Patients Receiving Influenza Vaccination Research Articles

Pediatric influenza vaccination in the perioperative setting: A quality improvement project.

Unmet need for seasonal influenza vaccination administration to pediatric patients exists at national and local levels. Vaccination during the perioperative period remains controversial, though opportunity exists to meet vaccination need through perioperative programs. The initial SMART Aim of this quality improvement initiative was to establish and increase seasonal influenza vaccination rate in eligible patients during in person preoperative clinic visits in a pediatric perioperative surgical home (PSH) to 10%. Informed by each prior season's experience, we increased our SMART Aim target for vaccinations in seasons two and three to 15 and 18%, respectively. Following the Model for Improvement methodology, the PSH team developed and implemented a perioperative pediatric influenza vaccination program. Across three influenza seasons, key interventions included updates to organizational perioperative vaccination policy, obtaining material influenza vaccination supplies, development of EHR tools, PSH staff education, and communication with patient-families. Rate of eligible patients receiving influenza vaccination at their PSH clinic appointment was tracked over time. Influenza vaccination rates were reported monthly during Season 1, then weekly during seasons two and three. The balancing measure was same day surgery case cancellations related to influenza vaccination given at PSH clinic appointment. Statistical analysis methods utilized include Shewart's control chart and statistical process control (SPC) standards. Special cause variation was determined by eight or more consecutive data points above or below the centerline. The influenza vaccination rates in each of the three influenza seasons exceeded vaccination rate goals of 10, 15, and 18%, respectively. A total of 695 vaccines have been administered since program inception. No same day surgical case cancellations were observed as balancing measure. Over three consecutive influenza vaccination seasons, we safely established and met vaccination rate goals of 10, 15, and 18% to eligible patients during preoperative clinic visits within a pediatric PSH system. Through iterative PDSA cycles, we continue to identify opportunities for future improvement. This suggests that the perioperative period presents opportunity for seasonal influenza vaccination with potential program expansion to include routine vaccines of childhood.

The prevalence of hepatitis B, influenza, and pneumococcal vaccination in diabetic patients Jeddah, Saudi Arabia

Background: Diabetes is one of the most prevalent diseases in Saudi Arabia to the extent that the country is ranked fourth in terms of incidence rate. Diabetes poses multiple health threats not only to patients but also to society and the healthcare system. Thus, numerous measures have been adapted to contain diabetes risk. One of these is the recommendation of vaccination sets for diabetic patients. This study aims to measure the coverage of hepatitis B virus (HBV), influenza, and pneumococcal vaccines in diabetic patients. Methods: Using a retrospective chart review, data were collected from 385 diabetic patients. An approved data collection sheet was used. Phone calls were utilized for subjective-based questions. The sample size was calculated via Raosoft@. Descriptive or inferential statistical analysis was performed using Statistical Package for the Social Sciences. Results: Type 1 and type 2 diabetic patients represented 44.2% and 55.8%, respectively. Only 15.2% of patients received influenza vaccination in the last 12 months. Approximately 14.2% of diabetic patients received the pneumococcal vaccine, while the HBV vaccination rate was 12.9%. Hospital admission within the last 12 months of influenza-vaccinated patients was 22.8%, while the unvaccinated patients recorded 77.8%. Diabetic patients reported that physicians' recommendation rates of vaccines were 25.8% for influenza vaccine, 15.5% for pneumococcal vaccine, and 10.8% for HBV vaccine. Conclusion: Measuring vaccination rates of 12.9%, 14.2%, and 15.2%, respectively, concludes that compliance with the medical recommendations of vaccinating diabetic patients is suboptimal. Healthcare institutions must collaborate with primary care physicians to integrate more efficient and adherent vaccination programs.

Effects of Banafine® , a fermented green banana-derived acidic glycoconjugate, on influenza vaccine antibody titer in elderly patients receiving gastrostomy tube feeding.

Immunosenescence can negatively affect cytokine production in elderly and may impair poor antibody responses to influenza vaccination and infection. Herein, the effects of Banafine® administration on influenza vaccine antibody titer in elderly patients (average age ∼80 years) receiving gastrostomy tube feeding were examined. In the double-blind, single-center, randomized clinical studies, 30 elderly bedridden patients were administered Banafine® or placebo for 8weeks. At week 4, all patients received influenza vaccination against H1N1, H3N2, B/Yamagata, or B/Victoria. Blood biochemical indices and serum antibody titers were assessed. Banafine® administration significantly increased hemagglutination inhibition titers in response to vaccination against H1N1, H3N2, and B/Yamagata in the elderly patients (P<0.05). Moreover, the seroconversion rate against H1N1 (47.1%) and H3N2 (29.4%) and seroprotection rate against H1N1 (71.4%) and both B strains (31.3% and 12.5%, respectively) were increased for the Banafine® group. These results suggest that Banafine® administration can increase antibody responses to influenza vaccination in bedridden hospitalized patients, and potentially modulate immune function in the elderly. PRACTICAL APPLICATION: Literature review suggested that most of the synbiotics are based on innate immunity, strain specific (probiotics), and are not consistently observed. Herein, in clinical studies we demonstrate that administration of Banafine® , a plant-based glycoconjugate, can increase antibody levels in bedridden hospitalized elderly patients following influenza vaccination.

Impact of influenza vaccination on amoxicillin prescriptions in older adults: A retrospective cohort study using primary care data.

Bacterial infections of the upper and lower respiratory tract are a frequent complication of influenza and contribute to the widespread use of antibiotics. Influenza vaccination may help reduce both appropriate and inappropriate prescribing of antibiotics. Electronic health records provide a rich source of information for assessing secondary effects of influenza vaccination. We conducted a retrospective study to estimate effects of influenza vaccine on antibiotic (amoxicillin) prescription in the elderly based on data from the Clinical Practice Research Datalink. The introduction of UK policy to recommend the influenza vaccine to older adults in 2000 led to a substantial increase in uptake, creating a natural experiment. Of 259,753 eligible patients that were unvaccinated in 1999 and aged≥65y by January 2000, 88,519 patients received influenza vaccination in 2000. These were propensity score matched 1:1 to unvaccinated patients. Time-to-amoxicillin was analysed using the Prior Event Rate Ratio (PERR) Pairwise method to address bias from time-invariant measured and unmeasured confounders. A simulation study and negative control outcome were used to help strengthen the validity of results. Compared to unvaccinated patients, those from the vaccinated group were more likely to be prescribed amoxicillin in the year prior to vaccination: hazard ratio (HR) 1.90 (95% confidence interval 1.83, 1.98). Following vaccination, the vaccinated group were again more likely to be prescribed amoxicillin, HR 1.64 (1.58,1.71). After adjusting for prior differences between the two groups using PERR Pairwise, overall vaccine effectiveness was 0.86 (0.81, 0.92). Additional analyses suggested that provided data meet the PERR assumptions, these estimates were robust. Once differences between groups were taken into account, influenza vaccine had a beneficial effect, lowering the frequency of amoxicillin prescribing in the vaccinated group. Ensuring successful implementation of national programmes of vaccinating older adults against influenza may help contribute to reducing antibiotic resistance.

Influenza, Shingles and Pneumococcal Vaccine Uptake, Offer and Refusal in Adult Populations at High-Risk for COVID-19: A UK Population-Based Cohort Study

Background: As COVID-19 vaccination programs are being rolled out globally, we studied the ethnic, deprivation, household size and comorbidity ‘patterning’ of existing vaccination programs in populations at high-risk for COVID-19, to inform risk-stratified vaccination strategies and mitigate health inequalities. Methods: A population-level cohort study of UK adults aged 65 years or older, using a large primary care database. We used multivariable logistic regression to assess uptake of influenza, pneumococcal and shingles vaccination across ethnic groups, deprivation quintile, household size, and comorbidities, computing odds ratios (OR) adjusted for age, sex, demographics, body mass index and smoking. Offers and refusals of each vaccination type were analysed in those not receiving them. Findings: The cohort comprised 2,054,463 patients from 1,318 general practices. 1,452,014 (70.7%) patients received influenza vaccine, 1,391,228 (67.7%) received pneumococcal vaccine, and 690,783 (53.4%) received shingles vaccine. Compared to Whites, influenza vaccination uptake was lower in Pakistani (adjusted odds ratio (OR) 0.82; 99% confidence interval: 0.74-0.90), Black Caribbean (OR 0.46; 0.43-0.48), Black African (OR 0.63; 0.58-0.68), Chinese (OR 0.70; 0.64-0.76) and ‘Other ethnic group’ (OR 0.65; 0.63-0.69). The Black Caribbean group had higher vaccination refusal than the White group for influenza vaccination (OR 1.17; 1.05-1.30). Vaccination uptake was lower among the more deprived and those living in household sizes above 3 or more persons, with some significant interactions between ethnicity and comorbidities. Uptake of all three vaccines was higher in those with asthma, COPD, type 2 diabetes, hypertension and learning disability, whilst lower in those with dementia. Interpretation: Whilst uptake and refusal of influenza, shingles and pneumococcal vaccination are patterned by ethnicity, deprivation, household size and comorbidities, vaccination offer is mostly patterned by comorbidities. This information can inform national policies to ensure equitable implementation of COVID-19 vaccination programs to avoid exacerbating health inequalities.Funding Statement: This project was funded by the Medical Research Council (Grant Ref: MR/V027778/1).Declaration of Interests: PST reports previous consultation with AstraZeneca and Duke-NUS outside the submitted work. KK is a Member of the Scientific Advisory Group for Emergencies (SAGE), Member of Independent SAGE, Director of the University of Leicester Centre for Black Minority Health and Trustee of the south Asian Health Foundation. JHC is a member of several SAGE committees and chair of the risk stratification subgroup of the NERVTAG. She is unpaid director of QResearch and founder and former medical director of ClinRisk Ltd (outside the submitted work). MP, AKC, HDM, DS, TAR, FZ, BRS, SJG, CC, CG have no interests to declare.

Risk Of Urticaria In Geriatric Stroke Patients Who Received Influenza Vaccination: A Retrospective Cohort Study.

ObjectiveUrticaria is a mast cell-related disease caused severe itching and the lifetime prevalence of urticaria is about 20% in general population. Our purpose is to evaluate risk of urticaria in geriatric stroke patients received influenza vaccination (IV).MethodsIn a cohort of 192,728 patients with newly diagnosed stroke aged over 65 years obtained from 23 million people in Taiwan’s National Health Insurance between 2000 and 2008, we identified 9890 stroke patients who received IV and 9890 propensity score-matched stroke patients who did not receive IV. Controlling for immortal time bias, both the IV and non-IV groups were followed for one year. Urticaria events were identified during the follow-up period. We calculated the adjusted rate ratios (RRs) and 95% confidence intervals (CIs) of the one-year risk of urticaria associated with IV.ResultsDuring the follow-up period of one year, stroke patients with IV had a significantly higher risk of urticaria compared with non-IV stroke patients (RR 1.81, 95% CI 1.47–2.23). An increased risk of urticaria in stroke patients with IV was noted in both sexes, patients 65–84 years of age, patients with comorbid medical conditions, and various time intervals of follow-up. Vaccinated stroke patients with hemorrhage (RR 4.00, 95% CI 1.76–9.10) and those who received intensive care (RR 5.14, 95% CI 2.32–11.4) had a very high risk of urticaria compared with those without IV.ConclusionReceiving IV may be associated with an increased risk of urticaria in stroke patients. We could not infer the causality from the current results because of this study’s limitations. Future investigations are needed to evaluate the possible mechanism underlying the association between IV and urticaria.

Effect of annual influenza vaccination on reducing lung cancer in patients with chronic obstructive pulmonary disease from a population-based cohort study.

Chronic obstructive pulmonary disease (COPD) patients are at a higher risk of development of lung cancer. Frequent exacerbations of COPD trigger the disease course to chronic inflammation which likely plays a role in the pathogenesis of lung cancer. Previous studies showed influenza virus infection is one of important causes for exacerbations of COPD. Therefore, the aim of this study was to know whether influenza vaccination could reduce the incidence of lung cancer in patients with COPD.This cohort study enrolled patients (≥55 years old) with a recorded diagnosis of COPD between January 1, 2000 and December 31, 2012 by using the Taiwan Health Insurance Database. A propensity score was calculated to reduce vaccine therapy selection bias. Cox proportional hazard regressions were used to investigate the association between the influenza vaccination and lung cancer incidence after adjusting for known confounding factors. Besides, we categorized the patients into 4 groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2–3, ≥4) to evaluate the dose-dependent effect on reducing lung cancer occurrence of lung cancer in COPD patients.Our study comprised of 28,752 eligible individuals from the COPD cohort database. Among them, 51% (14,630) received influenza vaccination; the rest (49%) of the COPD patients did not receive influenza vaccination. We observed that COPD patients receiving influenza vaccination had a lower risk of lung cancer (adjusted HR = 0.40, 95% CI (0.35–0.45), P < .001). We also founded comparable protective effect in both sexes and all age groups (55–64, 65–74, ≥75) regardless of influenza seasonality. Furthermore, dose-dependent protective effect could be seen after stratifying patients according to the total number vaccinations, the adjusted HRs for lung cancer risk were 0.48 (0.40–0.54) and 0.24 (0.20–0.29) for patients who received 2 to 3 and ≥4 vaccinations during the follow-up period.This population-based cohort study demonstrated that annual influenza vaccination administration could reduce incidence of lung cancer in COPD patients.

Impact of a student pharmacist-directed pilot intervention on influenza vaccination documentation and administration rates in older adults receiving parenteral anticancer therapy.

71 Background: Annual influenza vaccination is recommended for individuals 6 months and older. Older adults are at high-risk of developing influenza and complications associated with the virus. However, &lt; 50% of patients with cancer receive the influenza vaccine annually. In previous work at our institution, a quality improvement project identified that only 40% of adult patients initiating parenteral anticancer therapy between September and December 2017 were documented to have received the influenza vaccine. Therefore, a multidisciplinary student pharmacist-directed pilot intervention was developed to improve influenza vaccine documentation and administration rates, and we sought to investigate the impact of this intervention. Methods: All adult patients (≥65 years old) scheduled for parenteral anticancer therapy during November 2018 were screened for influenza vaccination documentation. Patients were identified by reviewing infusion center schedule. Under supervision of board-certified oncology pharmacists, two student pharmacists evaluated influenza vaccination documentation in the institution/network electronic medical record (EMR) and outside records. Patients with unknown vaccination history were identified for interview by pharmacy students. The student pharmacists collaborated with oncology nurses and clinicians to order and administer influenza vaccine to patients who agreed to vaccination. Influenza vaccination status was updated in the EMR following record reviews/interviews. Results: Student pharmacists screened 617 patient EMRs and interviewed 124 patients to verify vaccination status. Furthermore, 33 patients received influenza vaccination as a direct result of student pharmacist intervention. Overall, rate of influenza vaccination status documentation was 60.5%. Conclusions: Compared with historic data, we found promising results for a student pharmacist-directed pilot intervention, which demonstrated the potential to improve influenza vaccination status documentation and administration among older adults receiving parenteral anticancer therapy.

INFLUENZA VACCINATION AND PREVALENCE OF MYOCARDIAL INFARCTION: AN ANALYSIS OF THE 2014 US NATIONAL INPATIENT SAMPLE

Some studies suggest that patients receiving influenza vaccination have fewer instances of myocardial infarction (MI). We utilized the 2014 United States' National Inpatient Sample (NIS) database to study the relationship between influenza vaccination and prevalence of MI. This was a retrospective

50세 이상 천식 환자의 인플루엔자 백신 접종률 및 관련 요인

Objectives: This study aims to investigate the estimated proportion for influenza vaccination and to identify factors associated with influenza vaccination in Korean adults aged 50 and older with asthma. Methods: Data from 2010-2015 Community Health Survey(n=23,662) was used. A chi-square test was performed to investigate the estimated proportion for influenza vaccination, and a multiple logistic regression analysis was used to identify the factors associated with self-reported influenza vaccination. Results: In men, 42.3-49.5% of asthma patients 50–64 years of age, and 78.5-90.2% of elderly (over 65 years of age) asthma patients received influenza vaccination. In women, 49.7-61.9% of asthma patients 50–64 years of age, and 82.7-89.7% of elderly asthma patients received influenza vaccination(p<0.0001). Low education level, non-smoking, non-drinking, hypertension, diabetes and use of public center were related to high influenza vaccination in 50–64 years old men with asthma. Low education level, non-smoking, bad health status, hypertension, diabetes and use of public center were related to high influenza vaccination in 50–64 years old women with asthma. Non-smoking and use of public center were related to high influenza vaccination in over 65 years old men with asthma. White-collar jobs, smoking, absence of hypertension and use of public center were related to low influenza vaccination in over 65 years old women with asthma. Conclusions: Influenza vaccination remains relatively low in asthma patients 50–64 years of age. It is necessary to recommend vaccination to asthma patients, provide them with information, and devise other strategies to improve vaccination.

Racial Disparities in the Utilization of Recommended Supportive Care Among Patients with Multiple Myeloma in the United States

Introduction: Patients with Multiple Myeloma (MM) are living longer due to therapeutic advancements. With improving MM outcomes, supportive care measures focused on optimizing quality of life and minimizing treatment-related toxicities have become more relevant. Patients with MM report high rates of bone pain, skeletal-related events and infections for which bisphosphonates, influenza vaccination, and antiviral prophylaxis have been recommended. The extent to which these supportive care measures are used during routine clinical practice and the factors predicting utilization remain unknown.Methods: We selected older adults (age >65 years) diagnosed with MM between 2008-13 from the Surveillance Epidemiology and End Results-Medicare linked database. We excluded patients diagnosed at autopsy or by death certificate, those without continuous Medicare Parts A and B coverage from 12 months prior to diagnosis through death or end of study (12/31/2014). Additionally, we required continuous Part D claims from 12 months prior to diagnosis to 2 years after diagnosis. We required patients to receive anti-myeloma therapy and survive the first full flu season after diagnosis. Outcomes of interest included proportion of patients receiving guideline concordant supportive care therapy defined as 1) bisphosphonate therapy (zoledronic acid or pamidronic acid) within first 12 months after diagnosis, 2) influenza vaccination in the first flu season after diagnosis, and 3) receipt of antivirals (acyclovir, valacyclovir) among patients receiving bortezomib therapy. We estimated a multivariable logistic regression model for each outcome to evaluate potential predictors of supportive care use including patient characteristics (age, gender, race/ethnicity, comorbidity, disability status, diagnosis of CKD, socio-economic status, year of diagnosis), provider volume/experience (number of MM patients treated during a 12 month look back), and facility type (hospital outpatient vs community).Results: A total of 1,569 Medicare beneficiaries met our eligibility criteria. The median age was 74 years with 47% male and 73% non-Hispanic whites. Only 66% of Medicare beneficiaries on active MM therapy received bisphosphonates within 1 year of diagnosis. 53% of patients received influenza vaccination in the first flu season following diagnosis, and 44% received antiviral prophylaxis while receiving bortezomib therapy. Sensitivity analysis with and without pre-existing chronic kidney disease showed that 48% and 72% received bisphosphonates respectively. In the multivariate analysis, predictors of bisphosphonate non-usage included increasing age, (odds ratio [OR] for 85+ years 0.37; 95% confidence interval [CI] 0.23-0.58 compared to 66-69 years), non-Hispanic black and Hispanic ethnicity (OR 0.51; 95% CI 0.34-0.76 and OR 0.56; 95% CI 0.35-0.91 respectively compared to whites), and higher comorbidity index (for Elixhauser index of 3+ OR 0.41, 95% CI 0.29-0.57 compared to 0). Significant predictors of flu shot non-usage included non-Hispanic black ethnicity (OR 0.49; 95% CI 0.34-0.70 compared to whites), living in West (OR 0.53; 95% CI 0.38-0.75 compared to Midwest), having Medicaid dual coverage (OR 0.66; 95% CI 0.49-0.89) and lower comorbidity burden (For Elixhauser index of 3+ OR 1.44; 95% CI 1.07-1.93 compared to 0). Meanwhile, predictors of antiviral prophylaxis non usage included earlier years of diagnosis (global P<0.01, with increasing OR for more recent years), and higher comorbidity burden (For Elixhauser index of 3+ OR 0.40; 95% CI 0.24-0.67 compared to 0).Conclusion: We found significant under-utilization of supportive care measures focused at bone health and infection prevention among elderly adults with MM in the US. Similar to prior work evaluating utilization of novel MM therapies and transplantation, we found significant racial disparities in receipt of MM supportive care. Future studies should seek to identify reasons for such under-utilization of supportive care during MM therapy so that appropriate interventions may be implemented. DisclosuresZeidan:Agios: Consultancy; Celgene: Consultancy; Novartis: Consultancy; Incyte: Employment; Gilead: Consultancy; Ariad: Consultancy, Speakers Bureau; Abbvie: Consultancy; Pfizer: Consultancy. Podoltsev:Sunesis Pharmaceuticals: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; Boehringer Ingelheim: Research Funding; Astex Pharmaceuticals: Research Funding; Astellas Pharma: Research Funding; LAM Therapeutics: Research Funding; Celgene: Research Funding; Pfizer: Research Funding; Genentech: Research Funding; Daiichi Snakyo: Research Funding; Celator: Research Funding. Gore:Celgene: Consultancy, Research Funding. Ma:Celgene: Consultancy, Research Funding; Incyte: Consultancy. Davidoff:Celgene: Research Funding. Huntington:Celgene: Consultancy; Bayer: Consultancy; Janssen: Consultancy.

Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines–Heart Failure

ObjectivesThis study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF). BackgroundRespiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination. MethodsThis study evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling. ResultsThis study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated. ConclusionsNearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.

SAFETY OF INFLUENZA VACCINATION IN CHILDREN WITH SEVERE ALLERGY TO HEN'S EGGS: A PROSPECTIVE CASE SERIES STUDY

Influenza vaccination guidelines have recommended that pediatricians should consult with allergists in the case of for children with histories of anaphylaxis to hen's eggs. On the other hand, whether such children can be safely vaccinated is unclear. To evaluate the safety of influenza vaccination for children severely allergic to eggs. The study population consisted severe egg-allergic children that had never been immunized with influenza vaccine. The inclusion criteria of severe egg-allergic children included evidence of serum specific IgE antibodies to egg white or an ovomucoid level of class4 or more and complete elimination of dietary intake of eggs, or occurrence of Sampson Grade 3 to 5 anaphylactic reactions upon egg ingestion. Patients underwent skin prick tests, and received 0.1ml of influenza vaccine, followed in 30 minutes if no reaction with the remainder of an age-appropriate dose. We observed the subjects for 30 minutes afterwards, and they were observed by their patients during the subsequent 24 hours. A total of 17 patients were enrolled. All patients received influenza vaccination without an allergic reaction. Influenza vaccination is safe even in children with histories of severe egg allergy. influenza vaccination without an allergic reaction.

The association between influenza infection, vaccination, and atrial fibrillation: A nationwide case-control study

Influenza infection could activate systemic inflammatory responses and increase the sympathetic tone that plays an important role in the pathogenesis of atrial fibrillation (AF). The goal of the present study was to investigate whether influenza infection was a risk factor for AF. We also aimed to study whether influenza vaccination could decrease the risk of AF. From 2000 to 2010, a total of 11,374 patients with newly diagnosed AF were identified from the Taiwan National Health Insurance Research Database. On the same date of enrollment, 4 control patients (without AF) with matched age and sex were selected to be the control group for each study patient. The relationship between AF and influenza infection or vaccination 1 year before the enrollment was analyzed. Compared with patients without influenza infection or vaccination (reference group; n = 38,353), patients with influenza infection without vaccination (n = 1369) were associated with a significantly higher risk of AF with an odds ratio of 1.182 (P = .032) after adjustment for baseline differences. The risk of AF was lower in patients receiving influenza vaccination without influenza infection (n = 16,452) with an odds ratio of 0.881 (P < .001). In patients who have received influenza vaccination and experienced influenza infection (n = 696), the risk of AF was similar to that in the reference group (odds ratio 1.136; P = .214). The lower risk of AF with vaccination was consistently observed in subgroup analyses. Influenza infection was significantly associated with the development of AF, with an 18% increase in the risk, which could be reduced through influenza vaccination.

Characteristics and health behaviors of diabetic patients receiving influenza vaccination

ObjectiveEpidemiological research has posited a ‘healthy user’ bias in patients receiving influenza vaccination; thus we sought to evaluate potential healthy-user attributes and their associations with influenza vaccination. Research design & methodsBetween 2011 and 2013, adults with type 2 diabetes were enrolled in a prospective cohort in Alberta, Canada. Information collected included sociodemographics, diabetes-related data (e.g., duration, complications), health behaviors (e.g., smoking status), functional health status, and satisfaction with healthcare. Data were collected by a mailed, self-administered survey. Multivariable logistic regression analyses were used to identify potential healthy-user attributes independently associated with influenza vaccination. ResultsFrom a cohort of 2040 patients, 1287 (63%) reported receiving the influenza vaccine in the previous year. Average age of the cohort was 64 years (standard deviation 11) and 55% were male. In multivariable analysis, attributes independently associated with influenza vaccination included receiving preventive medications: aspirin (64% vs 44%; adjusted odds ratio, aOR 1.65, 95% CI 1.34–2.04); blood pressure medications (76% vs 56%; aOR 1.36, 95% CI 1.07–1.71); and cholesterol-lowering medications (74% vs 53%; aOR 1.50, 95% CI 1.19–1.89), as well as having a healthcare professional check feet for lesions (47% vs 31%; aOR 1.39, 95% CI 1.12–1.74). Additional covariates independently associated with influenza vaccination included: age over 65 years, respiratory disease, the number of additional comorbidities, and higher ratings of healthcare experience. ConclusionVaccinated diabetic patients exhibit many postulated attributes of ‘healthy users’, which has implications for the interpretation of epidemiological studies of influenza vaccine effectiveness, as well as targeting future vaccination campaigns.

273 Influenza vaccination in CF adults: Coverage level and adverse reactions

Objectives Influenza increases morbidity in CF individuals. Annual vaccination against influenza is a recommended measure in people with chronic respiratory diseases including CF. However, there are worries about adverse reactions of influenza vaccine in some patients and coverage level is generally low in the Czech Republic (approximately 5% of population). Methods We conducted a study in CF adults in Prague CF Centre regarding to coverage level and occurrence of adverse reactions after influenza vaccination using interviews during visits of CF clinic or by phone or e-mail in January 2015. Results 112 CF adults (59 males) with mean±SD age 27.3±6.2 years and mean±SD FEV 1 68±26 pred. were interviewed. Thirty-two (28.6%) patients received influenza vaccine. Among them, three patients experienced adverse reaction of mild intensity. In those who did not received a vaccination, eleven subjects reported adverse reactions in the past (two of them described it as severe), four patients experienced prolonged pulmonary exacerbations and others (58.0% of study group) had no interest in vaccination. Together, current or previous adverse reactions were reported in 14 (12.5%) subjects. Level of vaccination was not associated with sex, age or lung function. Conclusion Coverage level of influenza vaccination in Czech CF adults is low. The main reason is no interest for vaccination. Adverse reactions were quite frequent but usually with only mild intensity.

Community pharmacist-administered influenza immunization improves patient access to vaccination.

To describe the demographic characteristics and risk factors of patients receiving influenza vaccination in community pharmacies and to understand patient experiences and perceptions surrounding being vaccinated by a pharmacist. Survey data were collected by research pharmacists at 4 different community pharmacy locations in Toronto throughout a period of 8 weeks during October and November 2013. Participation in the survey was voluntary, and all patients vaccinated by pharmacists were invited to complete a survey following immunization. During the course of the study, 2498 vaccine doses were administered among all study sites, and 1502 surveys were completed. Our data showed a high degree of patient satisfaction, with 92% of patients indicating they were very satisfied with the pharmacist's injection technique and the services they received. Furthermore, 86% of patients were very comfortable with being vaccinated by a pharmacist, and 99% of patients reported they would recommend that friends and family be vaccinated by a pharmacist. Convenience and accessibility were major determinants of patient satisfaction, as shown by 46% of all written comments specifically addressing these factors. Of the patients surveyed, 25% were not regular annual vaccine recipients, and 47% were classified as being at high risk for influenza complications according to Public Health Agency of Canada criteria. Notably, 28% of total patients and 21% of high-risk patients reported that they would not have been immunized this year if pharmacy-based vaccination were not available. Our findings suggest that pharmacists provide a highly convenient and accessible option for seasonal flu vaccination that is viewed favourably by patients. Administration of the flu vaccine by pharmacists has the potential to positively affect public health by improving vaccination rates among high-risk patients, first-time or occasional vaccine recipients, and patients who may not otherwise have an opportunity to be vaccinated. It is hoped that expanding pharmacist vaccination services to include administration of other common vaccines would receive similar positive reception by patients and improve overall access to vaccination.

A138: Clinical Decision Support to Improve Preventive Care in Pediatric Systemic Lupus Erythematosus

Background/Purpose:Quality indicators, such as infection and cardiovascular disease (CVD) preventive care, for patients with systemic lupus erythematosus (SLE) have recently been published and can be utilized for assessing quality of care. Implementation of tools such as clinical decision support (CDS) within the electronic health record (EHR) can be utilized in quality care improvement efforts. The purpose of this quality improvement study is to test the chronic care model to study the relationship between CDS and rates of compliance with infection and CVD preventive care quality indicators for pediatric SLE patients at an outpatient rheumatology clinic.Methods:The study is a pilot retrospective design with a convenience sample. Documentation in the EHR of up to date vaccinations and lipid screen was measured before and after implementation of an electronic documentation template. Data for the comparative hypothesis was analyzed using Chi‐square test.Results:Baseline data was collected from 48 (70%) patient charts and post‐CDS data were collected from 20 (30%) patient charts. Before intervention, 15 (31.3%) patients received pneumonia vaccine and 17 (81.0%) of patients received vaccine after intervention. Sixteen (33.3%) patients received influenza vaccine before intervention and 20 (95.2%) received vaccine after intervention. Before intervention, 12 (25.0%) patients received lipid panels and 16 (76.2%) patients received lipid panels after intervention. All three differences were significantly different (Fisher's Exact p &lt; 0.001). Patents were 9 times more likely to receive the pneumococcal vaccination and lipid panels and 40 times more likely to receive the influenza vaccination post intervention than before intervention. Baseline QI rates, Post‐intervention QI rates, and statistical differences between groups PVX Vaccine Influenza Vaccine Lipid Panel Baseline patients meeting QI, n (%) 15 (31.3) 16 (33.3) 12 (25) Post CDS patients meeting QI, n (%) 17 (81) 20 (95) 16 (76) Fischer's Exact test significance .000 .000 .000 Cramer's V .459 .570 .480 Odds Ratio (95% CI) 9.35 (2.683–32.587) 40 (4.917–325.378) 9.6 (2.897–31.810) Pretest n = 48 (70%), poster intervention n = 20 (30%); p value &lt; 0.1Conclusion:Use of EHR CDS was associated with improved rates of preventive care for pSLE patients in the Pediatric Rheumatology outpatient setting. Our results suggested that patients were more likely to receive a screening lipid panel, influenza vaccination and pneumococcal vaccination if the health care provider used the EHR template with CDS.

Influenza vaccination in cancer patients undergoing systemic therapy.

BACKGROUNDCancer patients often experience preventable infections, including influenza A and B. These infections can be a cause of significant morbidity and mortality. The increased risk of infection may be because of either cancer itself or treatment-induced immunosuppression.1 Influenza immunization has been shown to decrease the risk of influenza infection in patients with intact immunity.2 In cancer patients, active immunization has been shown to confer protective immunity against several infections at similar rates to healthy individuals, which has translated into decreased duration and severity of infection and potentially improved morbidity and mortality.3OBJECTIVESTo assess the efficacy of influenza vaccination in stimulating immunological response in patients with cancer during chemotherapy compared to control groups.To assess the efficacy of influenza vaccination in preventing confirmed influenza and influenza-like illness and/or stimulating immunological response in children with cancer treated with chemotherapy, compared to placebo, no intervention, or different dosage schedules.To determine the adverse effects associated with influenza vaccination in patients with cancer.SEARCH METHODSWe searched MEDLINE/PubMed database for articles published from 1964 to 2013 using the search terms “cancer,” “adult,” “influenza vaccination,” and “chemotherapy.”SELECTION CRITERIAWe included studies based on systematic sampling with defined clinical criteria irrespective of the vaccination status of cancer patients. Studies measure the serological response or clinical response to compare between the study group and the control group. Studies assessed the inactivated influenza vaccines and live attenuated influenza vaccine (LAIV) protective serological reaction and the clinical outcomes after vaccination.DATA COLLECTION AND ANALYSISTwo independent authors assessed the methodological quality of included studies and extracted data.MAIN RESULTSWe included 16 studies (total number of participants = 1,076). None of the included studies reported clinical outcomes. All included studies reported on influenza immunity and adverse reaction on vaccination. We included 6 solid tumor studies and 10 hematological studies. In 12 studies, the serological response to influenza vaccine was compared in patients receiving chemotherapy (n = 425) versus those not receiving chemotherapy (n = 376). In three studies, the serological responses to influenza vaccination in patients receiving chemotherapy are compared to that in healthy adult. Measures used to assess the serological responses included a four-fold rise increase in antibody titer development of hemagglutination inhibition (HI) titer >40, and pre- and post-vaccination geometric mean titers (GMTs). Immune responses in patients receiving chemotherapy were consistently weaker (four-fold rise of 17–52%) than in those who had completed chemotherapy (50–83%) and healthy patients (67–100%). Concerning adverse effects, oncology patients received influenza vaccine, and the side effects described were mild local reactions and low-grade fever. No life-threatening or persistent adverse effects were reported.AUTHORS’ CONCLUSIONPatients with solid and some of hematological tumors are able to mount a serological response to influenza vaccine, but it remains unclear how much this response protects them from influenza infection or its complications. Meanwhile, influenza vaccine appears to be safe in these patients. While waiting results of randomized controlled trials to give us more details about the clinical benefits of the influenza vaccination, the clinicians should consider the currently proved benefits of influenza vaccination on management of the cancer patients undergoing systematic chemotherapy such as decrease in the duration and severity of the of the disease, and significant decrease in influenza-associated morbidity and mortality in these high-risk patients.3

Influence of corticosteroid therapy on the serum antibody response to influenza vaccine in elderly patients with chronic pulmonary diseases.

Annual influenza vaccination is strongly recommended for patients with chronic pulmonary diseases, such as bronchial asthma, chronic obstructive pulmonary disease (COPD), and interstitial pulmonary diseases. However, many of these patients regularly receive systemic and/or inhaled corticosteroid therapy, and the impact of corticosteroid therapy on influenza vaccine efficacy and safety is unclear. Patients with chronic pulmonary diseases were enrolled in the study and divided into three groups based on their maintenance therapy: (A) without corticosteroid therapy (17 males, three females; mean age, 72.3 ± 7.9), (B) oral corticosteroid therapy (four males, seven females; mean age, 66.1 ± 10.6), and (C) inhaled corticosteroid therapy (eight males, nine females; mean age, 62.4 ± 16.0). All patients received influenza vaccine, and serum hemagglutination inhibition (HI) antibodies against influenza strains A/H1N1, A/H3N2, and B were measured at baseline (before vaccination) and 4-6 weeks after vaccination. Sufficient antibody titers or significant increases were observed after vaccination compared with titers before vaccination in all three groups. No systemic reactions were reported. Long-term oral/inhaled corticosteroid therapy was not associated with vaccination side effects and did not affect the immune response to the influenza vaccine.