Seasonal influenza vaccination in patients with COPD: a systematic literature review

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Abstract

Background

Influenza is a frequent cause of exacerbations of chronic obstructive pulmonary disease (COPD). Exacerbations are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression, death, and ultimately, substantial healthcare-related costs. Despite longstanding recommendations to vaccinate vulnerable high-risk groups against seasonal influenza, including patients with COPD, vaccination rates remain sub-optimal in this population.

Methods

We conducted a systematic review to summarise current evidence from randomised controlled trials (RCTs) and observational studies on the immunogenicity, safety, efficacy, and effectiveness of seasonal influenza vaccination in patients with COPD. The selection of relevant articles was based on a three-step selection procedure according to predefined inclusion and exclusion criteria. The search yielded 650 unique hits of which 48 eligible articles were screened in full-text.

Results

Seventeen articles describing 13 different studies were found to be pertinent to this review. Results of four RCTs and one observational study demonstrate that seasonal influenza vaccination is immunogenic in patients with COPD. Two studies assessed the occurrence of COPD exacerbations 14 days after influenza vaccination and found no evidence of an increased risk of exacerbation. Three RCTs showed no significant difference in the occurrence of systemic effects between groups receiving influenza vaccine or placebo. Six out of seven studies on vaccine efficacy or effectiveness indicated long-term benefits of seasonal influenza vaccination, such as reduced number of exacerbations, reduced hospitalisations and outpatient visits, and decreased all-cause and respiratory mortality.

Conclusions

Additional large and well-designed observational studies would contribute to understanding the impact of disease severity and patient characteristics on the response to influenza vaccination. Overall, the evidence supports a positive benefit-risk ratio for seasonal influenza vaccination in patients with COPD, and supports current vaccination recommendations in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12890-017-0420-8) contains supplementary material, which is available to authorized users.

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Most cited references 43

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Public health impact of including two lineages of influenza B in a quadrivalent seasonal influenza vaccine.

Carrie Reed, Martin Meltzer, Lyn Finelli … (2012)

The annual trivalent influenza vaccine (TIV) includes viruses representing three influenza strains - one A/H1N1, one A/H3N2, and one B, although two antigenically distinct lineages of influenza B (Victoria and Yamagata) co-circulate annually in the United States. Predicting which lineage of influenza B will predominate during a season is challenging, and cross-protection by immunization against the other lineage is expected to be low. One proposed alternative is to produce a quadrivalent influenza vaccine (QIV) including an influenza B virus from each of the two circulating lineages. We estimated the additional public health benefit of QIV compared with TIV by calculating the expected impact on influenza-related health outcomes (illness, hospitalization, and death) over ten influenza seasons (1999/2000-2008/2009). We included data on the annual incidence of influenza-associated outcomes, virologic circulation, vaccine coverage, and vaccine effectiveness. We also considered annual vaccine production capacity, since available resources would have produced four vaccine viruses instead of three, potentially resulting in fewer doses of QIV. Use of QIV could have reduced annual cases (range: 2200-970,000), hospitalizations (range: 14-8200), and deaths (range: 1-485) in the US. During earlier seasons, adjusting production capacity for a fourth virus in QIV could have resulted in reduced overall influenza vaccine availability and net increases in influenza-associated outcomes. However, in recent seasons, the expected supply of QIV is likely to exceed the doses of vaccine actually administered. The potential net impact of QIV on influenza-associated outcomes is expected to vary between seasons, depending on annual variability in the incidence of influenza caused by the two influenza B lineages, vaccine coverage, and effectiveness. The additional protection provided by including a second lineage of influenza B could result in a modest reduction in influenza-associated outcomes. Published by Elsevier Ltd.

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Prevalence of viral infection detected by PCR and RT‐PCR in patients with acute exacerbation of COPD: A systematic review

Anant Mohan, Subhash Chandra, Dipti Agarwal … (2010)

ABSTRACT Background and objective: Viruses are important aetiological agents of acute exacerbation of COPD (AECOPD). Their reported prevalence varies from region to region. This systematic review calculated the prevalence of respiratory viral infections in AECOPD. Methods: A systematic search was performed using Medline, and references of relevant articles and conference proceedings were hand searched. Articles for review were selected based on the following criteria: (i) prospective or cross‐sectional study, (ii) original research, (iii) viral detection used the highly sensitive techniques of PCR and/or Reverse Transcriptase PCR (RT‐PCR), (iv) viral prevalence in AECOPD defined, and (v) full paper available in English. We assessed the study quality and extracted data independently and in duplicate using a pre‐defined data extraction form. Weighted mean prevalence (WMP) was calculated and a forest plot was constructed to show the dispersion. Results: Eight studies met the inclusion criteria. The WMP of respiratory viral infection in AECOPD was 34.1% (95% CI: 23.9–44.4). picornavirus was the most commonly detected virus with WMP 17.3% (95% CI: 7.2–27.3), followed by influenza; 7.4% (95% CI: 2.9–12.0), respiratory syncytial virus; 5.3% (95% CI: 1.6–9.0), corona viruses; 3.1% (95% CI: 0.4–5.8), parainfluenza; 2.6% (95% CI: 0.4–4.8), adenovirus; 1.1% (95% CI: −1.1 to 3.3), and human metapneumovirus; 0.7% (95% CI: −0.3 to 1.8). Maximum WMP was observed in studies from Europe followed by the USA, Australia and Asia. Picorna was the most common virus detected in Western countries whereas influenza was most common in Asia. Conclusions: This systematic review demonstrated that viruses are strongly associated with AECOPD, with the highest detection rates of viruses being in Europe. The geographical epidemiology of viruses may have important therapeutic implications for management of AECOPD.

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The global economic burden of asthma and chronic obstructive pulmonary disease.

S Ehteshami-Afshar, J FitzGerald, M M Doyle-Waters … (2016)

Non-communicable diseases are now the number one cause of disabilities and loss of life expectancy. Among them, chronic respiratory conditions constitute a major class. The burden of chronic respiratory diseases is generally increasing across the globe, and asthma and chronic obstructive pulmonary disease (COPD) are among the main causes of mortality and morbidity. However, the direct and indirect costs of these conditions vary across jurisdictions. This article reports on recent estimates of the costs of asthma and COPD, with a focus on comparing disease burden across different regions. Overall, there is tremendous variation in per capita annual costs of asthma and COPD. However, the methodology of the cost-of-illness studies is also vastly different, making it difficult to associate differences in reported costs to differences in the true burden of asthma and COPD. Suggestions are provided towards improving the validity and comparability of future studies.

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Author and article information

Contributors

Rafik Bekkat-Berkani: +1 (215) 779-6433 , Rafik.X.Bekkat-Berkani@gsk.com

Tom Wilkinson: T.Wilkinson@soton.ac.uk

Philippe Buchy: Philippe.X.Buchy@gsk.com

Gael Dos Santos: Gael.X.Dos-Santos@gsk.com

Dimitris Stefanidis: D.Stefanidis@hotmail.com

Jeanne-Marie Devaster: Jeanne-Marie.Devaster@gsk.com

Nadia Meyer: Nadia.X.Meyer@gsk.com

Journal

Journal ID (nlm-ta): BMC Pulm Med

Journal ID (iso-abbrev): BMC Pulm Med

Title: BMC Pulmonary Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2466

Publication date (Electronic): 3 May 2017

Publication date PMC-release: 3 May 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 79

Affiliations

[1 ]GRID grid.425090.a, , GSK, ; Wavre, Belgium

[2 ]ISNI 0000 0004 1936 9297, GRID grid.5491.9, Clinical and Experimental Sciences, Faculty of Medicine, , University of Southampton, ; Southampton, UK

[3 ]GSK, Singapore, Singapore

[4 ]Business & Decision Life Sciences, Brussels, Belgium

[5 ]GRID grid.425090.a, , GSK, ; Rixensart, Belgium

[6 ]GRID grid.425090.a, , Present address: GSK, ; Wavre, Belgium

[7 ]ISNI 0000 0001 2171 7500, GRID grid.420061.1, , Present address: Boehringer-Ingelheim Pharma GmbH & Co. KG, ; Ingelheim, Germany

[8 ]ISNI 0000 0004 0393 4335, GRID grid.418019.5, , Present address: GSK, ; 5 Crescent Drive, Philadelphia, PA 19112 USA

Article

Publisher ID: 420

DOI: 10.1186/s12890-017-0420-8

PMC ID: 5415833

PubMed ID: 28468650

SO-VID: 0e343522-fe55-4fbd-9cac-0ee6e6cb1b73

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 3 November 2016

Date revision received : 21 April 2017

Date accepted : 25 April 2017

Custom metadata

ScienceOpen disciplines: Respiratory medicine

Keywords: influenza,vaccination,copd,immunogenicity,efficacy,effectiveness,systematic review

Data availability:

ScienceOpen disciplines: Respiratory medicine

Keywords: influenza, vaccination, copd, immunogenicity, efficacy, effectiveness, systematic review

Seasonal influenza vaccination in patients with COPD: a systematic literature review

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Abstract

Background

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Conclusions

Electronic supplementary material

Related collections

Biomarkers for Inflammatory Lung Disease

Most cited references 43

Public health impact of including two lineages of influenza B in a quadrivalent seasonal influenza vaccine.

Prevalence of viral infection detected by PCR and RT‐PCR in patients with acute exacerbation of COPD: A systematic review

The global economic burden of asthma and chronic obstructive pulmonary disease.

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