Tesis

Seroproteksi Pasca-Vaksinasi Influenza dan Hubungannya dengan Influenza-Like Illness pada Populasi Usia Lanjut = Seroprotection After Influenza Vaccination and Its Relationship with Influenza-Like Illness in the Elderly.

Latar Belakang: Efikasi vaksin influenza pada populasi usia lanjut masih menjadi perdebatan. Studi sebelumnya menunjukkan penurunan seroproteksi yang lebih cepat pada usia lanjut. Belum ada studi hubungan seroproteksi dengan influenza-like illness pada usia lanjut Tujuan: Mengetahui hubungan status vaksinasi dengan seroproteksi bulan pertama dan mengetahui hubungan antara seroproteksi bulan pertama dengan kejadian influenza-like illness selama 6 bulan pasca-vaksinasi pada usia lanjut. Metode: Studi kohort ambispektif ini menggunakan data penelitian induk dengan subjek usia lanjut ≥ 60 tahun yang tinggal di komunitas Posyandu lansia wilayah Jakarta Timur, dan data primer dalam periode Desember 2015-Maret 2016. Vaksinasi Influenza yang dievaluasi adalah vaksin influenza trivalen inaktif. Seroproteksi didefinisikan sebagai titer Hemagglutinin Inhibition ≥ 1:40. Influenza-like Illness sesuai kriteria WHO adalah infeksi pernapasan akut yang ditandai oleh demam (suhu ≥38 0 C) dan batuk. Hasil: Terdapat 265 subjek pada penelitian ini, terdiri dari 133 subjek pada kelompok vaksinasi dan 132 subjek pada kelompok tidak vaksinasi. Proporsi seroproteksi pasca-vaksinasi pada bulan pertama, keempat, dan keenam adalah 92,5%; 83,5%; dan 74,4%. Analisis bivariat menunjukkan vaksinasi meningkatkan risiko terjadinya seroproteksi pada bulan pertama (RR 3,48,; IK 95% 2,61-4,65). Tidak ditemukan hubungan bermakna antara seroproteksi bulan pertama dengan insidens ILI selama 6 bulan pasca-vaksinasi (RR 0,325 IK 95% 0,04-2,641). Analisis multivariat menunjukkan OR seroproteksi setelah penyesuaian adalah 60,429 (IK 95% 25,323-144,206) dengan titer Hemagglutinin Inhibition ≥ 1:40 pra-vaksinasi sebagai variabel perancu. Simpulan: Proporsi seroproteksi pasca-vaksinasi pada bulan pertama, keempat, dan keenam adalah 92,5%; 83,5%; 74,4%. Terdapat hubungan bermakna antara status vaksinasi dengan seroproteksi. Tidak ditemukan hubungan bermakna antara seroproteksi bulan pertama dengan insidens influenza-like illness selama 6 bulan pasca-vaksinasi.
Kata Kunci: seroproteksi; vaksin influenza trivalen inaktif; influenza-like illness; usia lanjut



Background: The efficacy of influenza vaccines in the elderly is still being debated. Previous studies showed a faster decline of antibody titers in the elderly. The relationship between seroprotection with influenza-like illness in the elderly has not been established. Objective: To determine the relationship between vaccination status with seroprotection and to determine the relationship between first month seroprotection with the incidence of influenza-like illness 6 months postvaccination in the elderly. Methods: An ambispective cohort study was conducted using secondary data from the parent study of elderly subjects age ≥ 60 years who live in the community of Posyandu lansia in East Jakarta, and primary data taken from December 2015 to March 2016. The influenza vaccine evaluated was the Trivalent Inactivated Vaccine 2014/2015. Seroprotection defined as Hemagglutinin Inhibition titer ≥ 1:40. Influenza-like Illness according to WHO criteria is an acute respiratory infection characterized by fever (temperature ≥38 0 C) and cough. Results: There were 265 subjects in this study consisting of 133 subjects in the vaccine group and 132 subjects in the unvaccinated group. The proportion of post-vaccination seroprotection in the first, fourth, and sixth month was 92.5%; 83.5%; and 74.4%. Bivariate analysis showed vaccination increases the risk of seroprotection (RR 3.48 CI95% 2.61 to 4.65). Seroprotection achieved in the first month showed no statistical significance to the risk of ILI incidence 6 months after vaccination (RR 0.325 95% CI 0.04 to 2.641). Multivariate analysis showed adjusted OR for seroprotection is 60.429 (CI 95% from 25.323 to 144.206) with pre-vaccination Hemagglutinin Inhibition titer of ≥ 1:40 as the confounding variable. Conclusions: The proportion of seroprotection in the first, fourth, and sixth month post-vaccination is 92.5%; 83.5%; 74.4%. There is a significant relationship between vaccination and seroprotection. No significant relationship was found between first month seroprotection with the incidence of influenza-like illness during 6 months post-vaccination.
Keywords: seroprotection; trivalent inactivated influenza vaccine; influenza-like illness; elderly