Clinical impact of influenza immunization in patients with liver cirrhosis

Influenza vaccine is considered to reduce influenza-related morbidity and mortality in patients with underlying chronic medical conditions. Yet in liver cirrhosis, influenza vaccines have received little attention in determining the potential benefits.

We intended to evaluate the clinical benefits of influenza vaccination and clinical outcomes of influenza in patients with liver cirrhosis.

We performed a controlled, prospective clinical trial of 311 cirrhotic patients, who were enrolled in October 2004. Among them, 198 patients were vaccinated with a trivalent influenza vaccine and the rest were not vaccinated. Both groups were followed with respect to the occurrence of influenza-like illness (ILI) until May 2005.

Overall incidences of ILI (p=0.064) and culture positivity of influenza (p=0.009) were remarkably higher in unvaccinated group compared to the vaccinated group. Most of the cirrhotic patients with influenza had fever (91.6%) and complained of myalgia (83.3%) without respiratory symptoms, which were not typical clinical presentations of influenza. Influenza vaccination also decreased influenza-related complication rates in patients with liver cirrhosis.

Influenza vaccination should be recommended to all cirrhotic patients. High suspicion is required for early diagnosis and antiviral treatment, allowing for the frequent hepatic decompensation among cirrhotic patients.