, Sudbury, ON, Canada; John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, UK.
| | - Janet McElhaney
- Health Sciences North Research Institute, Sudbury, ON, Canada.
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50
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Crouse Quinn S, Jamison AM, Freimuth VS, An J, Hancock GR. Determinants of influenza vaccination among high-risk Black and White adults. Vaccine 2017; 35:7154-7159. [PMID: 29126805 PMCID: PMC5712242 DOI: 10.1016/j.vaccine.2017.10.083] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults with chronic conditions are at much greater risk of influenza-related morbidity and mortality, yet flu vaccine uptake remains suboptimal. Research focused on the high-risk population has been limited, particularly related to racial disparities in vaccination. We explore a broad range of demographic, racial, and psychosocial factors to identify predictors of vaccination among high-risk adults, with a focus on identify differences between Black and White adults. METHODS We conducted an online survey in March 2015, utilizing international research firm GfK's KnowledgePanel, for a nationally representative sample of Black and White adults (≥18, USA) and limited analysis adults with high-risk of influenza-related complications. Using two-way ANOVA, we assessed demographic, racial, and psychosocial predictors across vaccine uptake in the past five years and across racial group. RESULTS 424 (52.2%) Black and 388 (47.8%) White respondents with high-risk complications completed the survey. 383 (47.3%) reported vaccination annually, 99 (12.2%) most years, 104 (12.9%) once/twice, and 223 (27.6%) never.ANOVA confirmed significant differences in vaccine behavior for most demographic predictors (except education), all racial factors (including racial fairness, experiences of discrimination, etc.), and most psychosocial factors (including vaccine attitudes, trust in the vaccine, etc.). ANOVA confirmed significant differences for most factors by race. We observed significant interaction effects between race and vaccine behavior for subjective social status, access to medical care, knowledge of vaccine recommendations, vaccine attitudes, perceived side effect risks, descriptive norms, subjective norms, flu vaccine hesitancy, and flu vaccine confidence, thus implying racial differences in the connection between vaccine uptake and key demographic, racial, and psychosocial factors. CONCLUSIONS This study provides a novel examination of flu vaccine behavior among high-risk Blacks and Whites that identified factors influencing vaccine uptake.We found significant differences by race. Health care professionals can use this information to more effectively target high-risk adults during flu season.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742-2611, United States.
| | - Amelia M Jamison
- Maryland Center for Health Equity, University of Maryland, College Park, MD, United States
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States
| | - Ji An
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
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