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Marijic, P. ; Schwarzkopf, L. ; Maier, W. ; Trudzinski, F.* ; Schwettmann, L. ; Kreuter, M.*

Effects of influenza vaccination in patients with interstitial lung diseases: An epidemiological claims data analysis.

Ann. Am. Thorac. Soc. 19, 1479-1488 (2022)

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Rationale Vaccination is the most effective protection against influenza. Patients with interstitial lung diseases (ILD) represent a high-risk group for influenza complications. Thus, yearly influenza vaccination is recommended, but evidence on its effects is sparse. Objective This study aimed to compare all-cause mortality and all-cause and respiratory-related hospitalization between vaccinated and unvaccinated patients with ILD. Methods Using data from the largest German statutory health insurance fund (about 27 million insurees in 2020), we analyzed four influenza seasons from 2014/15 to 2017/18 and compared vaccinated to unvaccinated ILD patients. Starting from September 1 of each year we matched vaccinated to unvaccinated patients in a 1:1 ratio using a rolling cohort design. Mortality and hospitalization were compared with Kaplan-Meier plots and effects were calculated during the influenza season (in-season) with risk ratios (RR). Results Both, the vaccinated and the unvaccinated cohort included 7,503 patients in 2014/15, 10,318 in 2015/16, 12,723 in 2016/17, and 13,927 in 2017/18. Vaccination rates were low with 43.2% in season 2014/15 and decreased over time to 39.9% in season 2017/18. The RR for all-cause mortality were 0.79 (95%CI: 0.65, 0.97; p = 0.02) in season 2014/15, 0.66 (95%CI: 0.54, 0.80; p < 0.001) in 2015/16, 0.89 (95%CI: 0.76, 1.04; p = 0.15) in 2016/17, and 0.95 (95%CI: 0.81, 1.12; p = 0.57) in 2017/18. The effects on all-cause hospitalization and respiratory-related hospitalization were similar in all seasons. Conclusions Although an unequivocally beneficial impact of influenza vaccination in patients with ILD could not be demonstrated, we observed promising results regarding avoidance of all-cause mortality in half of the seasons observed. Given the low vaccination rates, further efforts are necessary to improve rates in ILD patients.

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