Abstract
Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases. Immunosuppressed patients have a high risk for influenza complications and an impaired immune response to vaccines. The total burden of immunosuppressive conditions in the United States, including those receiving emerging biologic therapies, remains unknown. We used the national claims database MarketScan to estimate the prevalence of immunosuppressive conditions and risk for acute respiratory illnesses (ARIs). We studied 47.2 million unique enrollees, representing 115 million person-years of observation during 2012–2017, and identified immunosuppressive conditions in 6.2% adults 18–64 years of age and 2.6% of children <18 years of age. Among 542,105 ARI hospitalizations, 32% of patients had immunosuppressive conditions. The risk for ARI hospitalizations was higher among enrollees with immunosuppression than among nonimmunosuppressed enrollees. Future efforts should focus on developing improved strategies, including vaccines, for preventing influenza in immunosuppressed patients, who are an increasing population in the United States.
Highlights
Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases
During August 2012–July 2017, a total of 47.2 million unique enrollees representing 115 million person-years of observation were included in the US MarketScan database (Table 4)
Among 115 million person-years contributed during the study period, we found a prevalence of 5.9% for immunosuppressive conditions; prevalence was higher for female patients (7.1%) than for male patients (4.7%) (Table 5)
Summary
Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases. Immunosuppressed patients have a high risk for influenza complications and an impaired immune response to vaccines. Future efforts should focus on developing improved strategies, including vaccines, for preventing influenza in immunosuppressed patients, who are an increasing population in the United States. Establishing a case definition for and quantifying the burden of immunosuppressive conditions might facilitate evaluation and use of influenza vaccines to enhance immune response in this high-risk target group. High-dose IIV has met prespecified criteria for superior efficacy against laboratoryconfirmed influenza compared with standard-dose IIV [15,17] These enhanced IIVs are not yet licensed for use in US patients
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