Effectiveness ประสิทธิผลของวัคซีนไข้หวัดใหญ่ต่อการลดการติดเชื้อไข้หวัดใหญ่ที่ยืนยันผลจากห้องปฏิบัติการในผู้ป่วยโรคปอดอุดกั้นเรื้อรังที่มีภาวะปอดอักเสบร่วมกับการกำเริบเฉียบพลันในประเทศไทย พ.ศ. 2554-2559: การศึกษาแบบย้อนหลังระดับประเทศโดยใช้รูปแบบ Test-Negative Design

Sutthinan Chawalchitiporn; Prabda Praphasiri; Kriengkrai Prasert; Pichaya Tantiyavarong; suriya naosri; Thananpad Jaratwaorapatra

Authors

Sutthinan Chawalchitiporn Faculty of Medicine, Thammasat University, Thailand
Prabda Praphasiri Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Thailand, Influenza and Vaccine Study Center, Nakhon Phanom Hospital, Thailand
Kriengkrai Prasert Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Thailand, Influenza and Vaccine Study Center, Nakhon Phanom Hospital, Thailand
Pichaya Tantiyavarong Faculty of Medicine, Thammasat University, Thailand
Suriya Naosri Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Thailand, Influenza and Vaccine Study Center, Nakhon Phanom Hospital, Thailand
Thananpad Jaratwaorapatra Influenza and Vaccine Study Center, Nakhon Phanom Hospital, Thailand

Keywords:

Influenza vaccine, Chronic obstructive pulmonary disease, Pneumonia, Vaccine effectiveness

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) who develop concurrent pneumonia and acute exacerbation represent a clinically severe group with increased risk of hospitalization and mortality. However, evidence on influenza vaccine effectiveness (VE) in this high-risk population remains limited in Thailand.

Objective: The objective of this investigation was to assess the efficacy of influenza vaccination in reducing influenza infection among patients with chronic obstructive pulmonary disease (COPD) who presented with acute exacerbation and pneumonia between 2011 and 2016. The specific objectives were to (1) Evaluate the efficacy of the vaccine against influenza infection by subtype, including influenza B, A(H1N1)pdm09, and A(H3N2). (2) Compare vaccine effectiveness across influenza seasons from 2011 to 2016; and (3) Assess variations in vaccine efficacy in relation to the severity of chronic obstructive pulmonary disease.

Methods: We conducted a nationwide retrospective by used test-negative design study. Analyzed administrative data from the National Health Security Office linked with RT-PCR confirmed influenza surveillance data from the Department of Medical Sciences between June 1, 2011 and May 31, 2016, covering five influenza seasons. Selected COPD patients aged ≥40 years presenting with concurrent pneumonia and acute exacerbation who underwent influenza RT-PCR testing were included. Multilevel Poisson regression with robust standard errors was used to estimate adjusted risk ratios (RRs), accounting for clustering at the provincial level and adjusting for demographic and clinical covariates. VE was calculated as (1 - adjusted RR) × 100.

Results: A total of 52,054 eligible episodes were analyzed, of which 45.8% were influenza-positive. The overall VE against laboratory-confirmed influenza infection was 56.1% (95% CI: 47.0–64.0; p<0.001), indicating moderate protection. Strain-specific analyses showed the highest VE against influenza B, followed by A(H1N1)pdm09 and A(H3N2). VE varied across seasons but remained consistently protective.

Conclusions: Seasonal influenza vaccination provides statistically significant and moderate protection against influenza infection among COPD patients with concurrent pneumonia and acute exacerbation. These findings support strengthening influenza vaccination strategies in high-risk patient groups.

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