Seasonal influenza vaccination in patients with COPD: a systematic literature review

Rafik Bekkat-Berkani,Gael Dos Santos,Philippe Buchy,Dimitris Stefanidis,Tom Wilkinson,Nadia Meyer,Jeanne-Marie Devaster

doi:10.1186/s12890-017-0420-8

Abstract

BackgroundInfluenza is a frequent cause of exacerbations of chronic obstructive pulmonary disease (COPD). Exacerbations are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression, death, and ultimately, substantial healthcare-related costs. Despite longstanding recommendations to vaccinate vulnerable high-risk groups against seasonal influenza, including patients with COPD, vaccination rates remain sub-optimal in this population.MethodsWe conducted a systematic review to summarise current evidence from randomised controlled trials (RCTs) and observational studies on the immunogenicity, safety, efficacy, and effectiveness of seasonal influenza vaccination in patients with COPD. The selection of relevant articles was based on a three-step selection procedure according to predefined inclusion and exclusion criteria. The search yielded 650 unique hits of which 48 eligible articles were screened in full-text.ResultsSeventeen articles describing 13 different studies were found to be pertinent to this review. Results of four RCTs and one observational study demonstrate that seasonal influenza vaccination is immunogenic in patients with COPD. Two studies assessed the occurrence of COPD exacerbations 14 days after influenza vaccination and found no evidence of an increased risk of exacerbation. Three RCTs showed no significant difference in the occurrence of systemic effects between groups receiving influenza vaccine or placebo. Six out of seven studies on vaccine efficacy or effectiveness indicated long-term benefits of seasonal influenza vaccination, such as reduced number of exacerbations, reduced hospitalisations and outpatient visits, and decreased all-cause and respiratory mortality.ConclusionsAdditional large and well-designed observational studies would contribute to understanding the impact of disease severity and patient characteristics on the response to influenza vaccination. Overall, the evidence supports a positive benefit-risk ratio for seasonal influenza vaccination in patients with COPD, and supports current vaccination recommendations in this population.

Highlights

Influenza is a frequent cause of exacerbations of chronic obstructive pulmonary disease (COPD)
The following studies were excluded: 1) Studies including patient groups with a mix of pulmonary diseases if results were not presented for COPD separately; 2) Studies with co-administration of pneumococcal vaccine to avoid confounding vaccine effects; 3) Efficacy studies without a control group receiving placebo; 4) Studies evaluating pandemic influenza vaccines only; 5) Letters to the editor, editorials, case reports or comments; 6) Articles published in languages other than English, Spanish, Italian, French, Dutch or German; 7) Studies of insufficient methodological quality; 8) Studies with mixed results for adults and children with no data presented separately; 9) Modelling studies
This study demonstrated a significant benefit (p < 0.001) in repeating influenza vaccinations in the same patient across several study seasons; four or more vaccinations over eight influenza seasons resulted in a substantial reduction in hospitalisations due to acute coronary syndrome in patients with COPD

Summary

Introduction

Influenza is a frequent cause of exacerbations of chronic obstructive pulmonary disease (COPD). Exacerbations are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression, death, and substantial healthcare-related costs. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality with a significant disease burden in both primary and secondary care. In 2010, 384 million individuals worldwide were estimated to have COPD, with a global prevalence of 11.7% [1]. COPD is the most common cause of death due to chronic respiratory disease, with 2.9 million deaths estimated in 2013 [2]. The frequency and severity of COPD exacerbations is strongly linked to disease progression, quality of life, hospitalisation, morbidity and mortality [5]. Exacerbations of COPD are characterised by acute worsening of symptoms due to airflow restriction resulting from

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