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Annual Revaccination Against Influenza and Mortality Risk in Community-Dwelling Elderly Persons
A. C. G. Voordouw, MD;
M. C. J. M. Sturkenboom, PhD;
J. P. Dieleman, PhD;
Th. Stijnen, PhD;
D. J. Smith, PhD;
J. van der Lei, PhD;
Bruno H. Ch. Stricker, MB, PhD
JAMA. 2004;292:2089-2095.
Context Although large-scale observational studies have demonstrated the effectiveness of influenza vaccination, no large studies have systematically addressed the clinical benefit of annual revaccinations.
Objective To investigate the effect of annual influenza revaccination on mortality in community-dwelling elderly persons.
Design, Setting, and Participants A population-based cohort study using the computerized Integrated Primary Care Information (IPCI) database in the Netherlands including community-dwelling individuals aged 65 years or older from 1996 through 2002. For each year, we computed the individual cumulative exposure to influenza vaccination since study start.
Main Outcome Measure Association between the number of consecutive influenza vaccinations and all-cause mortality vs no vaccination after adjusting for age, sex, chronic respiratory and cardiovascular disease, hypertension, diabetes mellitus, renal failure, and cancer.
Results The study population included 26 071 individuals, of whom 3485 died during follow-up. Overall, a first vaccination was associated with a nonsignificant annual reduction of mortality risk of 10% (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.78-1.03) while revaccination was associated with a reduced mortality risk of 24% (HR, 0.76; 95% CI, 0.70-0.83). Compared with a first vaccination, revaccination was associated with a reduced annual mortality risk of 15% (HR, 0.85; 95% CI, 0.75-0.96). During the epidemic periods this reduction was 28% (HR, 0.72; 95% CI, 0.53-0.96). Similar estimates were obtained for persons with and without chronic comorbidity and those aged 70 years or older at baseline. Overall, influenza vaccination is estimated to prevent 1 death for every 302 vaccinees at a vaccination coverage that varied between 64% and 74%.
Conclusion Annual influenza vaccination is associated with a reduction in all-cause mortality risk in a population of community-dwelling elderly persons, particularly in older individuals.
Author Affiliations: Pharmaco-epidemiology Unit, Departments of Internal Medicine and Epidemiology & Biostatistics (Drs Voordouw, Sturkenboom, Dieleman, Stijnen, and Stricker), Department of Medical Informatics (Drs Sturkenboom, Dieleman, and van der Lei), and Department of Virology (Dr Smith), Erasmus University Medical Center, Rotterdam, the Netherlands; Medicines Evaluation Board (Dr Voordouw) and DrugSafety Unit, Inspectorate for Health Care (Dr Stricker), the Hague, the Netherlands; and Department of Zoology, University of Cambridge, Cambridge, England (Dr Smith).
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