Efficacy of influenza vaccine among elderly patients by physical activity status
Tóm tắt
Although many studies have shown the usefulness of influenza vaccine in elderly in-patients, the efficacy of vaccination with regard to the daily physical activities of patients has not been fully evaluated. To address this issue, we correlated the use of medical resources with vaccination status in patients categorized according to their daily activity levels. The subjects comprised 237 in-patients at or above 51 years of age, who were hospitalized in the long-term care unit of a Japanese hospital between January and March, 1999. The vaccination status and medical resources use (i.e., oral antibiotics, injected antibiotics, blood cell count, chest X-ray) of each patient were recorded, and the patients were assigned to three subgroups, based on daily life activity scores. Vaccinated in-patients in the ‘bed-bound’ category required fewer medical resources, i.e., oral antibiotics (−2.29 days,P<0.05), injected antibiotics (−5.02 days,P<0.001), blood cell counts (−4.66 times,P<0.001), and chest X-rays (−4.31 times,P<0.001), compared with unvaccinated in-patients. There were no significant differences in treatment parameters between vaccinated and unvaccinated patients in the ‘partly limited’ or ‘no limitation’ categories. It is suggested that influenza vaccination significantly reduces the need for medical treatment only among those in-patients who are the least physically active. Further studies are required to replicate these findings, and to elucidate the underlying reasons for this reduction.
Tài liệu tham khảo
Barker WH. Excess pneumonia- and influenza-associated hospitalizations during influenza epidemics in the United States, 1970–1978. Am. J. Public Health 1986; 76: 761–765.
Ghendon Y. Influenza—its impact and control. World Health Stat Q 1992; 45: 306–311.
Gross PA, Quinnan GV Jr, Weksler ME, Setia U, Douglas RG Jr. Relation of chronic disease and immune response to influenza vaccine in the elderly. Vaccine 1989; 7: 303–308.
Potter JM, O’Donnell B, Carman WF, Roberts MA, Stott DJ. Serological response to influenza vaccination and nutritional and functional status of patients in geriatric medical long-term care. Age Aging 1999; 28: 141–145.
Webster RG. Immunity of influenza in the elderly. Vaccine 2000; 18: 1686–1689.
Deguchi Y, Takasugi Y, Tatara K. Efficacy of influenza vaccine in the elderly in welfare nursing homes: reduction in risks of mortality and morbidity during an influenza A(H3N2) epidemic. J. Medical Microbiology 2000; 49: 553–556.
Peter A, Patriarca MD, Judith A, Weber MPH, Robert A, Parker ScD, et al. Efficacy of influenza vaccine in nursing homes. JAMA 1985; 253: 1136–1139.
Cartter ML, Renzullo PO, Helgerson SD, Martin SM, Jekel JF. Influenza outbreaks in nursing homes: how effective is influenza vaccine in the institutionalized elderly? Infection Control and Hospital Epidemiology 1990; 11: 473–478.
Ohmit SE, Monto AS. Influenza vaccine effectiveness in preventing hospitalization among the elderly during influenza type A and type B seasons. Int. J. Epidemiol. 1995; 24: 1240–1248.
Odelin MF, Pozzetto B, Aymard M, Defayolle M, Jolly-Million J. Role of influenza vaccination in the elderly during an epidemic of A/H1N1 virus in 1988–1989: clinical and serological data. Gerontol. 1993; 39: 109–116.
Fattal-German M, Taillandier J, Mathieu D, Bauman F, Bizzini B. Usefulness of influenza vaccination in the elderly. Biomed Pharmacotherapy 1991; 45: 29–32.
Fedson DS. Clinical practice and public policy for influenza and pneumococcal vaccination of the elderly. Clinics in Geriatric Medicine 1992; 8: 183–199.
Ikematsu H, Nabeshima A, Kakuda K, Yamaji K, Havashi J, Gotou S, Oka T, Shirai T, Yamaga S, Kashiwagi K. Impact of influenza epidemics and efficacy of vaccination among geriatric inpatients.Kansenshougaku Zasshi (J. Jpn. Associ. for Infect. Dis.) 1998; 72: 60–66 (in Japanese).
Evans DB, Hensley MJ, O’Connor SJ. Influenza vaccination in Australia: a review of economic evidence for policy recommendations. Med. J. Australia 1988; 149: 540–543.
Manskopf J, Cates S, Griffin A. A pharmacoeconomic model for the treatment of influenza. Pharmacoeconomics 1999; 16: 73–84.
Homma Y, Kagamimori S, Naruse Y. Active life expectancy, life expectancy and ADL in Japanese elderly.Nihon Kousyuueiseizasshi (Jpn. J. Public Health) 1998; 45: 1018–1029 (in Japanese).
Pedhazur EJ. Multiple regression in behavioral research. Harcourt Brace College Publishers. Fort Worth, TX, 1997.
Bensing JM, Brink-Muinen AVD, Bakker DHD. Gender difference in practice: a Dutch study of general practitioners. Medical Care 1993; 31: 219–229.
Bertakis KD, Helms LJ, Callahan EJ, Azari R, Robbins JA. The influence of gender on physician practice style. Medical Care 1995; 33: 407–416.
Brink-Muinen AVD, Bensing JM, Kerssens JJ. Gender and communication style in general practice. Difference between women’s health care and regular health care. Medical Care 1998; 36: 100–106.
Logan AG, Haynes RB. Determinants of physicians’ competence in the management of hypertension. J. Hypertension 1986; 4: s367-s369.
Ramsey RG, Carline JD, Inui TS, Larson EB, LoGerfo JP, Norcini JJ, Wenrich MD. Change over time in the knowledge base of practicing internist. JAMA 1991; 266: 1103–1107.
SPSSR for Windows Base System Release 9.0J, Chicago IL, 1999.
Patriarca PA, Weber JA, Parker RA, Hall WN, Kendal AP, Bregman DJ. Efficacy of influenza vaccine in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985; 253: 1136–1139.
Iorio AM, Alatri A, Camilloni B, Neri M, Baglio G, Donatelli I. Antibody response to 1995–1996 influenza vaccine in institutionalized and non-insitutionalized elderly women. Gerontology 1999; 45: 31–38.
Szues T. The socio-economic burden of influenza. J. of Antimicrobial Chemotherapy 1999; 44: 11–15.
Kristin L, Nicole, Michael G. The health and economic benefits of influenza vaccination for healthy and at-risk persons aged 65 to 74 years. Pharmacoeconomics 1999; 16: 63–71.
Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost-effectiveness of vaccination against influenza among elderly living in the community. N. Engl. J. Med. 1994; 331: 778–784.
Howells CH, Vesselionova-Jenkins CK, Evans AD, James J. Influenza vaccination and mortality from bronchopneumonia in the elderly. Lancet 1975; 1: 381–383.
Hara Y, Ikematsu H, Nabeshima A, Hagihara A, Nobutomo K, Kashiwagi S. Cost of medication for influenza-infected elderly inpatients.Kansenshougaku Zasshi (J. Jpn. Associ. Infect. Dis.) 1999; 73: 689–693 (in Japanese).