TY - JOUR
T1 - Influenza vaccination and prevention of cardiovascular disease mortality – Authors' reply
AU - Paules, Catharine I.
AU - Subbarao, Kanta
N1 - Funding Information:
Catharine I Paules a Kanta Subbarao b [email protected] a Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA Office of the Director National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda MD USA b WHO Collaborating Centre for Reference and Research on Influenza and Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia WHO Collaborating Centre for Reference and Research on Influenza and Department of Microbiology and Immunology The University of Melbourne The Peter Doherty Institute for Infection and Immunity Melbourne VIC 3000 Australia We thank Daniel Caldeira, Joaquim J Ferreira, and João Costa for highlighting the effect of influenza infection on underlying cardiovascular disease and the role of influenza vaccination in potentially mitigating this risk. Although we briefly mentioned that influenza infection could exacerbate underlying cardiovascular disease in our Seminar, 1 we were unable to fully expand on this point because of word-count restrictions. In this regard, an epidemiological link between influenza and excess deaths associated with cardiovascular disease was suggested as early as in the 1930s. 2 Since then, several observational studies have supported an association between influenza infection, influenza-like illness, or respiratory tract infections and poor outcomes associated with underlying cardiovascular disease. In particular, a strong association with an increased risk of acute myocardial infarction has been reported. 2,3 Therefore, influenza vaccination could potentially prevent cardiovascular events; a Cochrane review evaluated evidence for this intervention. 4 The systematic analysis revealed that in randomised controlled trials that examined influenza vaccination as a mechanism of secondary prevention, significantly fewer cardiovascular deaths occurred in the vaccine group than in the control group (risk ratio 0·45, 95% CI 0·26–0·76; p=0·003). However, a difference was not observed for specific cardiovascular events such as acute myocardial infarction, and the effectiveness of influenza vaccination in primary prevention could not be assessed from available data. The findings from the Cochrane review had moderate bias because sample sizes were small and cardiovascular events were rare. However, the findings support influenza vaccination in individuals with cardiovascular disease, and are reflected in the recommendations for influenza vaccination from the US Centers for Disease Control and Prevention 5 and the European Centre for Disease Prevention and Control. 6 As stated by Caldeira and colleagues in their Correspondence, cardiovascular disease is a leading cause of death and disability worldwide. Mitigating the risk of influenza infection in this high-risk group through interventions such as vaccination could have a substantial positive effect on public health. More studies are needed to fully understand the association between influenza infection and cardiovascular events and the role of influenza vaccination as a prevention strategy. monkeybusinessimages We declare no competing interests.
PY - 2018/2/3
Y1 - 2018/2/3
UR - https://www.scopus.com/pages/publications/85044298077
UR - https://www.scopus.com/pages/publications/85044298077#tab=citedBy
U2 - 10.1016/S0140-6736(18)30144-2
DO - 10.1016/S0140-6736(18)30144-2
M3 - Letter
C2 - 29407031
AN - SCOPUS:85044298077
SN - 0140-6736
VL - 391
SP - 427
EP - 428
JO - The Lancet
JF - The Lancet
IS - 10119
ER -
SDG 3 Good Health and Well-being