Does influenza immunisation cause exacerbations of chronic airflow obstruction or asthma?
Authors: J. M. Watson, J. F. Cordier, K. G. Nicholson
Journal: Thorax (1997)

Influenza epidemics are regularly associated elderly. 10 Little difference has been reported in the symptoms observed in elderly people as a with excess mortality from respiratory, cardioresult of influenza or RSV infection. 11As vascular, and cerebrovascular disease and are patients who have received influenza vacassociated with increased death rates from diacination are no less likely than those unbetes and neoplasia. 1 2Increasing age, the presvaccinated to succumb to other respiratory tract ence of certain chronic medical conditions, infections, a proportion will inevitably contract and residence in chronic care facilities are all an infection in the week or two after imassociated with increasing morbidity and mormunisation and may attribute it to the vaccine.tality from influenza. [3]4][5] Many health authoritiesIn addition, average annual influenza attack in Europe and North America recommend inrates in the community during epidemics are fluenza immunisation of children and adults estimated at 10-20%, so most patients in any with chronic respiratory disease, including one year will be unaffected.asthma, as well as a range of other conditions. 6 Concern about possible side effects of in-Some also recommend immunisation of the fluenza immunisation have further reduced elderly in communal residential accomuptake rates.Precipitation of asthma or exmodation such as nursing homes where rapid acerbation of chronic airflow obstruction are spread is likely to follow the introduction of prominent among the concerns of some infection.Some countries recommend inpatients and doctors and, as a result, in Britain fluenza immunisation for all those aged over neither the British Thoracic Society nor the 65 years irrespective of their current health National Asthma Campaign have endorsed the status.guidelines produced by the British Government Despite the guidance, uptake of influenza recommending influenza vaccination in these immunisation by those for whom it is repatient groups. 12This brief review considers commended is low in many countries. 7 8 This the evidence that currently used inactivated may be due to doubts on the part of some influenza vaccines may cause a worsening of doctors and patients about the protective respiratory symptoms; reports relating to both efficacy of the vaccine.These doubts may asthma and chronic airflow obstruction sometimes be understandable.To be effective PHLS Communicable(chronic bronchitis, emphysema, chronic ob-Disease Surveillance the vaccine must match the currently circu-Centre, 61 Colindale structive pulmonary/lung disease) have been lating strains of influenza virus, but as the Avenue, London considered.vaccine components have to be selected six or NW9 5EQ, UK J M Watson more months in advance of the influenza season, the match may not always be ideal.In Service de addition, although influenza immunisation Role of viral respiratory infections Bronchopneumologie, Ho ˆpital Louis Pradel, generally provides protection in healthy chil-An association between respiratory virus in-BP Lyon Monchat, dren and adults in the range of 60-90%, and fections and exacerbations of asthma is well 69394 Lyon Cedex 03, considerable evidence is mounting that it proestablished, both in children 13 14 and adults. 15 16France J F Cordier vides useful protection in most seasons for the Influenza virus has been specifically associated elderly, 9 only a limited amount of evidence is with precipitation of asthma 14 15 17 and may, Department of available that it provides a similar degree of along with other respiratory viruses, contribute Microbiology, PO Box 138, Medical Sciences protection in the groups with chronic disease to the pathogenesis of asthma. 18The mech-Building, Leicester for whom it is recommended.anisms, however, leading to pathogenesis or University, Leicester Many patients are also disillusioned when the precipitation of virally induced asthma are LE1 9HN, UK vaccine does not protect against other causes of K G Nicholson poorly understood.Respiratory virus infections influenza-like illness.A variety of respiratory have also been associated with exacerbations Correspondence to: Dr J M Watson.pathogens may cause influenza-like illnesses of chronic airflow obstruction in adults. 19 and circulate frequently in the winter months.