Vaccine effectiveness against influenza-associated hospitalizations in adults with liver disease, 2015–2020: US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN)
Creators: name: Huang, Po-Han
name: Nowalk, Mary Patricia
name: Zimmerman, Richard K.
name: Olson, Samantha M.
name: Talbot, H. Keipp
name: Zhu, Yuwei
name: Gaglani, Manjusha
name: Murthy, Kempapura
name: Monto, Arnold S.
name: Martin, Emily T.
name: Silveira, Fernanda P.
name: Balasubramani, G.K.
Publisher: name: Taylor & Francis
Year: 2025
Subjects: subject: Medicine
subject: Biotechnology
subject: Chemical Sciences not elsewhere classified
subject: Sociology
subject: FOS: Sociology
subject: Immunology
subject: FOS: Clinical medicine
subject: Biological Sciences not elsewhere classified
subject: Cancer
subject: Science Policy
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology
subject: Computational Biology

description: Influenza causes 100,000–710,000 hospitalizations annually in the U.S. Patients with liver disease are at higher risk of severe outcomes following influenza infection. This study evaluated influenza vaccine effectiveness (VE) against influenza-associated hospitalization among adults with liver disease. Data from the U.S. Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN), a test-negative case-control study, from 2015 to 2020 were used to estimate VE among adults ≥18 years admitted for acute respiratory illness. VE was calculated as (1-adjusted odds ratio)*100%, comparing the odds of vaccine receipt between laboratory-confirmed influenza cases and test-negative controls using multiple logistic regression with inverse probability of treatment weighting (IPTW). In total, 1,622 (12.8%) of 12,704 adults had ≥1 liver disease(s). Compared with those without liver disease, adults with liver disease were more likely to be admitted to the intensive care unit (15.7% vs 12.8%, <i>p</i> = .001) or to die in hospital (3.0% vs 1.4%, <i>p</i> &lt; .001). The IPTW-adjusted VE against influenza-associated hospitalization was 27% (95% confidence interval [CI], 22–32%) among patients without liver disease, but the VE of 11% (95% CI, −8–26%) was not significant among those with liver disease. Significant effect modification of VE by the presence of liver disease was found (<i>p</i> &lt; .05 for interaction term). While influenza vaccination significantly reduced the risk of influenza-associated hospitalization among adults without liver disease, the protective effect was not significant among those with liver disease. Further studies are warranted to evaluate influenza VE in patients with different types of liver disease and with specific vaccine formulations. Using a test-negative, case-control study, we observed that influenza vaccination was associated with a significantly lower risk of influenza-associated hospitalization among adults without liver disease, but the protective effect was not significant among those with liver disease. Influenza is associated with a substantial health burden in the U.S. Patients with liver disease are more likely to experience serious health conditions or consequences from influenza. It is unclear whether influenza vaccination offers the same level of protection for patients with liver disease as it does for the general population. Our study aimed to investigate how effective influenza vaccines are in preventing hospitalization associated with influenza among adults with liver disease. In our study, influenza patients with liver disease were more likely to need intensive care or to die in the hospital compared to those without liver disease. Among patients with liver disease, we did not find enough evidence to support the effectiveness of influenza vaccination in preventing hospitalization associated with influenza. We believe future studies are needed to measure influenza vaccine effectiveness in patients with different types of liver disease and examine whether specific vaccine formulations can provide higher levels of protection for this population.