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Yang T, Tang L, Li P, Li B, Ye L, Zhou J. Effectiveness of inactivated influenza vaccine against laboratory-confirmed influenza among Chinese elderly: a test-negative design. BMC Geriatr 2024; 24:404. [PMID: 38714944 PMCID: PMC11077745 DOI: 10.1186/s12877-024-05003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Evidence on the effectiveness of influenza vaccination in the elderly is limited, and results are controversial. There are also few reports from China. METHODS We conducted a test-negative case-control study design to estimate influenza vaccine effectiveness (VE) against laboratory-confirmed influenza-associated visits among elderly (aged ≥ 60 years) across four influenza seasons in Ningbo, China, from 2018 to 19 to 2021-22. Influenza-positive cases and negative controls were randomly matched in a 1:1 ratio according to age, sex, hospital, and date of influenza testing. We used logistic regression models to compare vaccination odds ratios (ORs) in cases to controls. We calculated the VE as [100% × (1-adjusted OR)] and calculated the 95% confidence interval (CI) around the estimate. RESULTS A total of 30,630 elderly patients tested for influenza with virus nucleic acid or antigen during the study period. After exclusions, we included 1 825 influenza-positive cases and 1 825 influenza-negative controls. Overall, the adjusted VE for influenza-related visits was 63.5% (95% CI, 56.3-69.5%), but varied by season. Influenza VE was 59.8% (95% CI, 51.5-66.7%) for influenza A and 89.6% (95% CI, 77.1-95.3%) for influenza B. The VE for ages 60-69 and 70-79 was 65.2% (95% CI, 55.4-72.9%) and 69.8% (95% CI, 58.7-77.9%), respectively, but only 45.4% (95% CI, 6.2-68.2%) for ages 80 and over. CONCLUSIONS Standard-dose inactivated influenza vaccine has shown good protection in the elderly in China. However, protection may not be satisfactory in people aged 80 years and older.
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Affiliation(s)
- Tianchi Yang
- Institute of Immunization and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Ling Tang
- Ningbo Health Information Center, Ningbo, Zhejiang, China
| | - Pingping Li
- Jiangbei District Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Baojun Li
- Haishu District Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Lixia Ye
- Institute of Immunization and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang, China.
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China.
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Emami A, Pirbonyeh N, Moattari A, Javanmardi F. A decade genetic diversity in Circulating influenza B virus in Iran (2010-2019): Divergence from WHO-recommended vaccine strains. Vopr Virusol 2023; 68:385-393. [PMID: 38156573 DOI: 10.36233/0507-4088-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/15/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Data on the disease burden and circulation patterns of influenza B virus lineages for Iran are limited. OBJECTIVE This review aims to describe the pattern of influenza B occurrence in Iran, comparing it with the proposed vaccine strains and determining the match and mismatch with the prescribed vaccine annually. METHODS Various sources were used to retrieve information of the data; such as information from an online search of databases such as FluNet, GISAID, and NCBI. After extracting protein sequence records in GISAID, sequence alignment with vaccine strain and construction of a phylogenetic tree were performed. Subsequently, categories of the registered circulating strains were evaluated for matching with the vaccine strains. RESULTS Of the total registered influenza-positive samples, 20.21% were related to influenza B virus. The phylogenic tree was designed based on 43 samples registered in the GISAID database; 76.74 and 23.25% sequences were of Yamagata and Victoria lineages, respectively. The most prevalent influenza B virus strains circulating during the study years belonged to the Yamagata lineage. In general, the match of the influenza B virus predominant circulating strains with administrated vaccines was observed in Iran. However, a high level of mismatch between the vaccine strain and Iranian isolates was identified in 2016‒2017. CONCLUSION The review of match and mismatch in influenza vaccine in order to improve the composition of the prescribed vaccine in each region is very important because the vaccine efficacy decreased when the strain included in vaccine did not match the circulating epidemic strain.
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Affiliation(s)
- A Emami
- Shiraz University of medical sciences
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Rahman S, Hasan M, Alam MS, Uddin KMM, Moni S, Rahman M. The evolutionary footprint of influenza A subtype H3N2 strains in Bangladesh: implication of vaccine strain selection. Sci Rep 2022; 12:16186. [PMID: 36171388 PMCID: PMC9519982 DOI: 10.1038/s41598-022-20179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/09/2022] [Indexed: 11/09/2022] Open
Abstract
In February each year, World Health Organization (WHO) recommends candidate vaccine viruses for the forthcoming northern hemisphere (NH) season; however, the influenza season in the temperate zone of NH begins in October. During egg- or cell culture-propagation, the vaccine viruses become too old to confer the highest match with the latest strains, impacting vaccine effectiveness. Therefore, an alternative strategy like mRNA-based vaccine using the most recent strains should be considered. We analyzed influenza A subtype H3N2 strains circulating in NH during the last 10 years (2009-2020). Phylogenetic analysis revealed multiple clades of influenza strains circulating every season, which had substantial mismatches with WHO-recommended vaccine strains. The clustering pattern suggests that influenza A subtype H3N2 strains are not fixed to the specific geographical region but circulate globally in the same season. By analyzing 39 seasons from eight NH countries with the highest vaccine coverage, we also provide evidence that the influenza A, subtype H3N2 strains from South and Southeast Asia, including Bangladesh, had the highest genetic proximity to the NH strains. Furthermore, insilico analysis showed minimal effect on the Bangladeshi HA protein structure, indicating the stability of Bangladeshi strains. Therefore, we propose that Bangladeshi influenza strains represent genetic makeup that may better fit and serve as the most suitable candidate vaccine viruses for the forthcoming NH season.
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Affiliation(s)
- Sezanur Rahman
- Virology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh
| | - Mehedi Hasan
- Virology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh
| | - Md Shaheen Alam
- Virology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh
| | - K M Main Uddin
- Virology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh
| | - Sayra Moni
- Virology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh
| | - Mustafizur Rahman
- Virology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh. .,Genomics Centre, icddr,b, Mohakhali, Dhaka, 1212, Bangladesh.
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4
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Boddington NL, Mangtani P, Zhao H, Verlander NQ, Ellis J, Andrews N, Pebody RG. Live-attenuated influenza vaccine effectiveness against hospitalization in children aged 2-6 years, the first three seasons of the childhood influenza vaccination program in England, 2013/14-2015/16. Influenza Other Respir Viruses 2022; 16:897-905. [PMID: 35531630 PMCID: PMC9343328 DOI: 10.1111/irv.12990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In 2013, the United Kingdom began to roll-out a universal annual influenza vaccination program for children. An important component of any new vaccination program is measuring its effectiveness. Live-attenuated influenza vaccines (LAIVs) have since shown mixed results with vaccine effectiveness (VE) varying across seasons and countries elsewhere. This study aims to assess the effectiveness of influenza vaccination in children against severe disease during the first three seasons of the LAIV program in England. METHODS Using the screening method, LAIV vaccination coverage in children hospitalized with laboratory-confirmed influenza infection was compared with vaccination coverage in 2-6-year-olds in the general population to estimate VE in 2013/14-2015/16. RESULTS The overall LAIV VE, adjusted for age group, week/month and geographical area, for all influenza types pooled over the three influenza seasons was 50.1% (95% confidence interval [CI] 31.2, 63.8). By age, there was evidence of protection against hospitalization from influenza vaccination in both the pre-school (2-4-year-olds) (48.1%, 95% CI 27.2, 63.1) and school-aged children (5-6-year-olds) (62.6%, 95% CI 2.6, 85.6) over the three seasons. CONCLUSION LAIV vaccination in children provided moderate annual protection against laboratory-confirmed influenza-related hospitalization in England over the three influenza seasons. This study contributes further to the limited literature to date on influenza VE against severe disease in children.
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Affiliation(s)
- Nicki L. Boddington
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security AgencyLondonUK
| | | | - Hongxin Zhao
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security AgencyLondonUK
| | - Neville Q. Verlander
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security AgencyLondonUK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security AgencyLondonUK
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security AgencyLondonUK
| | - Richard G. Pebody
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security AgencyLondonUK,WHO Regional Office for EuropeWorld Health OrganizationCopenhagenDenmark
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Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020818. [PMID: 35055642 PMCID: PMC8775496 DOI: 10.3390/ijerph19020818] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/23/2021] [Accepted: 11/27/2021] [Indexed: 02/06/2023]
Abstract
Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effectiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influenza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; applied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, publication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed using a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017–2018 influenza season. The arVE was 3% (−2% to 7%) in the 2018–2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.
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Okoli GN, Abdulwahid T, Racovitan F, Righolt CH, Mahmud SM. Interim seasonal influenza vaccine effectiveness estimates as proxy for final estimates: analysis of systematically identified matched pairs of interim/final estimates from test-negative design studies in outpatient settings from 2010/11 to 2018/19. Expert Rev Vaccines 2021; 20:585-599. [PMID: 33682585 DOI: 10.1080/14760584.2021.1899821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Limited time for seasonal influenza vaccine development means that the World Health Organization has to consider interim (early) rather than final vaccine effectiveness (VE) estimates in deciding influenza vaccine composition. We assessed agreement between interim and final VE estimates, and factors that may determine a substantial difference (≥10%) between point estimates. METHODS This was a mixed methods study. We systematically searched, identified, and matched interim/final VE studies of test-negative design (TND) type in outpatient settings after the 2009/10 influenza pandemic. The chi-square statistic (χ2) was used to assess the statistical significance of the difference between paired interim/final VE estimates. We calculated the difference between point estimates and used multivariable logistic regression to assess factors that may determine a substantial difference. RESULTS We identified 68 interim/final VE pairs. There was no statistically significant difference between almost all compared pairs. An inconsistent statistical model for interim/final VE estimation and interim VE estimation before the epidemic peak increased the odds of having a substantial difference between estimates. CONCLUSION : Interim influenza VE appears to be sufficient for vaccine composition decision-making. Consistency in interim/final VE estimation, and interim VE estimation during/after epidemic peak may increase agreement between the VE estimates.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Tiba Abdulwahid
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Florentin Racovitan
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada.,Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada.,Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Okoli GN, Racovitan F, Abdulwahid T, Hyder SK, Lansbury L, Righolt CH, Mahmud SM, Nguyen-Van-Tam JS. Decline in Seasonal Influenza Vaccine Effectiveness With Vaccination Program Maturation: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2021; 8:ofab069. [PMID: 33738320 PMCID: PMC7953658 DOI: 10.1093/ofid/ofab069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence suggests that repeated influenza vaccination may reduce vaccine effectiveness (VE). Using influenza vaccination program maturation (PM; number of years since program inception) as a proxy for population-level repeated vaccination, we assessed the impact on pooled adjusted end-season VE estimates from outpatient test-negative design studies. METHODS We systematically searched and selected full-text publications from January 2011 to February 2020 (PROSPERO: CRD42017064595). We obtained influenza vaccination program inception year for each country and calculated PM as the difference between the year of deployment and year of program inception. We categorized PM into halves (cut at the median), tertiles, and quartiles and calculated pooled VE using an inverse-variance random-effects model. The primary outcome was pooled VE against all influenza. RESULTS We included 72 articles from 11 931 citations. Across the 3 categorizations of PM, a lower pooled VE against all influenza for all patients was observed with PM. Substantially higher reductions were observed in older adults (≥65 years). We observed similar results for A(H1N1)pdm09, A(H3N2), and influenza B. CONCLUSIONS The evidence suggests that influenza VE declines with vaccination PM. This study forms the basis for further discussions and examinations of the potential impact of vaccination PM on seasonal VE.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Florentin Racovitan
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tiba Abdulwahid
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Syed K Hyder
- Department of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Louise Lansbury
- Department of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan S Nguyen-Van-Tam
- Department of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, United Kingdom
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