Influenza vaccination is associated with a reduced risk of invasive aspergillosis in high-risk individuals in Taiwan: a population-based cohort study

ABSTRACT

Invasive aspergillosis (IA) has become the emerging life-threatening disease in recent years. Influenza has been identified as an independent risk factor for IA. Vaccination is the most effective way to prevent influenza, while whether it can reduce IA in high-risk population still uncertain. We aimed to investigate the association between influenza vaccination and the risk of IA in high-risk population. We performed a population-based cohort study of people who qualified for government-funded influenza vaccination and were at high risk for IA at the start of the influenza season each year between 2016 and 2019. We utilized Taiwan’s National Health Insurance Research Database to identify the influenza vaccination status and IA diagnosis during the follow-up period. We compared the risk of IA between people with and without vaccination using multivariable logistic regression analysis. Out of total 8,544,451 people who were eligible during the 3 influenza seasons, 3,136,477 (36.7%) were vaccinated. A total of 1179 IA cases with the incidence of 13.8 cases per 100,000 high-risk individuals were identified during the follow-up. Compared to non-vaccinated group, vaccinated individuals had a 21% risk reduction of IA (adjusted odds ratio 0.79, 95% confidence interval 0.70–0.90). Influenza vaccination was associated with a lower risk of IA among males, immunosuppressive conditions, malignancy, diabetes, and those having host factors according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Influenza vaccination is recommended for high-risk population to reduce the risk of IA.

KEYWORDS:

• Influenza vaccination
• influenza superinfection
• invasive aspergillosis
• chronic diseases
• health insurance database

Acknowledgements

We are grateful to the Health and Welfare Data Science Center, Ministry of Health and Welfare, for providing administrative and technical support, and to the Taiwan Centers for Disease Control for their open data. The results do not represent the opinions of the Ministry of Health and Welfare of Taiwan or the Taiwan Centers for Disease Control. YJC, JHC and TCC designed the study. YJC reviewed the literature, refined the data and performed statistical analysis, and wrote the draft of the manuscript. IFL provided statistical consulting. HLH provided clinical suggestions. IFL, JHC, HLH and TCC helped interpret the results and edit the manuscript. TCC got the resources to apply the data and supervised the project. All authors have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan; however, restrictions apply to the availability of these data, which were under approval for the current study, and therefore are not publicly available. The dataset used in this study was analysed in person at the Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan.

Additional information

Funding

This work was supported by the internal grant from Academia Sinica, Taiwan and partially supported by a grant from the Ministry of Science and Technology, Taiwan for supporting the publication fee (MOST 111-2121-M-001-002).