Prevention of mortality and pneumonia among nursing home older adults by dual pneumococcal and seasonal influenza vaccination during a pandemic caused by novel pandemic influenza A (H1N1).
OBJECTIVE
To evaluate the efficacy of dual vaccination of seasonal influenza and pneumococcus in nursing home older adults during a novel pandemic of influenza A (H1N1).


METHODS
Nine nursing homes in Hong Kong.


METHODS
A total of 532 nursing home older adults were included in the study.


METHODS
Efficacy of dual vaccination of seasonal influenza and pneumococcus in nursing home older adults during a novel pandemic influenza A (H1N1).


METHODS
A prospective 12-month cohort study was conducted on older residents from December 2009 to November 2010. Participants were divided into 3 groups according to their choice of vaccination: received both seasonal influenza and 23-valent pneumococcal polysaccharide vaccine (PPV-TIV group), received seasonal influenza vaccine alone (TIV group), and those who refused both vaccinations (unvaccinated group). Those who had received vaccination for influenza A (H1N1) were excluded. Outcome measures included mortality from all causes, pneumonia, and vascular causes.


RESULTS
There were 246 in the PPV-TIV group, 211 in the TIV group, and 75 in the unvaccinated group. Baseline characteristics were similar among the groups. The 12-month mortality rates of the PPV-TIV, TIV alone group, and unvaccinated group were 17.1%, 27.0%, and 37.3% respectively (P < .001). Multivariate analysis demonstrated that, compared with vaccination of seasonal influenza alone, dual vaccination significantly reduced all-cause mortality (hazard ratio [HR] 0.54; 95% confidence interval [CI]: 0.35-0.84; P < .01), mortality from pneumonia (HR 0.60; 95% CI: 0.35-0.99; P < .05), and mortality from vascular causes (HR 0.24; 95% CI: 0.09-0.64; P < .01).


CONCLUSIONS
During an influenza pandemic or when the circulating influenza strain was not matched by the trivalent seasonal influenza vaccine, dual vaccination of influenza and pneumococcus provided additional protection to nursing home older adults in reducing mortality.
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Pokfulam, Hong Kong SAR, China. tuenching@yahoo.com.hk
Tuen-Ching
TC
Chan
Ivan Fan-Ngai
IF
Hung
James Ka-Hay
JK
Luk
Yat-Fung
YF
Shea
Felix Hon-Wai
FH
Chan
Patrick Chiu-Yat
PC
Woo
Leung-Wing
LW
Chu
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007115:Immunization Schedule; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000401:mortality / Q000517:prevention & control; D008297:Male; D009735:Nursing Homes; D058873:Pandemics / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011014:Pneumonia / Q000517:prevention & control*; D011446:Prospective Studies; D017678:Sex Distribution; D013296:Streptococcus pneumoniae
D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines