Influenza prevalence and vaccine efficacy among diabetic patients in Qatar.

Seasonal influenza viruses may lead to severe illness and mortality in patients with comorbidities, including Diabetes Mellitus (DM). Vaccination against influenza in DM patients may reduce influenza incidence and severity. Before the emergence of the COVID-19 pandemic, influenza infections were the most prevalent respiratory infections in Qatar. Still, reports about influenza prevalence and vaccine efficacy in DM patients have not been reported. This study aimed to analyze influenza prevalence among other respiratory infections and assess influenza vaccine efficacy in DM patients in Qatar. Statistical analysis was performed on data obtained from Hamad Medical Corporation (HMC) database for patients that visited the emergency department (ED) with respiratory-like illnesses. The analysis was done for the period between January 2016 to December 2018. Among 17,525 patients who visited HMC-ED with clinical symptoms of respiratory infections, 2611(14.9%) were reported to have DM. Among DM patients, influenza was the most prevalent respiratory pathogen at 48.9%. Influenza virus A (IVA) was the most circulating type, contributing to 38.4%, followed by IVB contributing to 10.4% of total respiratory infections. Among the typed IVA-positive cases, 33.4% were H1N1, and 7.7% were H3N2. A significant decrease in influenza infections was reported in vaccinated DM patients (14.5%) when compared to non-vaccinated patients (18.9%) (p-value = 0.006). However, there was no significant relaxation in the clinical symptoms among vaccinated DM patients compared to their non-vaccinated counterparts. In conclusion, influenza was the most common etiology for respiratory viral infection among diabetic patients at the leading healthcare provider in Qatar. Although vaccination reduced the incidence rate among DM patients, it was less effective in preventing symptoms. Further studies on a larger cohort and for a more extended period are required to investigate influenza prevalence and vaccine efficacy among DM patients.

[1]  Seema Sylvia Dsouza Seasonal influenza disease and annual influenza vaccine coverage at Primary Health Care Corporation, Qatar, 2018–2019: a descriptive study , 2022, QScience Connect.

[2]  A. Hatzakis,et al.  Immunogenicity of SARS-CoV-2 BNT162b2 Vaccine in People with Diabetes: A Prospective Observational Study , 2022, Vaccines.

[3]  U. Fresán,et al.  Effect of influenza vaccination in preventing laboratory-confirmed influenza hospitalization in patients with diabetes mellitus. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  H. Yassine,et al.  Epidemiology of respiratory infections among adults in Qatar (2012-2017) , 2019, PloS one.

[5]  T. Gajanayake,et al.  Analysis of inflammatory cytokine and TLR expression levels in Type 2 Diabetes with complications , 2017, Scientific Reports.

[6]  K. R. Short,et al.  Influenza Virus and Glycemic Variability in Diabetes: A Killer Combination? , 2017, Front. Microbiol..

[7]  R. Jiménez-García,et al.  Influenza vaccination in people with type 2 diabetes, coverage, predictors of uptake, and perceptions. Result of the MADIABETES cohort a 7years follow up study. , 2017, Vaccine.

[8]  A. Badawi,et al.  Prevalence of Diabetes in the 2009 Influenza A (H1N1) and the Middle East Respiratory Syndrome Coronavirus: A Systematic Review and Meta-Analysis , 2016, Journal of public health research.

[9]  R. Jiménez-García,et al.  Influenza vaccination coverages among high risk subjects and health care workers in Spain. Results of two consecutive National Health Surveys (2011-2014). , 2016, Vaccine.

[10]  A. Majeed,et al.  Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes , 2016, Canadian Medical Association Journal.

[11]  Mohamed Khalifa,et al.  Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: A cross-sectional study. , 2015, Vaccine.

[12]  T. Chang,et al.  Increased resistin may suppress reactive oxygen species production and inflammasome activation in type 2 diabetic patients with pulmonary tuberculosis infection. , 2015, Microbes and infection.

[13]  N. Krishna,et al.  Hyperglycemia Inhibits Complement-Mediated Immunological Control of S. aureus in a Rat Model of Peritonitis , 2014, Journal of diabetes research.

[14]  V. Nerurkar,et al.  Reduced immune cell infiltration and increased pro-inflammatory mediators in the brain of Type 2 diabetic mouse model infected with West Nile virus , 2014, Journal of Neuroinflammation.

[15]  Omar Ali,et al.  Genetics of type 2 diabetes. , 2013, World journal of diabetes.

[16]  T. Pawełczyk,et al.  High glucose concentration impairs ATP outflow and immunoglobulin production by human peripheral B lymphocytes: involvement of P2X7 receptor. , 2013, Immunobiology.

[17]  Katherine H. Huang,et al.  Structure, Function and Diversity of the Healthy Human Microbiome , 2012, Nature.

[18]  C. Scagnolari,et al.  Detection of Respiratory Viruses in the 2009 Winter Season in Rome: 2009 Influenza a (H1N1) Complications in Children and Concomitant Type 1 Diabetes Onset , 2011, International journal of immunopathology and pharmacology.

[19]  H. Randeva,et al.  High glucose disrupts oligosaccharide recognition function via competitive inhibition: a potential mechanism for immune dysregulation in diabetes mellitus. , 2011, Immunobiology.

[20]  W. Haas,et al.  Mortality of 2009 pandemic influenza A(H1N1) in Germany. , 2010, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[21]  R. Allard,et al.  Diabetes and the Severity of Pandemic Influenza A (H1N1) Infection , 2010, Diabetes Care.

[22]  R. Burger,et al.  Influenza Virus , 2009, Transfusion Medicine and Hemotherapy.

[23]  T. van der Poll,et al.  Hyperglycemia enhances coagulation and reduces neutrophil degranulation, whereas hyperinsulinemia inhibits fibrinolysis during human endotoxemia. , 2008, Blood.

[24]  J. Taubenberger,et al.  The pathology of influenza virus infections. , 2008, Annual review of pathology.

[25]  J. Hillebrands,et al.  Viral infections as potential triggers of type 1 diabetes , 2007, Diabetes/metabolism research and reviews.

[26]  G. V. van Essen,et al.  Influenza vaccination coverage and reasons to refrain among high-risk persons in four European countries. , 2006, Vaccine.

[27]  P. Pozzilli,et al.  The immune response to influenza vaccination in diabetic patients , 1986, Diabetologia.

[28]  Diabetes: an overview. , 2003, Postgraduate medicine.

[29]  W. Primrose,et al.  Influenza and pneumococcal vaccination: patient perceptions , 2000, Postgraduate medical journal.

[30]  M. Tashiro,et al.  Update: influenza activity--United States and worldwide, 1999-2000 season, and composition of the 2000-01 influenza vaccine. , 2000, MMWR. Morbidity and mortality weekly report.

[31]  L S Geiss,et al.  Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults. , 1999, American journal of public health.

[32]  P. Reading,et al.  Increased Susceptibility of Diabetic Mice to Influenza Virus Infection: Compromise of Collectin-Mediated Host Defense of the Lung by Glucose? , 1998, Journal of Virology.

[33]  S. Lindstrom,et al.  Evolutionary characteristics of influenza B virus since its first isolation in 1940: dynamic circulation of deletion and insertion mechanism , 1998, Archives of Virology.

[34]  S. Massry,et al.  Polymorphonuclear Leukocytes in Non-Insulin-dependent Diabetes Mellitus: Abnormalities in Metabolism and Function , 1995, Annals of Internal Medicine.

[35]  Y. Ohno,et al.  In vitro production of interleukin-1, interleukin-6, and tumor necrosis factor-alpha in insulin-dependent diabetes mellitus. , 1993, The Journal of clinical endocrinology and metabolism.

[36]  P. Scuderi,et al.  Serum Levels of Tumor Necrosis Factor and IL-1α and IL-1β in Diabetic Patients , 1991, Diabetes Care.

[37]  J. Hoekstra,et al.  Influenza Infection and Diabetes Mellitus: Case for Annual Vaccination , 1990, Diabetes Care.

[38]  G. Keusch,et al.  Infection and diabetes: the case for glucose control. , 1982, The American journal of medicine.