开封市社会医疗保险参保人员流感疫苗成本效益分析

目的 评价社会医疗保险参保人员接种流感疫苗的成本效益.方法 对符合研究对象的7 000名参保职工,用随机抽样方法,抽取2 626人,进行问卷调查.采用历史性队列研究方法,对接种组和对照组进行回顾性调查.结果 流感疫苗接种后与接种前相比年人均感冒发病降低1.92次,降低64.43％(P＜0.05);接种流感疫苗比未种人群流感年人均发病次数降低0.95次,降低47.26％ (P＜ 0.05);接种疫苗后,出现发热等一般反应占7.17％,轻度过敏反应占1.81％.结论 接种流感疫苗是目前预防流感安全有效的措施,对全市参保的人员具有较高的成本效益.     

北京市老年人群流行性感冒疫苗免疫效果及成本效益评价

目的评价老年人群接种流行性感冒(流感)疫苗的效果和效益。方法选取北京市朝阳区和宣武区590名接种过流感疫苗,且年龄>60岁的老年人群为接种组,在社区中随机选择与接种组年龄、性别、健康状况等相匹配的602名未接种流感疫苗者为对照组。采用流行病学试验方法,在基线调查的基础上,分别于流感疫苗接种(基线调查)后的第1、3和6个月对试验组和对照组进行随访调查。结果接种组流感样疾病的发病率和就诊率均低于对照组,接种后第1、3和6个月内流感疫苗对流感样疾病的保护率分别为52.38%、36.84%和37.89%;接种流感疫苗减少流感样疾病就诊率分别为45.16%、50.54%和50.54%。接种组患感冒、其他呼吸系统疾病和慢性病的发病率和就诊率低于对照组,接种流感疫苗对感冒、其他呼吸道疾病和其他慢性疾病的保护率分别为49.54%、64.54%和38.82%。老年人群接种流感疫苗后第3和6个月内所获得的效益成本比为4.97∶1和4.98∶1。结论老年人群接种流感疫苗能有效地预防流感样疾病的发生,降低流感相关慢性疾病的发病率和复发率,且能够获得较高的成本效益。     

椒江区老年人接种流感疫苗的保护效果

目的评价台州市椒江区≥60岁老年人接种流感疫苗的保护效果,为推进老年人流感疫苗免费接种项目和提高流感疫苗接种率提供依据。方法在椒江区随机选取500名于2017年9—10月免费接种流感疫苗的≥60岁老年人为接种组,在相同社区选择性别、年龄和健康状况等因素1∶1匹配的从未接种过流感疫苗500名老年人为对照组,在疫苗接种(或基线调查)后12个月内随访调查流感样疾病(ILI)及并发症发生情况等,并评价流感疫苗的保护效果。结果496名接种组和479名对照组完成了全程随访调查。接种组老年人12个月内ILI发病率为8.06%,低于对照组的19.42%(P0.05),流感疫苗对ILI的保护率为58.46%。疫苗接种后3个月,接种组老年人因呼吸系统疾病门诊就诊率和住院率分别为5.44%和4.44%,均低于对照组的20.67%和8.35%(P0.05);两组接种后6个月和12个月的门诊就诊率和住院率差异均无统计学意义(P0.05)。结论老年人接种流感疫苗能有效预防ILI,降低因呼吸系统疾病的门诊就诊率和住院率。     

肺炎疫苗、流感疫苗联合接种对老年慢性病人群呼吸系统疾病的干预价值

目的 探讨肺炎疫苗、流感疫苗联合接种对老年慢性病人群呼吸系统疾病的干预价值。方法 选取2022年1—12月本院收治的87例老年慢性病患者作为研究对象,用随机数字表法将其分为肺炎疫苗接种组（29例）、流感疫苗接种组（29例）、联合接种组（29例）,对比三组患者接种后就诊和住院情况、流感及肺炎发生状况。结果 肺炎疫苗接种组和流感疫苗接种组感染率、病死率高于联合接种组（P<0.05）;观察组症状持续时间、住院时间短于对照组,住院次数低于对照组（P<0.05）;联合接种组不良反应发生率低于肺炎疫苗接种组、流感疫苗接种组（P<0.05）。结论 老年慢性病人群接受肺炎疫苗、流感疫苗联合接种,能明显降低疾病的发生,缩短住院时间,并有效防控流感、肺炎发病,有推广应用价值。     

干休所75岁以上老年人接种流感疫苗效果观察

目的评价居住在干休所中75岁以上老年人流感疫苗接种的预防效果。方法 2007年9～11月选取干休所接种流感疫苗的162例75岁以上老年人为接种组;同时按照年龄、性别、合并慢性疾病情况匹配,选取未接种流感疫苗的157例75岁以上老年人为对照组。调查分析流感疫苗接种后1年内两组老年人流感样疾病发病及就诊情况,以及慢性心脑血管疾病、慢性呼吸系统疾病、糖尿病等发病(复发)及就诊情况。结果接种组流感样疾病患病率22.22%,就诊率19.75%,均明显低于对照组患病率33.12%,就诊率31.21%,(P<0.05)。接种组心脑血管疾病、呼吸系统疾病、糖尿病(复发)患病率与对照组比较差异无统计学意义,就诊率62.96%明显低于对照组78.98%(P<0.01)。接种组接种疫苗后26例(16.05%)出现局部或全身反应,经对症处理后均恢复正常。结论接种流感疫苗可有效减少75岁以上老年人流感样疾病的发生,并能减少心脑血管疾病、呼吸系统疾病、糖尿病等疾病的就诊率。     

北京市宣武区流行性感冒疫苗保护效果和成本效益分析

目的分析和评估北京市宣武区居民应用流感疫苗后的保护效果和成本效益。方法通过抽样调查的方法,选取宣武区居民1000人作为研究对象,其中接种流感疫苗组501人,对照组499人,两组间年龄、性别、健康状况基本匹配,在基线调查的基础上,分别在接种流感疫苗后的第1、3和6个月对其进行随访调查。结果接种流感疫苗后第1、3和6个月内对ILI(流感样疾病)保护率分别为64.6%、43.2%和43.2%,因接种流感疫苗,ILI和普通感冒就诊率分别减少了61.7%、68.1%和68.1%;接种流感疫苗无不良接种反应发生;接种效益和效益成本比随着接种时间的延长而增加,接种后1、3、6个月疫苗的接种效益分别为-6.29、334.89、336.21,效益成本比分别为-0.09、4.97和4.98。结论流感疫苗接种是安全有效的,具有良好的保护作用和接种效益,应当加大推广接种。     

开封市社会医疗保险参保人员流行性感冒疫苗接种效果

目的了解社会医疗保险参保人员接种流行性感冒(流感)疫苗后的人群预防效果。方法选择开封市7 000名符合要求的参加医疗保险人员作为对象,用随机抽样方法,抽取2 626人,进行问卷调查。采用历史性队列研究方法,对接种组和对照组进行回顾性调查。结果流感疫苗接种后与接种前相比,年人均感冒发病次数降低1.92次,降低了64.43%(P﹤0.01);接种流感疫苗比未种人群年人均发病次数降低0.95次,降低了47.26%(P﹤0.01);差异均有统计学意义接种过流感疫苗者明显比未接种流感疫苗者所花费的药物治疗费用要低;接种疫苗后,出现发热等一般反应的占7.17%,轻度过敏反应的占1.81%。结论接种流感疫苗是目前预防流感安全有效的措施,对该市参保的人员具有较高的成本效益。     

2018-2019年台州市老年人接种流感疫苗的成本效益北大核心

目的评价台州市老年人2018-2019年接种流感疫苗的成本效益。方法采用前瞻性队列研究在社区招募≥60岁老年人分为流感疫苗接种组和非接种组,随访6个月,收集流感样病例经济负担和流感疫苗接种成本相关数据,计算接种流感疫苗的效益成本比。结果共纳入2073名研究对象,其中流感疫苗接种组1048名、非接种组1025名,流感样病例总经济负担中位数为552.9元,其中直接医疗费用200.0元、直接非医疗费用0.0元、间接费用为217.9元。人均流感疫苗接种成本为35.50元,其中疫苗、人力、工作经费成本分别为32.38元、2.63元、0.49元。人均接种流感疫苗效益为199.1元,效益成本比为5.6:1。结论2018-2019年台州市老年人接种流感疫苗具有良好的成本效益。     

西安市居民接种流感疫苗效果及影响因素研究

目的 研究流感疫苗效果及其影响因素.方法 随机整群抽样选择西安东方集团有限公司的2 818人进行问卷调查.接种组1 785人,未接种组1 033人.比较两组人群呼吸系统和心脑血管病住院率,并对疫苗降低住院率的影响因素进行logistic回归分析.结果 接种组标化后住院率为7.7%,对照组为11.900,接种组住院率仅为...     

某部新兵流感疫苗接种效果及效益分析

目的评价某部新兵接种流感疫苗的效果和效益,为部队制订流感疫苗接种策略提供依据。方法于2014年10月选取某部292名新兵接种流感疫苗,作为接种组,同时在该战区选择条件相近的1472名新兵作为对照组,于疫苗接种后70 d的新训期进行随访调查。结果流感疫苗接种组流感样发热疾病的发病率与对照组间差异有显著性意义,流感疫苗对流感样发热疾病的保护率为89.10%。新兵接种流感疫苗后70 d新训期的效益-成本比为5.44∶1。结论对刚到部队的新兵及时接种流感疫苗,可以有效减少流感样发热病例,以及因感染流感病毒造成的经济损失。     

Effectiveness of influenza vaccination in the elderly in South Africa

This study primarily aimed to estimate the association between influenza vaccination and the occurrence of hospitalization for acute respiratory or cardiovascular diseases, or all-cause death during the influenza season in an elderly population in South Africa. We conducted a nested case-control study using data from a cohort of 45 522 elderly members of a private medical funding organization during the moderate 2004 influenza season. In 1282 (2.8%) subjects the combined outcome occurred and the influenza vaccination rate in controls was 15.4%. After adjustments for measured confounders, vaccination was associated with a statistically significant reduction of 19% (95% confidence interval 3.1-32.9) in the combined outcome. Post-hoc sensitivity analysis of the potential impact of potential healthy user bias showed that confounding, if present, could have caused this finding. Our data were inconclusive regarding the benefits of influenza vaccination in elderly persons in South Africa and given the low vaccine uptake, long-term follow-up is warranted.     

Duration of influenza vaccine effectiveness in the elderly in Japan: A retrospective cohort study using large-scale population-based registry data

BackgroundThe immune response to influenza vaccination in the elderly is likely to be lower than that in young adults. Clinical protection may not persist year-round in the elderly. However, the effectiveness of influenza vaccine in the elderly has not been adequately studied, especially in terms of the duration of effectiveness.MethodsWe used a linked database of healthcare administrative claims data and vaccination records maintained by the municipality of a city in Kanto region of Japan. We studied individuals who were aged 65 years or older at baseline and were followed up between April 1, 2014 to March 31, 2020. The duration of influenza vaccine effectiveness by age category was analyzed using a time-dependent piecewise Cox proportional hazard model with time-dependent vaccine status, prior season vaccination and covariates confirmed in the baseline period (age, sex, cancer, diabetes, chronic obstructive pulmonary diseases, asthma, chronic kidney diseases, and cardiovascular diseases).ResultsWe identified an analysis population of 83,146 individuals, of which 7,401 (8.9%) had experienced influenza and 270 (0.32%) underwent influenza-related hospitalization. Individuals who were vaccinated during the first season (n = 47,338) were older than non-vaccinated individuals (n = 35,808) (average age, 75.8 vs. 74.1 years, respectively). The multivariable analysis showed a lower incidence of influenza in vaccinated individuals (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.43–0.51; P < 0.001), while the incidence of hospitalization for influenza did not differ significantly by vaccination status (HR, 0.79; 95% CI, 0.53–1.18; P = 0.249). Protective effectiveness against incidence was maintained for 4 or 5 months after vaccination in those aged 65–69 and 80-years, 5 months in 70–79 years.ConclusionsOur study identified moderate vaccine effectiveness in preventing the incidence of influenza in the Japanese elderly. Vaccine effectiveness showed a trend of gradual attenuation. Clinicians should suspect influenza infection even in those vaccinated, especially in elderly individuals who had received vaccination more than 4 or 5 months previously.     

基于倾向得分匹配的老年人接种流感疫苗对流感就诊的保护效果研究

目的 评估老年人接种流感疫苗对流感就诊的保护效果,并探讨倾向得分匹配法（PSM）在疫苗保护效果研究中的应用价值。方法 以成都市为研究现场,选取2017年9-12月间接种流感疫苗的60岁及以上老年人作为接种组,采用PSM法选取观察对象作为对照组。匹配后比较两组人群疫苗接种后一年内的流感就诊情况,评价疫苗保护效果。结果 流感疫苗接种组与未接种组各有1442例匹配成功。两组的一般人口学特征、生活方式及健康意识、基本健康状况等特征在匹配前有显著差异,匹配后两组协变量达到均衡。匹配后接种组和对照组流感就诊率分别为0.69%、2.84%,疫苗接种可减少之后一年内75.70%的流感就诊。结论 PSM可有效降低观察性研究组间的混杂偏倚,在疫苗接种效果评价中具有长远的应用价值。流感疫苗接种对降低≥60岁老年人流感就诊具有良好效果,今后有必要采取措施提高流感疫苗接种率。     

无锡市甲型H1N1流感及季节性流感疫苗接种效果分析

目的调查流感样病例(ILI)和无锡市一般人群中甲型H1N1流感疫苗及季节性流感疫苗的接种情况,评估疫苗接种后对人群的保护效果。方法以无锡市2家哨点医院为基础,采集流感样病例病毒核酸检测阳性的病例作为病例组,共1 529人,同时按照"病例"的电话信息,随机产生电话号码选择、年龄匹配的一般人群作为对照组,共380人。结果病例组甲型H1N1流感疫苗接种率为6.1%(94/1 529),对照组甲型H1N1流感疫苗接种率为12.1%(46/380),两组比较,差异有统计学意义(P0.01);甲型H1N1流感病例中接种甲型H1N1流感疫苗的比例为12.5%(3/24),门诊检测阴性的ILI病例接种甲型H1N1流感疫苗的比例为6.1%(78/1 273),"接种甲型H1N1流感疫苗"因素的OR值为0.457(P=0.201);以电话调查一般人群(330例)作为对照组,接种甲型H1N1流感疫苗的比例为13.3%(44/330),OR值为1.077(P=0.908)。结论该次调查说明接种甲型H1N1流感疫苗对预防流感样病例有一定效果,但由于样本量较少,24种方法病例对照分析均未得出差异有统计学意义。     

Evidence of bias in estimates of influenza vaccine effectiveness in seniors

BACKGROUND: Numerous observational studies have reported that seniors who receive influenza vaccine are at substantially lower risk of death and hospitalization during the influenza season than unvaccinated seniors. These estimates could be influenced by differences in underlying health status between the vaccinated and unvaccinated groups. Since a protective effect of vaccination should be specific to influenza season, evaluation of non-influenza periods could indicate the possible contribution of bias to the estimates observed during influenza season. METHODS: We evaluated a cohort of 72,527 persons 65 years of age and older followed during an 8 year period and assessed the risk of death from any cause, or hospitalization for pneumonia or influenza, in relation to influenza vaccination, in periods before, during, and after influenza seasons. Secondary models adjusted for covariates defined primarily by diagnosis codes assigned to medical encounters. RESULTS: The relative risk of death for vaccinated persons compared with unvaccinated persons was 0.39 [95% confidence interval (95% CI), 0.33-0.47] before influenza season, 0.56 (0.52-0.61) during influenza season, and 0.74 (0.67-0.80) after influenza season. The relative risk of pneumonia hospitalization was 0.72 (0.59-0.89) before, 0.82 (0.75-0.89) during, and 0.95 (0.85-1.07) after influenza season. Adjustment for diagnosis code variables resulted in estimates that were further from the null, in all time periods. CONCLUSIONS: The reductions in risk before influenza season indicate preferential receipt of vaccine by relatively healthy seniors. Adjustment for diagnosis code variables did not control for this bias. In this study, the magnitude of the bias demonstrated by the associations before the influenza season was sufficient to account entirely for the associations observed during influenza season.     

Influenza vaccine effectiveness in preventing hospitalization among Beijing residents in China, 2013–15

BackgroundEstimates of influenza vaccination effectiveness (VE) are valuable for populations where the vaccine has been promoted in order to support vaccination policy and to permit evaluation of vaccination strategies. Such studies would be important for China due to limited data available during seasons when the vaccine strains matched or mismatched the circulating viruses.MethodsWe conducted a test-negative study in hospitals in Beijing. Patients admitted to five hospitals in the city were enrolled during the winter influenza seasons of 2013–14 and 2014–15. Influenza virus infections were determined by PCR, and influenza vaccination records were extracted from a centralized electronic immunization registry. Influenza VE was estimated by logistic regression adjusting for age group, sex and chronic conditions, and matched by calendar week.ResultsA total of 2368 inpatients were recruited during the study period with a vaccination coverage in the control group of 12.8%. The overall estimate of influenza VE was 46.9% (95% CI: −20.4%, 76.6%) for the 2013–14 season and 5.0% (95% CI: −53.0%, 41.0%) for the 2014–15 season. Estimates of VE were relatively higher in children aged 6–17 years than older persons across two influenza seasons while estimates of VE for both adults and elderly were relatively low.ConclusionsOur findings were consistent with expected influenza vaccination effectiveness in seasons when the vaccine matched or mismatched circulating viruses. Strategies to increase influenza vaccine coverage could provide a public health benefit.     

Comparison between cohorts vaccinated and unvaccinated against influenza and pneumococcal infection

This study characterizes possible confounders that might make cohorts vaccinated and unvaccinated against influenza and pneumococcal infection different at baseline, with the hypothesis that the two cohorts are comparable. The similarity between health and demographic data was analysed by a randomized, multivariant study addressed to 10,000 persons aged 65 years and older in Stockholm County and was carried out in the form of a postal inquiry during the period December 2000 to May 2001. The study-population response rate was 78%. Of these, 66% (5,120 persons) had been given at least one influenza vaccination during the 3-year study period (1998-2000), 50% (3,780) had received one pneumococcal vaccination and 78% had received both vaccines during the period. The vaccination rate was lower in the age group 65-69 years (60%), compared with elderly cohorts aged over 70 years (67-72%, P < 0.001). Elderly persons living in nursing homes or institutions had higher vaccination rates than persons living in their own households (72 vs. 67%). Persons with underlying chronic diseases had higher vaccination rates (71%, P < 0.001) than those without underlying chronic diseases. Vaccine recipients had fewer days in hospital, compared with non-recipients. Unvaccinated persons with myocardial disease had nine times more days in hospital than vaccinated persons with myocardial disease. Vaccination against pneumococcal infection had an additional effect with influenza vaccination in reducing hospitalization for chronic lung diseases; influenza vaccination alone did not have this effect. In conclusion, the influenza and pneumococcal-vaccine recipients were older and had significantly more chronic lung and heart conditions than the unvaccinated cohort.     

国产流行性感冒病毒裂解疫苗上市后的安全性及免疫原性评价

目的评价国产流行性感冒裂解疫苗上市后的安全性与免疫原性。方法 2011年8~10月在河南省长葛、禹州和登封开展了多中心、随机、对照试验。6 171名观察对象随机分配到接种组(3 083人)和对照组(3 088人)。接种组每人接种一剂疫苗,对照组不接受任何处理,比较两组研究对象免疫后28 d不良反应发生率。在接种组随机抽取599人作为免疫效果评估对象,在免疫前和免疫后28 d,采用微量血凝抑制(HI)试验测定疫苗抗体。结果接种组全身和局部不良反应发生率分别为7.14%(220/3 083)和1.36%(42/3 083)。对照组全身不良反应发生率为1.17%(36/3 088),无局部不良反应发生。接种组全身和局部不良反应发生率均显著高于对照组(χ2=138.285,P<0.001;χ2=42.356,P<0.001)。接种组H1N1、H3N2及B型抗体阳转率分别为79.30%、82.80%和67.60%,抗体保护率分别为89.30%、98.30%和93.00%,GMT分别为1∶416、1∶796和1∶180。结论国产流行性感冒裂解疫苗具有良好的安全性和免疫原性,适宜推广应用。     

Trends in U.S. hospitalizations and inpatient deaths from pneumonia and influenza, 1996–2011

BackgroundTo reduce excess morbidity and mortality of pneumonia and influenza (PI), the Advisory Committee on Immunization Practices has recommended the use of 7-valent pneumococcal conjugate vaccine (PCV7), and incrementally expanded the target group for annual influenza vaccination of healthy persons, to ultimately include all persons ≥6 months of age without contraindications as of the 2010–2011 influenza season. We aimed to capture broader epidemiologic changes by looking at PI collectively.MethodsUsing interrupted time series, we evaluated the changes in the rates of PI hospitalization and inpatient death across three periods defined according to the changes in vaccination policy. We assessed linear trends adjusting for seasonality, sex, and age group, allowing for differential impact across age groups. PI hospitalizations were defined as a principal diagnosis of PI, or a principal diagnosis of sepsis or respiratory failure, accompanied by a secondary diagnosis of PI.ResultsOverall annual rates of PI hospitalizations and inpatient deaths declined by 95 per 100,000 (95% CI: 45–145) and by 4.4 per 100,000 (95% CI: 0.9–7.8), respectively. This translates to 295,000 fewer PI hospitalizations and 13,600 fewer PI inpatient deaths than expected based on the average rates from 1996 through 1999. PI hospitalizations dropped the most among seniors aged 65+ by 487 per 100,000, followed by children aged <2, by 228 per 100,000. PI inpatient deaths declined most among seniors aged 65+, by 25.3 per 100,000.ConclusionsIn this nationally representative study, PI hospitalizations and inpatient deaths decreased in U.S. between 1996 and 2011. There is a temporal association with the introduction and widespread use of pneumococcal conjugate vaccines, and the expansion of the target group for annual influenza vaccination to include all persons ≥6 months of age, while it is difficult to attribute these changes directly to specific vaccines used in this era.