• Jesús Castilla, Pere Godoy, Angela Domínguez, Iván Martínez-Baz, Jenaro Astray, Vicente Martín, Miguel Delgado-Rodríguez, Maretva Baricot, Nuria Soldevila, José María Mayoral, José María Quintana, Juan Carlos Galán, Ady Castro, Fernando González-Candelas, Olatz Garín, Marc Saez, Sonia Tamames, Tomás Pumarola, and CIBERESP Cases and Controls in Influenza Working Group Spain.
• Instituto de Salud Pública de Navarra, Pamplona, Spain. jcastilc@navarra.es
• Clin. Infect. Dis. 2013 Jul 1;57(2):167-75.

BackgroundIn most seasons, the influenza vaccine is effective in preventing influenza, but it is not clear whether it is equally effective in preventing mild and severe cases. We designed a case-control study to compare the effectiveness of the influenza vaccine in preventing outpatient, inpatient, and severe or fatal cases of laboratory-confirmed influenza.MethodsHospitalized patients (n = 691) with laboratory-confirmed influenza in the 2010-2011 season recruited in 29 Spanish hospitals were individually matched by age, admission/visit date, and province with an outpatient with laboratory-confirmed influenza and an outpatient control. Severe cases were considered those patients admitted to intensive care units or who died in the hospital (n = 177). We compared the influenza vaccine status of controls and outpatient cases, inpatient cases, and severe cases using conditional logistic regression adjusted for potential confounding factors. Severe and nonsevere inpatient influenza cases were compared using unconditional logistic regression. Vaccine effectiveness was (1 - odds ratio) × 100.ResultsVaccine effectiveness was 75% (adjusted odds ratio [AOR], 0.25; 95% confidence interval [CI], .16-.39) in preventing influenza outpatient cases, 60% (AOR, 0.40; 95% CI, .25-.63) in preventing influenza-associated hospitalizations, and 89% (AOR, 0.11; 95% CI, .04-.37) in preventing severe cases. In inpatients, influenza vaccination was associated with a lower risk of severe influenza (AOR, 0.42; 95% CI, .22-.80).ConclusionsInfluenza vaccination prevented influenza cases and hospitalizations and was associated with a better prognosis in inpatients with influenza. The combined effect of these 2 mechanisms would explain the high effectiveness of the vaccine in preventing severe cases due to influenza.

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