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Vaccine. 2019 May 27;37(24):3179-3189. doi: 10.1016/j.vaccine.2019.04.051. Epub 2019 Apr 30.

Impact of influenza vaccination on healthcare utilization - A systematic review.

Author information

1
Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal, Canada; Research Institute - CHU Sainte Justine, Canada.
2
Research Institute - CHU Sainte Justine, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Canada.
3
Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal, Canada; Institut national de santé publique du Québec, Canada.
4
Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal, Canada; Research Institute - CHU Sainte Justine, Canada; Department of Pediatric Laboratory Medicine, CHU Sainte-Justine, Canada; Infection Prevention & Control, CHU Sainte-Justine, Canada. Electronic address: c.quach@umontreal.ca.

Abstract

INTRODUCTION:

Although a vaccine-preventable disease, influenza causes approximately 3-5 million cases of severe illness and about 290,000-650,000 deaths worldwide, which occur primarily among people 65 years and older. Nonetheless, prevention of influenza and its complications rely mainly on vaccination. We aimed to systematically evaluate influenza vaccine effectiveness at reducing healthcare utilization in older adults, defined as the reduction of outpatient visits, ILI and influenza hospitalizations, utilization of antibiotics and cardiovascular events by vaccination status during the influenza season.

METHODS:

We searched MEDLINE, EMBASE, CINAHL, Cochrane Library and considered any seasonal influenza vaccine, excluding the pandemic (2009-10 season) vaccine. Reviewers independently assessed data extraction and quality assessment.

RESULTS:

Of the 8308 citations retrieved, 22 studies were included in the systematic review. Overall, two studies (9%) were deemed at moderate risk of bias, thirteen (59%) at serious risk of bias and seven (32%) at critical risk of bias. For outpatient visits, we found modest evidence of protection by the influenza vaccine. For all-cause hospitalization outcomes, we found a wide range of results, mostly deemed at serious risk of bias. The included studies suggested that the vaccine may protect older adults against influenza hospitalizations and cardiovascular events. No article meeting our inclusion criteria explored the use of antibiotics and ILI hospitalizations. The high heterogeneity between studies hindered the aggregation of data into a meta-analysis.

CONCLUSION:

The variability between studies prevented us from drawing a clear conclusion on the effectiveness of the influenza vaccine on healthcare utilization in older adults. Overall, the data suggests that the vaccine may result in a reduction of healthcare utilization in the older population. Further studies of higher quality are necessary.

KEYWORDS:

Aged; Healthcare; Influenza; Vaccine effectiveness; Vaccines

PMID:
31047677
DOI:
10.1016/j.vaccine.2019.04.051
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