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Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality
Influenza vaccination is proven effective in preventing influenza. However, long-term effects on mortality have never been supported by direct evidence. In this study we assessed the long-term outcome of influenza vaccination on mortality in the elderly by conducting a 25-year follow-up study of a R...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532873/ https://www.ncbi.nlm.nih.gov/pubmed/31120943 http://dx.doi.org/10.1371/journal.pone.0216983 |
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author | Verhees, Ruud Andreas Fritz Thijs, Carel Ambergen, Ton Dinant, Geert Jan Knottnerus, Johannes Andreas |
author_facet | Verhees, Ruud Andreas Fritz Thijs, Carel Ambergen, Ton Dinant, Geert Jan Knottnerus, Johannes Andreas |
author_sort | Verhees, Ruud Andreas Fritz |
collection | PubMed |
description | Influenza vaccination is proven effective in preventing influenza. However, long-term effects on mortality have never been supported by direct evidence. In this study we assessed the long-term outcome of influenza vaccination on mortality in the elderly by conducting a 25-year follow-up study of a RCT on the efficacy of influenza vaccination as baseline. The RCT had been conducted in the Netherlands 5 years before vaccination was recommended for those aged >65 and 17 years before recommending it for those aged >60. The RCT included 1838 community-dwelling elderly aged ≥ 60 that had received an intramuscular injection with the inactivated quadrivalent influenza vaccine (n = 927) or placebo (n = 911) during the 1991/1992 winter. In our follow-up study, outcomes included all-cause mortality, influenza-related mortality and seasonal mortality. Unadjusted and adjusted hazard ratios (HRs) were estimated by Cox regression and sub-hazard ratios (SHRs) by competing risk models. Secondary analyses included subgroup analyses by age and disease status. The vital status up to January 1, 2017 was provided in 1800/1838 (98%) of the cases. Single influenza vaccination did not reduce all-cause mortality when compared to placebo (adjusted HR 0.95, 95% CI 0.85−1.05). Also, no differences between vaccination and placebo group were shown for underlying causes of death or seasonal mortality. In those aged 60–64, median survival increased with 20.1 months (95% CI 2.4–37.9), although no effects on all-cause mortality (adjusted HR 0.86, 95% CI 0.72−1.03) could be demonstrated in survival analysis. In conclusion, this study did not demonstrate a statistically significant effect following single influenza vaccination on long-term mortality in community-dwelling elderly in general. We propose researchers designing future studies on influenza vaccination in the elderly to fit these studies for longer-term follow-up, and suggest age-group comparisons in observational research. Clinical trial registry number: NTR6179. |
format | Online Article Text |
id | pubmed-6532873 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-65328732019-06-05 Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality Verhees, Ruud Andreas Fritz Thijs, Carel Ambergen, Ton Dinant, Geert Jan Knottnerus, Johannes Andreas PLoS One Research Article Influenza vaccination is proven effective in preventing influenza. However, long-term effects on mortality have never been supported by direct evidence. In this study we assessed the long-term outcome of influenza vaccination on mortality in the elderly by conducting a 25-year follow-up study of a RCT on the efficacy of influenza vaccination as baseline. The RCT had been conducted in the Netherlands 5 years before vaccination was recommended for those aged >65 and 17 years before recommending it for those aged >60. The RCT included 1838 community-dwelling elderly aged ≥ 60 that had received an intramuscular injection with the inactivated quadrivalent influenza vaccine (n = 927) or placebo (n = 911) during the 1991/1992 winter. In our follow-up study, outcomes included all-cause mortality, influenza-related mortality and seasonal mortality. Unadjusted and adjusted hazard ratios (HRs) were estimated by Cox regression and sub-hazard ratios (SHRs) by competing risk models. Secondary analyses included subgroup analyses by age and disease status. The vital status up to January 1, 2017 was provided in 1800/1838 (98%) of the cases. Single influenza vaccination did not reduce all-cause mortality when compared to placebo (adjusted HR 0.95, 95% CI 0.85−1.05). Also, no differences between vaccination and placebo group were shown for underlying causes of death or seasonal mortality. In those aged 60–64, median survival increased with 20.1 months (95% CI 2.4–37.9), although no effects on all-cause mortality (adjusted HR 0.86, 95% CI 0.72−1.03) could be demonstrated in survival analysis. In conclusion, this study did not demonstrate a statistically significant effect following single influenza vaccination on long-term mortality in community-dwelling elderly in general. We propose researchers designing future studies on influenza vaccination in the elderly to fit these studies for longer-term follow-up, and suggest age-group comparisons in observational research. Clinical trial registry number: NTR6179. Public Library of Science 2019-05-23 /pmc/articles/PMC6532873/ /pubmed/31120943 http://dx.doi.org/10.1371/journal.pone.0216983 Text en © 2019 Verhees et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Verhees, Ruud Andreas Fritz Thijs, Carel Ambergen, Ton Dinant, Geert Jan Knottnerus, Johannes Andreas Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality |
title | Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality |
title_full | Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality |
title_fullStr | Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality |
title_full_unstemmed | Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality |
title_short | Influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. No impact on long-term mortality |
title_sort | influenza vaccination in the elderly: 25 years follow-up of a randomized controlled trial. no impact on long-term mortality |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532873/ https://www.ncbi.nlm.nih.gov/pubmed/31120943 http://dx.doi.org/10.1371/journal.pone.0216983 |
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