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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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Waterlow NR, Radhakrishnan S, Dawa J, van Leeuwen E, Procter SR, Lambach P, Bresee J, Mazur M, Eggo RM, Jit M. Potential health and economic impact of paediatric vaccination using next-generation influenza vaccines in Kenya: a modelling study. BMC Med 2023; 21:106. [PMID: 36949456 PMCID: PMC10032252 DOI: 10.1186/s12916-023-02830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Influenza is a major year-round cause of respiratory illness in Kenya, particularly in children under 5. Current influenza vaccines result in short-term, strain-specific immunity and were found in a previous study not to be cost-effective in Kenya. However, next-generation vaccines are in development that may have a greater impact and cost-effectiveness profile. METHODS We expanded a model previously used to evaluate the cost-effectiveness of seasonal influenza vaccines in Kenya to include next-generation vaccines by allowing for enhanced vaccine characteristics and multi-annual immunity. We specifically examined vaccinating children under 5 years of age with improved vaccines, evaluating vaccines with combinations of increased vaccine effectiveness, cross-protection between strains (breadth) and duration of immunity. We evaluated cost-effectiveness using incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits (INMBs) for a range of values for the willingness-to-pay (WTP) per DALY averted. Finally, we estimated threshold per-dose vaccine prices at which vaccination becomes cost-effective. RESULTS Next-generation vaccines can be cost-effective, dependent on the vaccine characteristics and assumed WTP thresholds. Universal vaccines (assumed to provide long-term and broad immunity) are most cost-effective in Kenya across three of four WTP thresholds evaluated, with the lowest median value of ICER per DALY averted ($263, 95% Credible Interval (CrI): $ - 1698, $1061) and the highest median INMBs. At a WTP of $623, universal vaccines are cost-effective at or below a median price of $5.16 per dose (95% CrI: $0.94, $18.57). We also show that the assumed mechanism underlying infection-derived immunity strongly impacts vaccine outcomes. CONCLUSIONS This evaluation provides evidence for country-level decision makers about future next-generation vaccine introduction, as well as global research funders about the potential market for these vaccines. Next-generation vaccines may offer a cost-effective intervention to reduce influenza burden in low-income countries with year-round seasonality like Kenya.
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Affiliation(s)
- Naomi R Waterlow
- Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK.
| | - Sreejith Radhakrishnan
- Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G61 1QH, UK
| | - Jeanette Dawa
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Washington State University - Global Health Kenya, Nairobi, Kenya
| | - Edwin van Leeuwen
- Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, NW9 5EQ, UK
| | - Simon R Procter
- Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
| | - Philipp Lambach
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | | | | | - Rosalind M Eggo
- Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
| | - Mark Jit
- Centre for Mathematical Modeling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
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Sullivan SG, Arriola CS, Bocacao J, Burgos P, Bustos P, Carville KS, Cheng AC, Chilver MB, Cohen C, Deng YM, El Omeiri N, Fasce RA, Hellferscee O, Huang QS, Gonzalez C, Jelley L, Leung VK, Lopez L, McAnerney JM, McNeill A, Olivares MF, Peck H, Sotomayor V, Tempia S, Vergara N, von Gottberg A, Walaza S, Wood T. Heterogeneity in influenza seasonality and vaccine effectiveness in Australia, Chile, New Zealand and South Africa: early estimates of the 2019 influenza season. ACTA ACUST UNITED AC 2020; 24. [PMID: 31718744 PMCID: PMC6852316 DOI: 10.2807/1560-7917.es.2019.24.45.1900645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We compared 2019 influenza seasonality and vaccine effectiveness (VE) in four southern hemisphere countries: Australia, Chile, New Zealand and South Africa. Influenza seasons differed in timing, duration, intensity and predominant circulating viruses. VE estimates were also heterogeneous, with all-ages point estimates ranging from 7-70% (I2: 33%) for A(H1N1)pdm09, 4-57% (I2: 49%) for A(H3N2) and 29-66% (I2: 0%) for B. Caution should be applied when attempting to use southern hemisphere data to predict the northern hemisphere influenza season.
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Affiliation(s)
- Sheena G Sullivan
- World Health Organization (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, Australia
| | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States
| | - Judy Bocacao
- National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Pamela Burgos
- Programa Nacional de Inmunizaciones, Ministerio de Salud, Santiago, Chile
| | - Patricia Bustos
- Sección de Virus Respiratorios y Exantematicos, Instituto de Salud Publica de Chile, Santiago, Chile
| | - Kylie S Carville
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Health, and Central Clinical School, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Monique Bm Chilver
- Discipline of General Practice, University of Adelaide, Adelaide, Australia
| | - Cheryl Cohen
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Yi-Mo Deng
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Reference and Research on Influenza, Melbourne, Australia
| | - Nathalie El Omeiri
- Pan American Health Organization(PAHO)/WHO Regional Office for the Americas, Washington, United States
| | - Rodrigo A Fasce
- Subdepartamento de Enfermedades Virales, Instituto de Salud Publica de Chile, Santiago, Chile
| | | | - Q Sue Huang
- National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Cecilia Gonzalez
- Programa Nacional de Inmunizaciones, Ministerio de Salud, Santiago, Chile
| | - Lauren Jelley
- National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Vivian Ky Leung
- World Health Organization (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, Australia
| | - Liza Lopez
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
| | | | - Andrea McNeill
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Maria F Olivares
- Departamento de Epidemiologia, Ministerio de Salud, Santiago, Chile
| | - Heidi Peck
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Reference and Research on Influenza, Melbourne, Australia
| | | | - Stefano Tempia
- MassGenics, Duluth, United States.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,National Institute for Communicable Diseases, Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States
| | - Natalia Vergara
- Departamento de Epidemiologia, Ministerio de Salud, Santiago, Chile
| | - Anne von Gottberg
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Sibongile Walaza
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Timothy Wood
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
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Hemagglutinin and Neuraminidase Antibodies Are Induced in an Age- and Subtype-Dependent Manner after Influenza Virus Infection. J Virol 2020; 94:JVI.01385-19. [PMID: 31941786 PMCID: PMC7081922 DOI: 10.1128/jvi.01385-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022] Open
Abstract
Data on the immunologic responses to neuraminidase (NA) is lacking compared to what is available on hemagglutinin (HA) responses, despite growing evidence that NA immunity can be protective and broadly cross-reactive. Understanding these NA responses during natural infection is key to exploiting these properties for improving influenza vaccines. Using two community-acquired influenza cohorts, we showed that the induction of both HA and NA antibodies after infection is influenced by age and subtypes. Such response dynamics suggest the influence of immunological memory, and understanding how this process is regulated will be critical to any vaccine effort targeting NA immunity. Despite evidence that antibodies targeting the influenza virus neuraminidase (NA) protein can be protective and are broadly cross-reactive, the immune response to NA during infection is poorly understood compared to the response to hemagglutinin (HA) protein. As such, we compared the antibody profile to HA and NA in two naturally infected human cohorts in Auckland, New Zealand: (i) a serosurvey cohort, consisting of pre- and post-influenza season sera from PCR-confirmed influenza cases (n = 50), and (ii) an immunology cohort, consisting of paired sera collected after PCR-confirmation of infection (n = 94). The induction of both HA and NA antibodies in these cohorts was influenced by age and subtype. Seroconversion to HA was more frequent in those <20 years old (yo) for influenza A (serosurvey, P = 0.01; immunology, P = 0.02) but not influenza B virus infection. Seroconversion to NA was not influenced by age or virus type. Adults ≥20 yo infected with influenza A viruses were more likely to show NA-only seroconversion compared to children (56% versus 14% [5 to 19 yo] and 0% [0 to 4 yo], respectively). Conversely, children infected with influenza B viruses were more likely than adults to show NA-only seroconversion (88% [0 to 4 yo] and 75% [5 to 19 yo] versus 40% [≥20 yo]). These data indicate a potential role for immunological memory in the dynamics of HA and NA antibody responses. A better mechanistic understanding of this phenomenon will be critical for any future vaccines aimed at eliciting NA immunity. IMPORTANCE Data on the immunologic responses to neuraminidase (NA) is lacking compared to what is available on hemagglutinin (HA) responses, despite growing evidence that NA immunity can be protective and broadly cross-reactive. Understanding these NA responses during natural infection is key to exploiting these properties for improving influenza vaccines. Using two community-acquired influenza cohorts, we showed that the induction of both HA and NA antibodies after infection is influenced by age and subtypes. Such response dynamics suggest the influence of immunological memory, and understanding how this process is regulated will be critical to any vaccine effort targeting NA immunity.
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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: 81] [Impact Index Per Article: 20.3] [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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Rondy M, El Omeiri N, Thompson MG, Levêque A, Moren A, Sullivan SG. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. J Infect 2017; 75:381-394. [PMID: 28935236 PMCID: PMC5912669 DOI: 10.1016/j.jinf.2017.09.010] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults. METHODS We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18-64 and 65 years and above) using random-effects models. RESULTS We identified 3411 publications and 30 met our inclusion criteria. Between 2010-11 and 2014-15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18-64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59),37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI:-3;30) when A(H3N2) variant viruses predominated. CONCLUSIONS Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant.
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Affiliation(s)
- Marc Rondy
- Epiconcept, Paris, France; Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux F-33000, France.
| | - Nathalie El Omeiri
- Université Libre de Bruxelles, School of Public Health, Brussels, Belgium
| | - Mark G Thompson
- US Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, USA
| | - Alain Levêque
- Université Libre de Bruxelles, School of Public Health, Brussels, Belgium
| | | | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Cowling BJ, Caini S, Chotpitayasunondh T, Djauzi S, Gatchalian SR, Huang QS, Koul PA, Lee PI, Muttalif AR, Plotkin S. Influenza in the Asia-Pacific region: Findings and recommendations from the Global Influenza Initiative. Vaccine 2017; 35:856-864. [PMID: 28081970 DOI: 10.1016/j.vaccine.2016.12.064] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/15/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
The fourth roundtable meeting of the Global Influenza Initiative (GII) was held in Hong Kong, China, in July 2015. An objective of this meeting was to gain a broader understanding of the epidemiology, surveillance, vaccination policies and programs, and obstacles to vaccination of influenza in the Asia-Pacific region through presentations of data from Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Taiwan, Thailand, and Vietnam. As well as a need for improved levels of surveillance in some areas, a range of factors were identified that act as barriers to vaccination in some countries, including differences in climate and geography, logistical challenges, funding, lack of vaccine awareness and education, safety concerns, perceived lack of vaccine effectiveness, and lack of inclusion in national guidelines. From the presentations at the meeting, the GII discussed a number of recommendations for easing the burden of influenza and overcoming the current challenges in the Asia-Pacific region. These recommendations encompass the need to improve surveillance and availability of epidemiological data; the development and publication of national guidelines, where not currently available and/or that are in line with those proposed by the World Health Organization; the requirement for optimal timing of vaccination programs according to local or country-specific epidemiology; and calls for advocacy and government support of vaccination programs in order to improve availability and uptake and coverage. In conclusion, in addition to the varied epidemiology of seasonal influenza across this diverse region, there are a number of logistical and resourcing issues that present a challenge to the development of optimally effective vaccination strategies and that need to be overcome to improve access to and uptake of seasonal influenza vaccines. The GII has developed a number of recommendations to address these challenges and improve the control of influenza.
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Affiliation(s)
- Benjamin J Cowling
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Saverio Caini
- NIVEL, Dutch Institute for Health Services Research, Utrecht, The Netherlands
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | | | - Salvacion R Gatchalian
- University of the Philippines Manila, College of Medicine, Philippine General Hospital, Manila City, Philippines
| | - Q Sue Huang
- Institute of Environmental Science and Research (ESR), Wallaceville, Upper Hutt, New Zealand
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ping-Ing Lee
- National Taiwan University Children's Hospital, Taipei, Taiwan
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A Pyrosequencing-Based Approach to High-Throughput Identification of Influenza A(H3N2) Virus Clades Harboring Antigenic Drift Variants. J Clin Microbiol 2016; 55:145-154. [PMID: 27795346 DOI: 10.1128/jcm.01840-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/18/2016] [Indexed: 11/20/2022] Open
Abstract
The rapid evolution of influenza A(H3N2) viruses necessitates close monitoring of their antigenic properties so the emergence and spread of antigenic drift variants can be rapidly identified. Changes in hemagglutinin (HA) acquired by contemporary A(H3N2) viruses hinder antigenic characterization by traditional methods, thus complicating vaccine strain selection. Sequence-based approaches have been used to infer virus antigenicity; however, they are time consuming and mid-throughput. To facilitate virological surveillance and epidemiological studies, we developed and validated a pyrosequencing approach that enables identification of six HA clades of contemporary A(H3N2) viruses. The identification scheme of viruses of the H3 clades 3C.2, 3C.2a, 3C.2b, 3C.3, 3C.3a, and 3C.3b is based on the interrogation of five single nucleotide polymorphisms (SNPs) within three neighboring HA regions, namely 412 to 431, 465 to 481, and 559 to 571. Two bioinformatics tools, IdentiFire (Qiagen) and FireComb (developed in-house), were utilized to expedite pyrosequencing data analysis. The assay's analytical sensitivity was 10 focus forming units, and respiratory specimens with threshold cycle (CT) values of <34 typically produced good quality pyrograms. When applied to 120 A(H3N2) virus isolates and 27 respiratory specimens, the assay displayed 100% agreement with clades determined by HA sequencing coupled with phylogenetics. The multi-SNP analysis described here was readily adopted by another laboratory with pyrosequencing capabilities. The implementation of this approach enhanced the findings from virological surveillance and epidemiological studies between 2013 and 2016, which examined more than 3,000 A(H3N2) viruses.
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McAnerney JM, Walaza S, Tempia S, Blumberg L, Treurnicht FK, Madhi SA, Valley-Omar Z, Cohen C. Estimating vaccine effectiveness in preventing laboratory-confirmed influenza in outpatient settings in South Africa, 2015. Influenza Other Respir Viruses 2016; 11:177-181. [PMID: 27865064 PMCID: PMC5304569 DOI: 10.1111/irv.12436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2016] [Indexed: 11/29/2022] Open
Abstract
Trivalent seasonal influenza vaccine effectiveness during the 2015 season in South Africa was assessed using a test‐negative case control study design. Influenza A(H1N1)pdm09 was the dominant circulating strain. Overall influenza vaccine coverage was 3.2% (29/899). The vaccine effectiveness estimate, against any influenza virus infection, adjusted for age, underlying conditions and timing within season was 46.2% (95% CI: −23.5 to 76.5), and 53.6% (95% CI: −62.6 to 80.3) against influenza A(H1N1)pdm09.
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Affiliation(s)
- Johanna M McAnerney
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Sibongile Walaza
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Stefano Tempia
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Lucille Blumberg
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Florette K Treurnicht
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Shabir A Madhi
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Faculty of Health Sciences, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Valley-Omar
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Division of Medical Virology, Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
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Broberg E, Melidou A, Prosenc K, Bragstad K, Hungnes O. Predominance of influenza A(H1N1)pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in Europe. ACTA ACUST UNITED AC 2016; 21:30184. [PMID: 27074657 DOI: 10.2807/1560-7917.es.2016.21.13.30184] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
Abstract
Influenza A(H1N1)pdm09 viruses predominated in the European influenza 2015/16 season. Most analysed viruses clustered in a new genetic subclade 6B.1, antigenically similar to the northern hemisphere vaccine component A/California/7/2009. The predominant influenza B lineage was Victoria compared with Yamagata in the previous season. It remains to be evaluated at the end of the season if these changes affected the effectiveness of the vaccine for the 2015/16 season.
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Affiliation(s)
- Eeva Broberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Fielding JE, Levy A, Chilver MB, Deng YM, Regan AK, Grant KA, Stocks NP, Sullivan SG. Effectiveness of seasonal influenza vaccine in Australia, 2015: An epidemiological, antigenic and phylogenetic assessment. Vaccine 2016; 34:4905-4912. [PMID: 27577556 DOI: 10.1016/j.vaccine.2016.08.067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND A record number of laboratory-confirmed influenza cases were notified in Australia in 2015, during which type A(H3) and type B Victoria and Yamagata lineages co-circulated. We estimated effectiveness of the 2015 inactivated seasonal influenza vaccine against specific virus lineages and clades. METHODS Three sentinel general practitioner networks conduct surveillance for laboratory-confirmed influenza amongst patients presenting with influenza-like illness in Australia. Data from the networks were pooled to estimate vaccine effectiveness (VE) for seasonal trivalent influenza vaccine in Australia in 2015 using the case test-negative study design. RESULTS There were 2443 eligible patients included in the study, of which 857 (35%) were influenza-positive. Thirty-three and 19% of controls and cases respectively were reported as vaccinated. Adjusted VE against all influenza was 54% (95% CI: 42, 63). Antigenic characterisation data suggested good match between vaccine and circulating strains of A(H3); however VE for A(H3) was low at 44% (95% CI: 21, 60). Phylogenetic analysis indicated most circulating viruses were from clade 3C.2a, rather than the clade included in the vaccine (3C.3a). VE point estimates were higher against B/Yamagata lineage influenza (71%; 95% CI: 57, 80) than B/Victoria (42%, 95% CI: 13, 61), and in younger people. CONCLUSIONS Overall seasonal vaccine was protective against influenza infection in Australia in 2015. Higher VE against the B/Yamagata lineage included in the trivalent vaccine suggests that more widespread use of quadrivalent vaccine could have improved overall effectiveness of influenza vaccine. Genetic characterisation suggested lower VE against A(H3) influenza was due to clade mismatch of vaccine and circulating viruses.
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Affiliation(s)
- James E Fielding
- Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, Melbourne, Victoria, Australia; National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Avram Levy
- PathWest Laboratory Medicine WA, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Monique B Chilver
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Yi-Mo Deng
- World Health Organization Collaborating Centre for Reference and Research on Influenza, The Doherty Institute, Melbourne, Victoria, Australia
| | - Annette K Regan
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Communicable Disease Control Directorate, Western Australia Department of Health, Perth, Western Australia, Australia
| | - Kristina A Grant
- Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, Melbourne, Victoria, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Sheena G Sullivan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia; World Health Organization Collaborating Centre for Reference and Research on Influenza, The Doherty Institute, Melbourne, Victoria, Australia; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
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The year past and the year ahead – some facts and figures about Eurosurveillance. Euro Surveill 2016. [DOI: 10.2807/1560-7917.es.2016.21.1.30098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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