Effects of influenza immunization on pneumonia in the elderly

Figures & data

Figure 1. Schematic description of pathophysiological changes and development of pneumonia after influenza infection.

Table 1. Meta-analyses of influenza vaccine effectiveness against pneumonia- or influenza-related hospitalization in the elderly.

Author	Published year	Setting	Study design (No. of studies)	Subject age (years)	Pooled vaccine effectiveness, percent (95% CI)
Domnich et al.^16	2017	Community and nursing home	Case-control (4)	≥ 65	49 (39 to 61)^*
Darvishian et at^21	2014	Community	Cohort (8)	≥ 60	33 (23 to 43)^†
					25 (6 to 40)^‡
Chan et al.^17	2014	Nursing home	Cohort (3)	≥ 60	37 (18 to 53)
			Case-control (4)
Jefferson et al.^18	2010	Nursing home	Cohort (17)	≥ 65	46 (33 to 56)
		Community	Cohort (8)		27 (21 to 33)
Vu et al.^19	2002	Community	Cohort (2)	≥ 65	33 (27 to 38)
			Case-control (7)
Gross et al.^20	1995	Community and nursing home^§	Cohort (9)	≥ 65	53 (35 to 66)

* Vaccine effectiveness of MF59-adjuvanted influenza vaccine.

† Vaccine effectiveness from conventional meta-analyses.

‡ Vaccine effectiveness from meta-analyses adjusted for internal and external bias.

§ Most studies consisted of institutionalized elderly except for one study.

Table 2. Cohort studies of influenza vaccine effectiveness (VE) for preventing pneumonia- or influenza-related hospitalization among the community-dwelling elderly.

Author	Publication year	Country	Study periods	Subject age (years)	Sample size	VE (95% CI)
Arriola et al.^22	2017	United States	2013–2014	≥65	1,588	−2 (−27 to 19)
Arriola et al.^25	2015	United States	2012–2013	65–74	1,296	20 (−6 to 39)
				≥75	2,680	−2 (−23 to 16)
Song et al.^14	2015	South Korea	2013–2014	≥65	573	55 (29 to 71)
Simpson et al.^26	2013	United Kingdom	2000–2009	≥65	1,358	12 (−2 to 24)
Baxter et al.^27	2010	United States	1997–2008	≥65	4,018,380	9 (3 to 14)
Nichol et al.^29	2007	United States	1990–2000	≥65	713,812	27 (23 to 32)
Nordin et al.^30	2001	United States	1996–1997	≥65	124,582	20 (5 to 31)
			1997–1998		158,454	24 (14 to 34)
Nichol e al.^32	1999	United States	1990–1996	≥65	147,551	39 (26 to 52)
Baker et al.^38	1980	United States	1968–1969	≥65	9,760	2 (−23 to 13)
			1972–1973		10,740	74 (−8 to 94)

Table 3. Case-control studies of influenza vaccine effectiveness (VE) for preventing pneumonia- or influenza-related hospitalization among community-dwelling elderly.

Author	Publication year	Country	Study period	Subject age (years)	Sample size	VE (95% CI)
Grijalva et al.^24	2015	United States	2010–2012	≥65	429	48 (−33 to 80)
Mahmud et al.^23	2015	Canada	2009–2010	≥65	5,852	10 (−16–30)
Jackson et al.^28	2008	United States	2000–2003	≥65	3,519	9 (−10 to 23)
Crocetti et al.^31	2001	Italy	1994–1995	≥65	825	33 (5 to 52)
Puig-Barbera et al.^33	1997	Spain	1994–1995	≥65	249	79 (45 to 92)
Ohmit et al.^34	1995	United States	1990–1991	≥65	2,197	31 (4 to 51)
			1991–1992		2,761	32 (7 to 50)
Mullooly et al.^35	1994	United States	1981–1989	≥65, non-high-risk group	150,713	40 (1 to 64)
				≥65, high-risk group	100,321	30 (17 to 42)
Fedson et al.^36	1993	United States	1982–1983	≥65	10,471	37 (15 to 53)
			1985–1986		9,720	39 (19 to 53)
Foster et al.^37	1992	United States	1989–1990	≥65	2,507	33 (8 to 52)

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