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Martins JP, Santos M, Martins A, Felgueiras M, Santos R. Seasonal Influenza Vaccine Effectiveness in Persons Aged 15-64 Years: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1322. [PMID: 37631889 PMCID: PMC10459161 DOI: 10.3390/vaccines11081322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Influenza is a respiratory disease caused by the influenza virus, which is highly transmissible in humans. This paper presents a systematic review and meta-analysis of randomized controlled trials (RCTs) and test-negative designs (TNDs) to assess the vaccine effectiveness (VE) of seasonal influenza vaccines (SIVs) in humans aged 15 to 64 years. An electronic search to identify all relevant studies was performed. The outcome measure of interest was VE on laboratory-confirmed influenza (any strain). Quality assessment was performed using the Cochrane risk-of-bias tool for RCTs and the ROBINS-I tool for TNDs. The search identified a total of 2993 records, but only 123 studies from 73 papers were included in the meta-analysis. Of these studies, 9 were RCTs and 116 were TNDs. The pooled VE was 48% (95% CI: 42-54) for RCTs, 55.4% (95% CI: 43.2-64.9) when there was a match between the vaccine and most prevalent circulating strains and 39.3% (95% CI: 23.5-51.9) otherwise. The TNDs' adjusted VE was equal to 39.9% (95% CI: 31-48), 45.1 (95% CI: 38.7-50.8) when there was a match and 35.1 (95% CI: 29.0-40.7) otherwise. The match between strains included in the vaccine and strains in circulation is the most important factor in the VE. It increases by more than 25% when there is a match with the most prevalent circulating strains. The laboratorial method for confirmation of influenza is a possible source of bias when estimating VE.
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Affiliation(s)
- João Paulo Martins
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- CEAUL—Centro de Estatística e Aplicações, Faculdade de Ciências, Campo Grande, Universidade de Lisboa, 1749-016 Lisboa, Portugal; (M.F.); (R.S.)
| | - Marlene Santos
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
| | - André Martins
- Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
| | - Miguel Felgueiras
- CEAUL—Centro de Estatística e Aplicações, Faculdade de Ciências, Campo Grande, Universidade de Lisboa, 1749-016 Lisboa, Portugal; (M.F.); (R.S.)
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Leiria, Campus 2, Morro do Lena—Alto do Vieiro, Apartado 4163, 2411-901 Leiria, Portugal
| | - Rui Santos
- CEAUL—Centro de Estatística e Aplicações, Faculdade de Ciências, Campo Grande, Universidade de Lisboa, 1749-016 Lisboa, Portugal; (M.F.); (R.S.)
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Leiria, Campus 2, Morro do Lena—Alto do Vieiro, Apartado 4163, 2411-901 Leiria, Portugal
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Orrico-Sánchez A, Valls-Arévalo Á, Garcés-Sánchez M, Álvarez Aldeán J, Ortiz de Lejarazu Leonardo R. Efficacy and effectiveness of influenza vaccination in healthy children. A review of current evidence. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:396-406. [PMID: 36681572 DOI: 10.1016/j.eimce.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/08/2022] [Indexed: 01/21/2023]
Abstract
Influenza is common in healthy children and adolescents and is associated with a high rate of hospitalization in this group, especially for those <5 years. Although the WHO has recommended vaccination in children under 5 years of age since 2012, it is really implemented in few countries today. The aim of this paper was to review the available evidence on the efficacy/effectiveness of influenza vaccination in healthy children <18 years of age through a non-systematic search of studies conducted between 2010 and 2020. Despite the high variability in results due to differences in design, vaccine type and season included in the 41 selected studies, statistically significant studies show efficacy values for the influenza vaccine of between 25.6% and 74.2%, and effectiveness from 26% to 78.8%. Although a systematic review would be necessary to corroborate the evidence, this review suggests that paediatric vaccination is generally an effective measure for preventing influenza in healthy children in line with international organisms' recommendations.
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Affiliation(s)
- Alejandro Orrico-Sánchez
- Área de Investigación en vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO) - Salud Pública, Valencia, Spain
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Neighbors CE, Myers ER, Weerasinghe NP, Wijayaratne GB, Bodinayake CK, Nagahawatte A, Tillekeratne LG, Woods CW. Influenza Vaccination Implementation in Sri Lanka: A Cost-Effectiveness Analysis. Vaccines (Basel) 2023; 11:vaccines11050932. [PMID: 37243036 DOI: 10.3390/vaccines11050932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Influenza causes an estimated 3 to 5 million cases of severe illness annually, along with substantial morbidity and mortality, particularly in low- and middle-income countries (LMICs). Currently, Sri Lanka has no influenza vaccination policies and does not offer vaccination within the public healthcare sector. Therefore, we performed a cost-effectiveness analysis of influenza vaccine implementation for the Sri Lankan population. We designed a static Markov model that followed a population cohort of Sri Lankans in three age groups, 0-4, 5-64, and 65+ years, through two potential scenarios: trivalent inactivated vaccination (TIV) and no TIV across twelve-monthly cycles using a governmental perspective at the national level. We also performed probabilistic and one-way sensitivity analyses to identify influential variables and account for uncertainty. The vaccination model arm reduced influenza outcomes by 20,710 cases, 438 hospitalizations, and 20 deaths compared to no vaccination in one year. Universal vaccination became cost-effective at approximately 98.01% of Sri Lanka's 2022 GDP per capita (incremental cost-effectiveness ratio = 874,890.55 Rs/DALY averted; 3624.84 USD/DALY averted). Results were most sensitive to the vaccine coverage in the 5-64-year-old age group, the cost of the influenza vaccine dose in the 5-64-years-old age group, vaccine effectiveness in the under-5-years-old age group, and the vaccine coverage in the under-5-years-old age group. No value for a variable within our estimated ranges resulted in ICERs above Rs. 1,300,000 (USD 5386.15) per DALY adverted. Providing influenza vaccines was considered highly cost-effective compared to no vaccines. However, large-scale national studies with improved data are needed to better inform estimates and determine the impact of vaccination implementation.
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Affiliation(s)
- Coralei E Neighbors
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC 27710, USA
| | - Evan R Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Nayani P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
| | - Gaya B Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
| | - Champica K Bodinayake
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Ajith Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - L Gayani Tillekeratne
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Christopher W Woods
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
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Efficacy and effectiveness of influenza vaccination in healthy children. A review of current evidence. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ortega-Sanchez IR, Mott JA, Kittikraisak W, Khanthamaly V, McCarron M, Keokhonenang S, Ounaphom P, Pathammavong C, Phounphenghack K, Sayamoungkhoun P, Chanthavilay P, Bresee J, Tengbriacheu C. Cost-effectiveness of seasonal influenza vaccination in pregnant women, healthcare workers and adults >= 60 years of age in Lao People's Democratic Republic. Vaccine 2021; 39:7633-7645. [PMID: 34802790 DOI: 10.1016/j.vaccine.2021.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pregnant women, healthcare workers (HW), and adults >= 60 years have shown an increased vulnerability to seasonal influenza virus infections and/or complications. In 2012, the Lao People's Democratic Republic (Lao PDR) initiated a national influenza vaccination program for these target groups. A cost-effectiveness evaluation of this program was undertaken to inform program sustainability. METHODS We designed a decision-analytical model and collected influenza-related medical resource utilization and cost data, including indirect costs. Model inputs were obtained from medical record abstraction, interviews of patients and staff at hospitals in the national influenza sentinel surveillance system and/or from literature reviews. We compared the annual disease and economic impact of influenza illnesses in each of the target groups in Lao PDR under scenarios of no vaccination and vaccination, and then estimated the cost-effectiveness of the vaccination program. We performed sensitivity analyses to identify influential variables. RESULTS Overall, the vaccination of pregnant women, HWs, and adults >= 60 years could annually save 11,474 doctor visits, 1,961 days of hospitalizations, 43,027 days of work, and 1,416 life-years due to laboratory-confirmed influenza illness. After comparing the total vaccination program costs of 23.4 billion Kip, to the 18.4 billion Kip saved through vaccination, we estimated the vaccination program to incur a net cost of five billion Kip (599,391 USD) annually. The incremental cost per life-year saved (ICER) was 44 million Kip (5,295 USD) and 6.9 million Kip (825 USD) for pregnant women and adults >= 60 years, respectively. However, vaccinating HWs provided societal cost-savings, returning 2.88 Kip for every single Kip invested. Influenza vaccine effectiveness, attack rate and illness duration were the most influential variables to the model. CONCLUSION Providing influenza vaccination to HWs in Lao PDR is cost-saving while vaccinating pregnant women and adults >= 60 is cost-effective and highly cost-effective, respectively, per WHO standards.
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Affiliation(s)
- Ismael R Ortega-Sanchez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Joshua A Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.
| | - Wanitchaya Kittikraisak
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Viengphone Khanthamaly
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Vientiane, Lao PDR
| | - Margaret McCarron
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | | | - Joseph Bresee
- Task Force for Global Health and Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
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Abstract
Influenza vaccine effectiveness (VE) wanes over the course of a temperate climate winter season but little data are available from tropical countries with year-round influenza virus activity. In Singapore, a retrospective cohort study of adults vaccinated from 2013 to 2017 was conducted. Influenza vaccine failure was defined as hospital admission with polymerase chain reaction-confirmed influenza infection 2–49 weeks after vaccination. Relative VE was calculated by splitting the follow-up period into 8-week episodes (Lexis expansion) and the odds of influenza infection in the first 8-week period after vaccination (weeks 2–9) compared with subsequent 8-week periods using multivariable logistic regression adjusting for patient factors and influenza virus activity. Records of 19 298 influenza vaccinations were analysed with 617 (3.2%) influenza infections. Relative VE was stable for the first 26 weeks post-vaccination, but then declined for all three influenza types/subtypes to 69% at weeks 42–49 (95% confidence interval (CI) 52–92%, P = 0.011). VE declined fastest in older adults, in individuals with chronic pulmonary disease and in those who had been previously vaccinated within the last 2 years. Vaccine failure was significantly associated with a change in recommended vaccine strains between vaccination and observation period (adjusted odds ratio 1.26, 95% CI 1.06–1.50, P = 0.010).
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Chua H, Feng S, Lewnard JA, Sullivan SG, Blyth CC, Lipsitch M, Cowling BJ. The Use of Test-negative Controls to Monitor Vaccine Effectiveness: A Systematic Review of Methodology. Epidemiology 2020; 31:43-64. [PMID: 31609860 PMCID: PMC6888869 DOI: 10.1097/ede.0000000000001116] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The test-negative design is an increasingly popular approach for estimating vaccine effectiveness (VE) due to its efficiency. This review aims to examine published test-negative design studies of VE and to explore similarities and differences in methodological choices for different diseases and vaccines. METHODS We conducted a systematic search on PubMed, Web of Science, and Medline, for studies reporting the effectiveness of any vaccines using a test-negative design. We screened titles and abstracts and reviewed full texts to identify relevant articles. We created a standardized form for each included article to extract information on the pathogen of interest, vaccine(s) being evaluated, study setting, clinical case definition, choices of cases and controls, and statistical approaches used to estimate VE. RESULTS We identified a total of 348 articles, including studies on VE against influenza virus (n = 253), rotavirus (n = 48), pneumococcus (n = 24), and nine other pathogens. Clinical case definitions used to enroll patients were similar by pathogens of interest but the sets of symptoms that defined them varied substantially. Controls could be those testing negative for the pathogen of interest, those testing positive for nonvaccine type of the pathogen of interest, or a subset of those testing positive for alternative pathogens. Most studies controlled for age, calendar time, and comorbidities. CONCLUSIONS Our review highlights similarities and differences in the application of the test-negative design that deserve further examination. If vaccination reduces disease severity in breakthrough infections, particular care must be taken in interpreting vaccine effectiveness estimates from test-negative design studies.
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Affiliation(s)
- Huiying Chua
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Benjamin J Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Young B, Sadarangani S, Jiang L, Wilder-Smith A, Chen MIC. Duration of Influenza Vaccine Effectiveness: A Systematic Review, Meta-analysis, and Meta-regression of Test-Negative Design Case-Control Studies. J Infect Dis 2019; 217:731-741. [PMID: 29220496 DOI: 10.1093/infdis/jix632] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/01/2017] [Indexed: 02/03/2023] Open
Abstract
Background Whether influenza vaccination offers protection for the duration of an influenza season was called into question recently after analysis of data from test-negative design (TND) case-control studies. Method The published literature was systematically reviewed to identify TND studies that estimated the change in vaccine effectiveness (VE) with respect to time since vaccination. Results Fourteen studies were identified through the literature search as meeting eligibility criteria. Meta-analyses were performed to compare VE 15-90 days after vaccination to VE 91-180 days after vaccination. A significant decline in VE was observed for influenza virus subtype A/H3 (change in VE, -33; 95% confidence interval [CI], -57 to -12) and type B (change in VE, -19; 95% CI, -33 to -6). VE declined for influenza virus subtype A/H1, but this difference was not statistically significant (change in VE -8; 95% CI, -27 to 21). A multivariable mixed-effects meta-regression model indicated that the change VE was associated with the proportion of study participants who were cases and the proportion who were vaccinated controls (P < .05). This could reflect biological effects such as (1) mismatch between the vaccine received and the circulating strains (among cases), (2) herd immunity (among controls), or (3) the reduced power of individual TND studies in the later parts of an influenza outbreak. Conclusions Exploration of new influenza vaccination strategies must be a priority for influenza control, particularly in tropical countries with year-round influenza virus activity.
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Affiliation(s)
- Barnaby Young
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sapna Sadarangani
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lili Jiang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Annelies Wilder-Smith
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Public Health, University of Heidelberg, Germany
| | - Mark I-Cheng Chen
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Feng S, Chiu SS, Chan ELY, Kwan MYW, Wong JSC, Leung CW, Chung Lau Y, Sullivan SG, Malik Peiris JS, Cowling BJ. Effectiveness of influenza vaccination on influenza-associated hospitalisations over time among children in Hong Kong: a test-negative case-control study. THE LANCET RESPIRATORY MEDICINE 2018; 6:925-934. [PMID: 30442587 DOI: 10.1016/s2213-2600(18)30419-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The protection conferred by influenza vaccination is generally thought to last less than a year, necessitating annual revaccination. However, the speed with which influenza vaccine effectiveness might decline during a year is unknown, which is of particular importance for locations with year-round influenza activity. We aimed to assess how influenza vaccine effectiveness changes by time intervals between vaccination and admission to hospital, taking advantage of almost year-round circulation of influenza in Hong Kong. METHODS In this test-negative case-control study, we analysed vaccine effectiveness in children (aged 6 months to 17 years) who were admitted to hospital in Hong Kong over 5 consecutive years (2012-17). We included those who were admitted to general wards in four public hospitals in Hong Kong with a fever (≥38°C) and any respiratory symptom, such as runny nose, cough, or sore throat. We used direct immunofluorescence assay and reverse transcription PCR to detect influenza virus infection, and recorded children's influenza immunisation history. We compared characteristics of positive cases and negative controls and examined how vaccine effectiveness changed by time between vaccination and admission to hospital with regression analyses. FINDINGS Between Sept 1, 2012, and Aug 31, 2017, we enrolled 15 695 children hospitalised for respiratory infections, including 2500 (15·9%) who tested positive for influenza A or B and 13 195 (84·1%) who tested negative. 159 (6·4%) influenza-positive cases and 1445 (11·0%) influenza-negative cases had been vaccinated. Most vaccinations were done by December of each influenza vaccination season. Influenza-related admissions to hospital occurred year-round, with peaks in January through March in most years and a large summer peak in 2016; pooled vaccine effectiveness for children of all ages was 79% (95% CI 42-92) for September to December, 67% (57-74) for January to April, and 43% (25-57) for May to August. Vaccine effectiveness against influenza A or B was estimated as 79% (95% CI 64-88) within 0·5-2 months of vaccination, 60% (46-71) within >2-4 months, 57% (39-70) within >4-6 months, and 45% (22-61) within >6-9 months. In separate analyses by type and subtype, we estimated that vaccine effectiveness declined by 2-5 percentage points per month. INTERPRETATION Influenza vaccine effectiveness decreased during the 9 months after vaccination in children in Hong Kong. Our findings confirm the importance of annual vaccination in children. Influenza vaccines that provide broader and longer-lasting protection are needed to provide year-round protection in regions with irregular influenza seasonality or lengthy periods of influenza activity. FUNDING Health and Medical Research Fund, Hong Kong and the Research Grants Council, Hong Kong.
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Affiliation(s)
- Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Susan S Chiu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital and Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eunice L Y Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital and Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mike Y W Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Joshua S C Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Chi-Wai Leung
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Yiu Chung Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sheena G Sullivan
- WHO Collaborating Center for Reference and Research on Influenza at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA; Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Clinical and laboratory predictors of influenza infection among individuals with influenza-like illness presenting to an urban Thai hospital over a five-year period. PLoS One 2018. [PMID: 29513698 PMCID: PMC5841736 DOI: 10.1371/journal.pone.0193050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Early diagnosis of influenza infection maximizes the effectiveness of antiviral medicines. Here, we assess the ability for clinical characteristics and rapid influenza tests to predict PCR-confirmed influenza infection in a sentinel, cross-sectional study for influenza-like illness (ILI) in Thailand. Participants meeting criteria for acute ILI (fever > 38°C and cough or sore throat) were recruited from inpatient and outpatient departments in Bangkok, Thailand, from 2009-2014. The primary endpoint for the study was the occurrence of virologically-confirmed influenza infection (based upon detection of viral RNA by RT-PCR) among individuals presenting for care with ILI. Nasal and throat swabs were tested by rapid influenza test (QuickVue) and by RT-PCR. Vaccine effectiveness (VE) was calculated using the case test-negative method. Classification and Regression Tree (CART) analysis was used to predict influenza RT-PCR positivity based upon symptoms reported. We enrolled 4572 individuals with ILI; 32.7% had detectable influenza RNA by RT-PCR. Influenza cases were attributable to influenza B (38.6%), A(H1N1)pdm09 (35.1%), and A(H3N2) (26.3%) viruses. VE was highest against influenza A(H1N1)pdm09 virus and among adults. The most important symptoms for predicting influenza PCR-positivity among patients with ILI were cough, runny nose, chills, and body aches. The accuracy of the CART predictive model was 72.8%, with an NPV of 78.1% and a PPV of 59.7%. During epidemic periods, PPV improved to 68.5%. The PPV of the QuickVue assay relative to RT-PCR was 93.0% overall, with peak performance during epidemic periods and in the absence of oseltamivir treatment. Clinical criteria demonstrated poor predictive capability outside of epidemic periods while rapid tests were reasonably accurate and may provide an acceptable alternative to RT-PCR testing in resource-limited areas.
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Kittikraisak W, Suntarattiwong P, Ditsungnoen D, Klungthong C, Fernandez S, Yoon IK, Lindblade K, Dawood FS, Olsen SJ, Chotpitayasunondh T. Effectiveness of the 2013 and 2014 Southern Hemisphere Influenza Vaccines Against Laboratory-confirmed Influenza in Young Children Using a Test-negative Design, Bangkok, Thailand. Pediatr Infect Dis J 2016; 35:e318-25. [PMID: 27307102 PMCID: PMC5021558 DOI: 10.1097/inf.0000000000001280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Thai Advisory Committee on Immunization Practices recommends annual influenza vaccination for children 6 months through 2 years of age, although older children may be vaccinated on request. We evaluated the effectiveness of the 2013 and 2014 inactivated influenza vaccines to reduce medically attended, laboratory-confirmed influenza illness among Thai children aged 7-60 months. METHODS From September 2013-May 2015, children with influenza-like illness were screened with a rapid influenza diagnostic test. Enrolled children had nasal and throat swabs tested for influenza viruses using polymerase chain reaction. Cases and controls were subjects testing positive and negative, respectively, for influenza viruses by polymerase chain reaction. Vaccination status was ascertained from vaccination cards. Vaccine effectiveness (VE) was calculated as 100% × (1 - odds ratio of vaccination among cases vs. controls). RESULTS Of the 1377 children enrolled, cases (n = 490) and controls (n = 887) were similar in demographic characteristics. Cases were less likely to receive influenza vaccine than controls in 2013 (6% vs. 14%; P = 0.02), but not in 2014 (6% vs. 7%; P = 0.57). Among cases, 126 (26%) were positive for influenza A(H1N1)pdm09 virus, 239 (49%) for influenza A(H3N2) and 124 (25%) for influenza B. One specimen was positive for both influenza A(H3N2) and B viruses. VE for full vaccination against all viruses was 64% (95% confidence interval: 21% to 84%) in 2013 and 26% (95% confidence interval: -47% to 63%) in 2014. CONCLUSIONS Influenza vaccination was low among Thai children in this study, and VE varied by year, highlighting the need for annual monitoring of VE to better understand vaccine program effectiveness.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Stefan Fernandez
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - In-Kyu Yoon
- International Vaccine Institute, Seoul, Korea
| | - Kim Lindblade
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S. Dawood
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sonja J. Olsen
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
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