Influenza Vaccine: Safe for Patients With SLE?

Investigators assessed the effect of annual influenza vaccination on morbidity and mortality in patients with lupus.

Annual influenza vaccination is associated with reduced morbidity and mortality in patients with systemic lupus erythematosus (SLE), according to research published in Scientific Reports.

Jin-Hua Chen, PhD, of the Biostatistics Center and School of Health Care Administration, College of Management, at Taipei Medical University in Taipei, Taiwan, and colleagues used Taiwan’s National Health Insurance Research Database (NHIRD) to conduct a retrospective cohort study assessing incidence of hospitalization, morbidity, and mortality in patients with SLE who did or did not receive an annual influenza vaccination.

Primary study outcomes included total hospitalization; hospitalization for pneumonia, septicemia, bacteremia, viremia, and heart disease; intensive care unit (ICU) admission; in-hospital dialysis; and death.

Between 2001 and 2011, 12,728 patients with SLE and a catastrophic illness certification were identified; 10,125 patients were ultimately enrolled in the study (1765 vaccinated and 8360 nonvaccinated). Mean age in the vaccine cohort was 46 years, and these patients had more comorbidities than those in the nonvaccine cohort (mean age: 37 years).

The researchers found that the incidence rate ratio (IRR) for morbidity among the cohorts did not differ; assessment of adjusted hazard ratios [HR] revealed a prospective association with influenza vaccination. Overall, patients in the vaccine cohort had a lower hospitalization rate (adjusted HR: 0.82; 95% confidence interval [CI], 0.73-0.92; P <.001) and were less likely to be admitted to the ICU (adjusted HR: 0.55; 95% CI, 0.39-0.79; P <.001), less likely to be hospitalized for septicemia, bacteremia, or viremia (adjusted HR: 0.48; 95% CI, 0.32-0.73; P <.001), less likely to need in-hospital dialysis (adjusted HR: 0.40; 95% CI, 0.20-0.81; P <.05), and “less predisposed to death,” (adjusted HR: 0.39; 95% CI, 0.26-0.59; P <.001), according to the investigators.

“Because of the high annual incidence of influenza…vaccination is a clinically relevant concern in patients with SLE. Our study demonstrated that influenza vaccination in patients with SLE is associated with a reduced risk of morbidity and mortality, supporting the annual vaccination in such patients,” wrote Dr Chen and colleagues.

“Additional large-scale prospective studies are warranted to investigate the efficacy of influenza vaccination…in adults with SLE,” they concluded.

Study Limitations

  • The NHID provided only limited sociodemographic characteristics; these variables were not adjusted for the analysis.
  • Information on SLE severity — including disease activity, organ damage, and antibody levels —  was unavailable.
  • Drug data, including immunosuppressive and glucocorticosteroid use, were also unavailable.
  • Selection bias may have occurred. 

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Chang CC, Chang YS, Chen WS, Chen YH, Chen JH. Effects of annual influenza vaccination on morbidity and mortality in patients with systemic lupus erythematosus: a nationwide cohort study. Sci Rep. 2016;6:37817. doi: 10.1038/srep37817