Influenza vaccination is safe and immunogenic when administered to hospitalized patients.

CONTEXT: Very few high-risk persons receive influenza vaccine while hospitalized. Health care providers may be reluctant to administer the influenza vaccine to hospitalized patients because of insufficient data related to the safety and immunogenicity of vaccinating this population. OBJECTIVE: To evaluate the safety and immunogenicity of the influenza vaccine administered to hospitalized patients compared to ambulatory clinic patients. DESIGN: Prospective cohort study. SETTING: A 711-bed, acute-care, private tertiary hospital and two private internal medicine clinics from October 1 to December 25, 1999. PARTICIPANTS: 51 inpatients; 177 outpatients. INTERVENTION: All study participants received influenza vaccine. Serum samples for antibody assays were collected at baseline and at 3 weeks after vaccination. Study participants were mailed a questionnaire to elicit information about adverse effects of vaccination. MAIN OUTCOME MEASURE: Seroconversion rates (4-fold increase in hemagglutination-inhibiting antibodies) and seroprotection rates (titers > or = 1:40) to the influenza vaccine in hospitalized and ambulatory patients. RESULTS: The seroconversion and post-vaccination seroprotection rates in the inpatient group were 65% (33/51) and 88% (45/51) compared to 55% (98/177) and 94% (167/177) in the ambulatory clinic patients. Soreness at the site of injection was the most common adverse effect, reported by 12% of both the inpatients (5/42) and ambulatory clinic patients (20/171). Seventy-four percent of patients (31/41 inpatients and 127/174 outpatients) reported no significant side effect to vaccination. CONCLUSIONS: Influenza vaccine is at least as safe and immunogenic in hospitalized patients as it is in ambulatory patients. These data can be used to help convince health care providers to order the influenza vaccine for their hospitalized patients.

Clinical and humanistic outcomes in patients with gastroesophageal reflux disease converted from omeprazole to lansoprazole.

BACKGROUND: Omeprazole and lansoprazole are 2 proton pump inhibitors (PPIs) currently available in the United States. Both PPIs are approved for the treatment of gastroesophageal reflux disease (GERD) and are commonly converted in therapeutic interchange programs. OBJECTIVE: To measure clinical and humanistic outcomes in patients with GERD converted from treatment with omeprazole to treatment with lansoprazole through a managed care plan policy. METHODS: Patients with heartburn or GERD receiving omeprazole covered by a local health plan were surveyed by telephone. Data collected included symptom frequency, severity, over-the-counter heartburn preparation use, diet, lifestyle, and overall satisfaction. Patients were then converted to therapy with lansoprazole and again interviewed after at least 30-day use of the new PPI. Demographic data were obtained from the health plan database for analysis. RESULTS: A total of 105 patients completed both telephone surveys. After the conversion, 37% of the patients experienced more frequent symptoms while awake. Symptom severity score was significantly higher (more severe) after conversion (mean score of 1.34 vs 2.26). Thirty-three percent of study patients consumed more over-the-counter heartburn preparations, and 13% changed their diet more frequently due to heartburn symptoms after conversion. Overall patient satisfaction score decreased significantly (less satisfied) after conversion (mean score of 9.0 vs 7.2). There were no significant differences in alcohol and tobacco consumption before and after conversion, while patients consumed significantly less caffeine after conversion. CONCLUSIONS: After the PPI therapeutic interchange from omeprazole to lansoprazole, patients with GERD or heartburn previously stabilized while receiving omeprazole experienced more severe symptoms and expressed decreased patient satisfaction. These results suggest a need to monitor symptoms after similar interchange programs.