An exploratory study to assess patterns of influenza- and pneumonia-related mortality among the Italian elderly

Older adults are at disproportionately high risk of severe influenza-related outcomes and represent the main target of the annual influenza vaccination. The protective effect of seasonal influenza vaccination on the observed mortality indicators is controversial. In this ecological study, spatiotemporal patterns of pneumonia- and influenza-related mortality registered in the Italian elderly over seven (2011-2017) consecutive seasons were explored and the epidemiological association between the observed local pneumonia- and influenza-related mortality and influenza vaccination campaign features were modeled by using both fixed- and random-effects panel regression models. The descriptive spatiotemporal analysis showed a clear North-South gradient, where northern regions tended to report more pneumonia- and influenza-related deaths. After adjustment for potential confounders, it was found that each 1% increase in influenza vaccination coverage rate would be associated (P < .001) with a 1.6-1.9% decrease in pneumonia- and influenza-related mortality. Moreover, each 1% increase in the use of MF59 (R)-adjuvanted trivalent influenza vaccine would be associated (P < .05) with a further 0.4% decrease in pneumonia- and influenza-related mortality. This study supports the increase in annual influenza vaccination in Italy and suggests that a higher level of use of the adjuvanted influenza vaccine in the elderly may be beneficial.