EFFICIENCY OF INFLUENZA VACCINATION IN PATIENTS WITH CIRCULATORY SYSTEM DISEASES UNDER DISPENSARY OBSERVATION IN OUTPATIENT CLINICS: PROSPECTIVE FOLLOW-UP MONITORING DATA

Aim. To estimate an efficiency of influenza vaccination in patients with circulatory system diseases diseases (CSD) under 3-year follow-up in outpatient clinics.

Methods. The efficiency of influenza vaccination was investigated in CSD patients followed up at 2Ivanovo outpatient clinics and 2Saratov ones. The investigation enrolled 817 people, including 367 patients who consented to Grippol Plus influenza vaccination and 450 who refused.

Results. During 36-month follow-up after being included in the study the vaccinated group showed a significantly fewer influenza and acute respiratory viral infections than the non-vaccinated group (28 and 442; р<0.0001). The vaccinated group had fewer CSD worsening cases per patient (p=0.04) and CSD-associated hospitalization rates (p=0.006) than the non-vaccinated group. In the vaccinated group, the total number of cases of cerebral stroke, myocardial infarction, deaths from cardiovascular diseases (CVD) was significantly less (17) compared with non-vaccinated (38), р=0.03. The risk of infectious diseases and acute cardiovascular event (myocardial infarction, stroke, death from CVD) was significantly lower in the group of vaccinated patients: by 36% (p=0.001) and by 59% (p=0.008), respectively.

Conclusion. Influenza vaccination, as an essential component of complex medical prevention, leads to reduction in incidence of infectious diseases and of CSD worsening including myocardial infarction, stroke, and death from CVD in patients under 3-year monitoring in outpatient clinics

circulatory system diseases, influenza, acute respiratory viral infections, vaccination, prospective study

1. National guidelines on cardiovascular prevention. Kardiovaskulyarnaya Terapiya i Profilaktika. 2011;10(6) Suppl 2:1-25. (In Russ.) [Национальные рекомендации по кардиоваскулярной профилактике. Кардиоваскулярная Терапия и Профилактика. 2011; 10 (6) Приложение 2: 1-25].

2. Influenza Vaccination as Secondary Prevention for Cardiovascular Disease A. Science Advisory from the AHA/ACC Circulation 2006;114:1549-53.

3. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2016: 37;2315-81.

4. Udell J.A., Zawi R., Bhatt D.L., et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310(16):1711-20.

5. Sprenger M.J., Mulder P.G., Beyer W.E. et al. Impact of influenza on mortality in relation to age and underlying disease, 1967-1989. Int J Epidemiol. 1993;22:334-40.

6. Madjid M., Casscells S.W. Of birds and men: cardiologists’ role in influenza pandemics. Lancet. 2004; 364:1309.

7. Saltykova T.S. The incidence of influenza and mortality from diseases of the cardiovascular and respiratory systems of the elderly. Ter Arkhiv. 2008;11:40-4. (In Russ.) [Салтыкова Т.С. Заболеваемость гриппом и смертность от болезней сердечно-сосудистой и дыхательной систем лиц пожилого возраста. Терапевтический Архив. 2008;11:40-4].

8. Dawood F.S., Iuliano A.D., Reed С. et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. Lancet Infect Dis. 2012;12:687–95.

9. Kontsevaya A.V., Kalinina A.M., Balanova Yu.A., et al. The association of cardiovascular disease with flu in different climatic regions and the effectiveness of vaccination against influenza as a means of prevention of cardiovascular complications (analytical review). Profilakticheskaya Meditsina. 2012;(6):6075. (In Russ.) [Концевая А.В., Калинина А.М., Баланова Ю.А., и др. Ассоциация сердечно-сосудистых заболеваний с гриппом в различных климатогеографических регионах и эффективность вакцинации от гриппа как способа профилактики сердечно-сосудистых осложнений (аналитический обзор). Профилактическая Медицина. 2012;6:60-75].

10. Мadjid M., Miller C.C., Zarubaev V.V., et al. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: from 8 years of autopsies in 34,892 subjects. Eur Heart J. 2007;28:1205-10.

11. Spodick D.H., Flessas A.P., Johnson M.M. Association of acute respiratory symptoms with onset of acute myocardial infarction: prospective investigation of 150 consecutive patients and matched control patients. Am J Cardiol. 1984; 53:481–82.

12. Meier C.R., Jick S.S., Derby L.E., et al. Acute respiratory-tract infections and risk of first-time acute myocardial infarction. Lancet. 1998;351:1467–71.

13. Warren-Gash C., Smeeth L., Hayward A.C. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infect Dis. 2009; 9:601–10.

14. Warren-Gash C., Hayward AC., Hemingway H. et al. Influenza Infection and Risk of Acute Myocardial Infarction in England and Wales: A CALIBER Self-Controlled Case Series Study. J Infect Dis. 2012;206(11):1652-9.

15. Smeeth L., Thomas S.L., Hall A.J, et al. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004;351:2611-8.

16. Siriwardena A.N., Gwini S.M., Coupland C.A. Influenza vaccination, pneumococcal vaccination and risk of acute myocardial infarction: matched case-control study. CMAJ. 2010;182: 1617-23.

17. Gwini S.M., Coupland C.A., Siriwardena A.N. The effect of influenza vaccination on risk of acute myocardial infarction: self-controlled case-series study. Vaccine. 2011;29:1145–9.

18. Gurfinkel E.P., de la Fuente R., Mendiz O., Mautner B. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study. Eur Heart J. 2004;25:25–31.

19. de Diego C., Vila-Corcoles A., Ochoa O. et al. Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. European Heart Journal. 2009;30:209–16.

20. Naghavi M., Barlas Z., Siadaty S., et al. Association of influenza vaccination and reduced risk of recurrent myocardial infarction. Circulation. 2000;102:3039–45.

21. Nichol K.L., Nordin J., Mullooly J., et al. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348:1322-32.

22. Smeeth L., Thomas S.L., Hall A.J. et al. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004;351:2611–8.

23. Lavallee P., Perchaud V., Gautier-Bertrand M., et al. Association between influenza vaccination and reduced risk of brain infarction. Stroke. 2002;33:513–8.

24. Meyers D.G. Myocardial infarction, stroke, and sudden cardiac death may be prevented by influenza vaccination. Curr Atheroscler Rep. 2003;5:146–9.

25. Grau A.J., Fischer B., Barth C., et al. Influenza vaccination is associated with a reduced risk of stroke. Stroke. 2005;36:1501-6.

26. On approval of the national calendar of preventive vaccinations and immunization schedule by epidemic indications. Russian Ministry of Health Order from March 21, 2014, N125n. Available at: www.rosminzdrav.ru/opendata/7707778246-Nats%20kalendar%20profilak%20privivok. Checked by December 23, 2016. (In Russ.) [Об утверждении национального календаря профилактических прививок и календаря прививок по эпидемическим показаниям. Приказ МЗ РФ N125н от 21.03.2014 г. Доступно на: www.rosminzdrav.ru/opendata/7707778246-Nats%20kalendar%20profilak%20privivok. Проверено 23.12.2016].

27. About measures for the prevention of influenza and acute respiratory viral infections in the epidemiological season 2016-2017 years. Resolution of the Chief Sanitary Doctor of Russia N70 from 06.03.2016. Available at: http://www.rospotrebnadzor.ru/deyatelnost/epidemiological- surveillance/ ELEMENT_ID = 6687. Checked by December 23, 2016. (In Russ.) [О мероприятиях по профилактике гриппа и острых респираторных вирусных инфекций в эпидсезоне 2016-2017 годов. Постановление Главного санитарного врача РФ N70 от 03.06.2016 г. Доступно на: http://www.rospotrebnadzor.ru/deyatelnost/epidemiological- surveillance/?ELEMENT_ID=6687. Проверено 23.12.2016].

28. Boytsov S.A., Chuchalin A.G., eds. Dispensary observation of patients with chronic non-communicable diseases and a high risk of their development. Guidelines. Moscow: SRCPM; 2014. (In Russ.) [Бойцов С.А., Чучалин А.Г., ред. Диспансерное наблюдение больных хроническими неинфекционными заболеваниями и с высоким риском их развития. Методические рекомендации. Москва: ГНИЦПМ; 2014].

29. Boytsov S.A., Lukyanov M.M., Platonov E.V., et al. study the effectiveness and safety of influenza vaccination in patients with diseases of the circulatory system. Profilakticheskaya Meditsina; 2014; (6): 13-20. (In Russ.) [Бойцов С.А., Лукьянов М.М., Платонова Е.В. и др. Исследование эффективности и безопасности вакцинопрофилактики гриппа у пациентов с болезнями системы кровообращения. Профилактическая Медицина; 2014;(6):13-20].

30. Platonova E.V., Gorbunov V.M., Belova E.N., et al. Vaccine prophylaxis of seasonal influenza in patients with cardiovascular disease. Aspects of the three-year observation: vaccination coverage and evaluation of its safety. Profilakticheskaya Meditsina; 2015;(6):13-8. (In Russ.) [Платонова Е.В., Горбунов В.М., Белова Е.Н., и др. Вакцинопрофилактика сезонного гриппа у больных с сердечно- сосудистыми заболеваниями. Аспекты трехлетнего наблюдения: охват вакцинацией и оценка ее безопасности. Профилактическая Медицина; 2015;(6):13-8].