2021年 · 第101卷第08期

Studies have confirmed that compared with the standard antigen content influenza vaccine, the elderly ≥65 years old vaccinated with high antigen content influenza vaccine has higher relative vaccine effectiveness (RVE) in most influenza seasons. Studies have shown that the relative vaccine effect of cell culture vaccine is slightly higher than that of chicken embryo culture vaccine in the 2017-2018 influenza season with influenza A (H3N2) virus as the dominant circulating strain. This study aimed to analyze the relative vaccine efficacy of influenza vaccination in retirement health insurance-enrolled seniors ≥65 years of age in the United States during the 2018-2019 influenza season. Inverse probability processing weighted and Poisson regression methods were used to evaluate the relative vaccine effect of influenza vaccination on preventing influenza hospitalization or emergency medical treatment, including people aged ≥65 years who participated in Medicare and received influenza vaccine from August 5, 2018 to January 31, 2019. Among 12 777,214 insured beneficiaries, adjuvanted influenza vaccines cultured in chicken embryos (RVE 7.7%; 95%CI: 3.9% to 11.4%) and influenza vaccines with high antigen content cultured in chicken embryos (RVE: 4.9%; 95%CI: 1.7% ~8.1%) was slightly higher than that of tetravalent influenza vaccine cultured with chicken embryos. There was no statistically significant difference in efficacy between cell-cultured quadrivalent influenza vaccine and chicken embryo-cultured quadrivalent influenza vaccine (RVE 2.5%; 95%CI：-2.4%~7.3%）。 Studies suggest that there is no significant difference in the effectiveness of influenza vaccines for the elderly that have been approved for marketing in the United States in the 2018-2019 flu season. Consistent with previous studies, this study further confirmed that the efficacy of adjuvant-containing influenza vaccine and high antigen-content influenza vaccine cultured in chicken embryos in the elderly is slightly higher than that of tetravalent influenza vaccine cultured in chicken embryos.

Seasonal influenza can cause an annual burden of severe lower respiratory tract infections (LRTIs) and other respiratory diseases (such as chronic obstructive pulmonary disease). Clarification of the disease burden pyramid of influenza-related LRTIs (including LRTI incidence, hospitalizations, and deaths) is essential for a comprehensive understanding of the disease spectrum and the development of influenza surveillance and prevention measures. The 2017 Global Burden of Disease Study (GBD) used Bayesian predictive models and counterfactual methods to estimate influenza-related LRTI incidence, hospitalizations, and death Burden by age, sex, year, and country (region). The results showed that in 2017, the global number of deaths caused by influenza-related LRTI across all ages was 145,000 (95%UI: 99,000 to 200,000). Mortality from influenza-related LRTI was highest among older adults ≥70 years of age [16.4/100,000 (95%UI: 11.6/100,000 to 21.9/100,000)]; The region with the highest rate of all-age mortality is Eastern Europe [5.2/100,000 (95%UI: 3.5/100,000~7.2/100,000)]. Influenza-related LRTI caused 9.459 million cases (95%UI: 3.709 million to 22.935 million) hospitalizations and 81.536 million hospital days (95%UI: 24,330 million to 259,851 million). 11.5%（95%UI: 10.0%-12.9%) of LRTI incidence was attributable to influenza, including 54.481 million (95%UI: 38.465 million to 73.864 million) and 8.172 million (95%UI: 5 million to 13.296 million) severe cases. The study suggests that the annual health damage caused by influenza-related LRTI to the world cannot be ignored, and influenza vaccination should be considered, and influenza prevention measures should be improved.

The use of mechanical circulation assistance in influenza virus-associated myocarditis complicated with refractory cardiogenic shock (rCS) is still lacking in evidence. This study is a single-center, prospective, observational study based on the last two influenza epidemic seasons. Objective to observe the effect of venous-arterial extracorporeal membrane oxygenation (V-A ECMO) and ventricular assist system combined with mechanical circulation assistance in patients with influenza-related myocarditis complicated with rCS. Patients diagnosed with influenza-related myocarditis combined with rCS and undergoing MCS in the intensive care unit of Hannover Medical School, Germany, were studied. Subsequently, propensity score matching analysis was performed in patients with acute myocardial infarction with rCS and non-ischemic cardiomyopathy with rCS. Seven patients with influenza-related myocarditis complicated with rCS were aged (56 ± 10) years, 4 male, 2 influenza A and 5 influenza B. All patients were not vaccinated against influenza. Mechanical circulation assistance is the combined application of V-AECMO and Impella ventricular assistance system. Two patients experienced out-of-hospital cardiac arrest, V-A ECMO was established during extracorporeal cardiopulmonary resuscitation (ECPR), and all patients died within 18 days of admission. After propensity score matching analysis, the 30-day mortality rate of patients with influenza-related rCS was significantly higher than that of patients with acute myocardial infarction or non-ischemic cardiomyopathy-related rCS receiving combined mechanical circulation assistance. Although patients with influenza-associated myocarditis complicated with rCS were initially stabilized after receiving combined mechanical circulatory assistance, the worsening process of shock was not prevented, so that all patients died. Influenza virus infections can have severe effects on organs other than the heart, resulting in mechanical circulatory assistance also failing to reverse end organ damage, with devastating consequences.

Extracorporeal membrane oxygenation (ECMO) is recommended by most international health organizations for saving patients with acute hypoxic respiratory failure caused by novel coronavirus pneumonia (COVID-19). However, up to now, the preliminary reports of ECMO application to COVID-19 have all shown high case fatality rates, and there is still a lack of large-scale international cohort studies. This study was derived from the in vitro life support organization (ELSO) registration study and included epidemiological, hospitalization course and prognosis data of patients aged ≥16 years old who received ECMO support due to confirmed COVID-19 from January 16, 2020 to May 1, 2020 in 213 hospitals in 36 countries. The primary study endpoint was to analyze in-hospital mortality within ECMO establishment 90 by time to event. A multivariate Cox regression model was applied to analyze whether patient and hospitalization factors were associated with hospital mortality. Data were included for a total of 1 035 COVID-19 patients receiving ECMO support, of which 67 (6%) were still hospitalized at the time of publication, 311 (30%) were discharged home or transferred to rehabilitation centers for continued treatment, 101 (10%) were discharged to long-term care centers or unspecified facilities, 176 (17%) were transferred to other hospitals, and 380 (37%) died. After data propensity processing analysis by death or discharge, the in-hospital mortality rate was 39% (380/968). Circulatory support with ECMO was an independent risk factor for increased in-hospital mortality (HR=1.89，95%CI：1.20~2.97）。 Subgroup analysis of patients with COVID-19 with acute respiratory distress syndrome supported by intravenous-intravenous ECMO revealed an estimated cumulative case fatality rate of 38.0% (95%CI：34.6~41.5）。 For ECMO-supported COVID-19 patients, the estimated cumulative mortality rate within 90 days of ECMO establishment and the in-hospital mortality rate after data propensity processing by death or discharge were less than 40%. These data from 213 hospitals worldwide provide a broad estimate of case fatality among COVID-19 patients receiving ECMO support.