Influenza vaccination is associated with a reduced risk of invasive aspergillosis in high-risk individuals in Taiwan: a population-based cohort study

Yi-Jyun Chen; I-Feng Lin; Jen-Hsiang Chuang; Hung-Ling Huang; Ta-Chien Chan

doi:10.1080/22221751.2022.2155584

Influenza vaccination is associated with a reduced risk of invasive aspergillosis in high-risk individuals in Taiwan: a population-based cohort study

Emerg Microbes Infect. 2023 Dec;12(1):2155584. doi: 10.1080/22221751.2022.2155584.

Authors

Yi-Jyun Chen¹, I-Feng Lin¹, Jen-Hsiang Chuang^{1

2}, Hung-Ling Huang^{3

4

5

6}, Ta-Chien Chan^{1

7}

Affiliations

¹ Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Centers for Disease Control, Taipei, Taiwan.
³ Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁵ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁶ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan.

Abstract

Invasive aspergillosis (IA) has become the emerging life-threatening disease in recent years. Influenza has been identified as an independent risk factor for IA. Vaccination is the most effective way to prevent influenza, while whether it can reduce IA in high-risk population still uncertain. We aimed to investigate the association between influenza vaccination and the risk of IA in high-risk population. We performed a population-based cohort study of people who qualified for government-funded influenza vaccination and were at high risk for IA at the start of the influenza season each year between 2016 and 2019. We utilized Taiwan's National Health Insurance Research Database to identify the influenza vaccination status and IA diagnosis during the follow-up period. We compared the risk of IA between people with and without vaccination using multivariable logistic regression analysis. Out of total 8,544,451 people who were eligible during the 3 influenza seasons, 3,136,477 (36.7%) were vaccinated. A total of 1179 IA cases with the incidence of 13.8 cases per 100,000 high-risk individuals were identified during the follow-up. Compared to non-vaccinated group, vaccinated individuals had a 21% risk reduction of IA (adjusted odds ratio 0.79, 95% confidence interval 0.70-0.90). Influenza vaccination was associated with a lower risk of IA among males, immunosuppressive conditions, malignancy, diabetes, and those having host factors according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Influenza vaccination is recommended for high-risk population to reduce the risk of IA.

Keywords: Influenza vaccination; chronic diseases; health insurance database; influenza superinfection; invasive aspergillosis.

MeSH terms

Aspergillosis*
Cohort Studies
Humans
Influenza Vaccines*
Influenza, Human* / complications
Influenza, Human* / epidemiology
Influenza, Human* / prevention & control
Invasive Fungal Infections*
Male
Risk Factors
Taiwan / epidemiology
Vaccination

Substances

Influenza Vaccines

Grants and funding

This work was supported by the internal grant from Academia Sinica, Taiwan and partially supported by a grant from the Ministry of Science and Technology, Taiwan for supporting the publication fee (MOST 111-2121-M-001-002).