Do influenza and pneumococcal vaccines prevent community-acquired respiratory infections among older people with diabetes and does this vary by chronic kidney disease? A cohort study using electronic health records

Helen I. McDonald, Sara L. Thomas, Elizabeth R.C. Millett, Jennifer Quint, Dorothea Nitsch

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18 Citations (SciVal)

Abstract

Objective: We aimed to estimate the effectiveness of influenza and 23-valent pneumococcal polysaccharide vaccination on reducing the burden of community-acquired lower respiratory tract infection (LRTI) among older people with diabetes, and whether this varied by chronic kidney disease (CKD) status. Research design and methods: We used linked UK electronic health records for a retrospective cohort study of 190 492 patients ≥65 years with diabetes mellitus and no history of renal replacement therapy, 1997-2011. We included communityacquired LRTIs managed in primary or secondary care. Infection incidence rate ratios were estimated using the Poisson regression. Pneumococcal vaccine effectiveness (VE) was calculated as (1-effect measure). To estimate influenza VE, a ratio-of-ratios analysis (winter effectiveness/summer effectiveness) was used to address confounding by indication. Final VE estimates were stratified according to estimated glomerular filtration rate and proteinuria status. Results: Neither influenza nor pneumococcal vaccine uptake varied according to CKD status. Pneumococcal VE was 22% (95% CI 11% to 31%) against community-acquired pneumonia for the first year after vaccination, but was negligible after 5 years. In the ratio-of-ratios analysis, current influenza vaccination had 7% effectiveness for preventing community-acquired LRTI (95% CI 3 to 12). Pneumococcal VE was lower among patients with a history of proteinuria than among patients without proteinuria ( p=0.04), but otherwise this study did not identify variation in pneumococcal or influenza VE by markers of CKD. Conclusions: The public health benefits of influenza vaccine may be modest among older people with diabetes. Pneumococcal vaccination protection against community-acquired pneumonia declines swiftly: alternative vaccination schedules should be investigated.

Original languageEnglish
Article numbere000332
JournalBMJ Open Diabetes Research and Care
Volume5
Issue number1
DOIs
Publication statusPublished - 3 Apr 2017
Externally publishedYes

Bibliographical note

Funding Information:
Funding This work was supported by National Institute for Health Research (grant number CDF 2010-03-32 to SLT) and Kidney Research UK (grant number ST2/2011 to HIMD). JQ was funded on an MRC Population Health Scientist Fellowship (grant number G0902135).

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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