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Russell CA, Fouchier RAM, Ghaswalla P, Park Y, Vicic N, Ananworanich J, Nachbagauer R, Rudin D. Seasonal influenza vaccine performance and the potential benefits of mRNA vaccines. Hum Vaccin Immunother 2024; 20:2336357. [PMID: 38619079 PMCID: PMC11020595 DOI: 10.1080/21645515.2024.2336357] [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: 11/13/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
Influenza remains a public health threat, partly due to suboptimal effectiveness of vaccines. One factor impacting vaccine effectiveness is strain mismatch, occurring when vaccines no longer match circulating strains due to antigenic drift or the incorporation of inadvertent (eg, egg-adaptive) mutations during vaccine manufacturing. In this review, we summarize the evidence for antigenic drift of circulating viruses and/or egg-adaptive mutations occurring in vaccine strains during the 2011-2020 influenza seasons. Evidence suggests that antigenic drift led to vaccine mismatch during four seasons and that egg-adaptive mutations caused vaccine mismatch during six seasons. These findings highlight the need for alternative vaccine development platforms. Recently, vaccines based on mRNA technology have demonstrated efficacy against SARS-CoV-2 and respiratory syncytial virus and are under clinical evaluation for seasonal influenza. We discuss the potential for mRNA vaccines to address strain mismatch, as well as new multi-component strategies using the mRNA platform to improve vaccine effectiveness.
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Affiliation(s)
- Colin A. Russell
- Department of Medical Microbiology & Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron A. M. Fouchier
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
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2
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Sobierajski T, Rykowska D, Wanke-Rytt M, Kuchar E. Vaccine or Garlic-Is It a Choice? Awareness of Medical Personnel on Prevention of Influenza Infections. Vaccines (Basel) 2022; 11:vaccines11010066. [PMID: 36679911 PMCID: PMC9865668 DOI: 10.3390/vaccines11010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preventing the spread of the influenza virus is one of the primary health policy challenges of many countries worldwide. One of the more effective ways to prevent infection is influenza vaccination, and the people who enjoy the most public confidence in preventive health care are health workers (HWs). For this reason, it is crucial to study the attitudes of HWs toward influenza vaccination. METHODS The survey was conducted among 950 medical (physicians and nurses) and administrative staff in three academic hospitals. Respondents to the survey were selected on a random-target basis to represent hospital employees in the study best. The survey was conducted using the PAPI method between August and September 2020. RESULTS Respondents considered hand washing (52.8%) and avoiding contact with sick people (49.3%) the most effective ways to prevent influenza infection. Three in ten respondents considered wearing a protective mask (30.1%) and getting vaccinated against influenza (29.9%) is fully effective in preventing influenza. Influenza vaccination as effective in preventing influenza virus infection was chosen more often by those who worked in a pediatric hospital. Nurses were twice less likely than physicians to declare that influenza vaccination prevents infection (42.4% for nurses vs. 84.0% for physicians). At the same time, 20.4% of nurses believed that eating garlic effectively prevented influenza infection, and 28.1% declared daily vitamin C helpful. CONCLUSIONS The study pointed to significant educational gaps regarding the role and effectiveness of influenza vaccination in the process of influenza virus infection and indicated a firm belief in medical myths, especially in the nursing community, related to protection against influenza virus infection.
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Affiliation(s)
- Tomasz Sobierajski
- Faculty of Applied Social Sciences and Resocialization, University of Warsaw, 26/28 Krakowskie Przedmieście Str., 00-927 Warsaw, Poland
- Correspondence: ; Tel.: +48-503-456-234
| | - Dominika Rykowska
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 63a Żwirki & Wigury Str., 02-091 Warsaw, Poland
| | - Monika Wanke-Rytt
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 63a Żwirki & Wigury Str., 02-091 Warsaw, Poland
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 63a Żwirki & Wigury Str., 02-091 Warsaw, Poland
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3
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Cauchi JP, Borg ML, Džiugytė A, Attard J, Melillo T, Zahra G, Barbara C, Spiteri M, Drago A, Zammit L, Debono J, Souness J, Agius S, Young S, Dimech A, Chetcuti I, Camenzuli M, Borg I, Calleja N, Tabone L, Gauci C, Vassallo P, Baruch J. Digitalizing and Upgrading Severe Acute Respiratory Infections Surveillance in Malta: System Development. JMIR Public Health Surveill 2022; 8:e37669. [PMID: 36227157 PMCID: PMC9764153 DOI: 10.2196/37669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/17/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. OBJECTIVE We sought to describe the process of digitizing and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the COVID-19 pandemic from February to November 2021. We described the characteristics of people included in the surveillance system and compared different SARI case definitions, including their advantages and disadvantages. This study also discusses the process, output, and future for SARI and other public health surveillance opportunities. METHODS Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, whereas other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onward, we mapped key stakeholders and digitized most surveillance processes. RESULTS By November 30, 2021, 903 SARI cases were reported, with 380 (42.1%) positive for SARS-CoV-2. Of all SARI hospitalizations, 69 (7.6%) were admitted to the intensive care unit, 769 (85.2%) were discharged, 27 (3%) are still being treated, and 107 (11.8%) died. Among the 107 patients who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (n=57, 53.3%) and chronic heart disease (n=49, 45.8%). CONCLUSIONS The implementation of enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing the monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes.
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Affiliation(s)
- John Paul Cauchi
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | | | - Aušra Džiugytė
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | - Jessica Attard
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | - Tanya Melillo
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | - Graziella Zahra
- Molecular Dianostics Pathology Department, Mater dei Hospital, Msida, Malta
| | | | | | - Allan Drago
- Emergency Department, Mater Dei Hospital, Msida, Malta
| | - Luke Zammit
- Emergency Department, Mater Dei Hospital, Msida, Malta
| | | | | | | | | | | | | | | | | | - Neville Calleja
- Directorate for Health Information and Research, Msida, Malta
| | | | - Charmaine Gauci
- Superintendent of Public Health, Ministry of Health, Msida, Malta
| | - Pauline Vassallo
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | - Joaquin Baruch
- Health Promotion and Disease Prevention Directorate, Msida, Malta
- European Programme for Intervention Epidemiology Training program, European Centre for Disease Prevention and Control, Solna, Sweden
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4
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Jones RP, Ponomarenko A. Roles for Pathogen Interference in Influenza Vaccination, with Implications to Vaccine Effectiveness (VE) and Attribution of Influenza Deaths. Infect Dis Rep 2022; 14:710-758. [PMID: 36286197 PMCID: PMC9602062 DOI: 10.3390/idr14050076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 08/29/2023] Open
Abstract
Pathogen interference is the ability of one pathogen to alter the course and clinical outcomes of infection by another. With up to 3000 species of human pathogens the potential combinations are vast. These combinations operate within further immune complexity induced by infection with multiple persistent pathogens, and by the role which the human microbiome plays in maintaining health, immune function, and resistance to infection. All the above are further complicated by malnutrition in children and the elderly. Influenza vaccination offers a measure of protection for elderly individuals subsequently infected with influenza. However, all vaccines induce both specific and non-specific effects. The specific effects involve stimulation of humoral and cellular immunity, while the nonspecific effects are far more nuanced including changes in gene expression patterns and production of small RNAs which contribute to pathogen interference. Little is known about the outcomes of vaccinated elderly not subsequently infected with influenza but infected with multiple other non-influenza winter pathogens. In this review we propose that in certain years the specific antigen mix in the seasonal influenza vaccine inadvertently increases the risk of infection from other non-influenza pathogens. The possibility that vaccination could upset the pathogen balance, and that the timing of vaccination relative to the pathogen balance was critical to success, was proposed in 2010 but was seemingly ignored. Persons vaccinated early in the winter are more likely to experience higher pathogen interference. Implications to the estimation of vaccine effectiveness and influenza deaths are discussed.
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Affiliation(s)
- Rodney P Jones
- Healthcare Analysis and Forecasting, Wantage OX12 0NE, UK
| | - Andrey Ponomarenko
- Department of Biophysics, Informatics and Medical Instrumentation, Odessa National Medical University, Valikhovsky Lane 2, 65082 Odessa, Ukraine
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5
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Mercier E, D'Aoust PM, Thakali O, Hegazy N, Jia JJ, Zhang Z, Eid W, Plaza-Diaz J, Kabir MP, Fang W, Cowan A, Stephenson SE, Pisharody L, MacKenzie AE, Graber TE, Wan S, Delatolla R. Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak. Sci Rep 2022; 12:15777. [PMID: 36138059 DOI: 10.1101/2022.06.28.22276884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 05/27/2023] Open
Abstract
Recurrent influenza epidemics and pandemic potential are significant risks to global health. Public health authorities use clinical surveillance to locate and monitor influenza and influenza-like cases and outbreaks to mitigate hospitalizations and deaths. Currently, global integration of clinical surveillance is the only reliable method for reporting influenza types and subtypes to warn of emergent pandemic strains. The utility of wastewater surveillance (WWS) during the COVID-19 pandemic as a less resource intensive replacement or complement for clinical surveillance has been predicated on analyzing viral fragments in wastewater. We show here that influenza virus targets are stable in wastewater and partitions favorably to the solids fraction. By quantifying, typing, and subtyping the virus in municipal wastewater and primary sludge during a community outbreak, we forecasted a citywide flu outbreak with a 17-day lead time and provided population-level viral subtyping in near real-time to show the feasibility of influenza virus WWS at the municipal and neighbourhood levels in near real time using minimal resources and infrastructure.
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Affiliation(s)
- Elisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Ocean Thakali
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Nada Hegazy
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Jian-Jun Jia
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Zhihao Zhang
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Walaa Eid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Julio Plaza-Diaz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Md Pervez Kabir
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Wanting Fang
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Aaron Cowan
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Sean E Stephenson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Lakshmi Pisharody
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Shen Wan
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada.
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6
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Mercier E, D'Aoust PM, Thakali O, Hegazy N, Jia JJ, Zhang Z, Eid W, Plaza-Diaz J, Kabir MP, Fang W, Cowan A, Stephenson SE, Pisharody L, MacKenzie AE, Graber TE, Wan S, Delatolla R. Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak. Sci Rep 2022; 12:15777. [PMID: 36138059 PMCID: PMC9493155 DOI: 10.1038/s41598-022-20076-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Recurrent influenza epidemics and pandemic potential are significant risks to global health. Public health authorities use clinical surveillance to locate and monitor influenza and influenza-like cases and outbreaks to mitigate hospitalizations and deaths. Currently, global integration of clinical surveillance is the only reliable method for reporting influenza types and subtypes to warn of emergent pandemic strains. The utility of wastewater surveillance (WWS) during the COVID-19 pandemic as a less resource intensive replacement or complement for clinical surveillance has been predicated on analyzing viral fragments in wastewater. We show here that influenza virus targets are stable in wastewater and partitions favorably to the solids fraction. By quantifying, typing, and subtyping the virus in municipal wastewater and primary sludge during a community outbreak, we forecasted a citywide flu outbreak with a 17-day lead time and provided population-level viral subtyping in near real-time to show the feasibility of influenza virus WWS at the municipal and neighbourhood levels in near real time using minimal resources and infrastructure.
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Affiliation(s)
- Elisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Ocean Thakali
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Nada Hegazy
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Jian-Jun Jia
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Zhihao Zhang
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Walaa Eid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Julio Plaza-Diaz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Md Pervez Kabir
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Wanting Fang
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Aaron Cowan
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Sean E Stephenson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Lakshmi Pisharody
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 8L1, Canada
| | - Shen Wan
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, K1N 6N5, Canada.
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7
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Zhang Y, Wang Y, Jia C, Li G, Zhang W, Li Q, Chen X, Leng W, Huang L, Xie Z, Zhang H, You W, An R, Jiang H, Zhao X, Cheng S, Tan J, Cui W, Gao F, Lu W, Wang Y, Yang Y, Xia S, Wang S. Immunogenicity and safety of an egg culture-based quadrivalent inactivated non-adjuvanted subunit influenza vaccine in subjects ≥3 years: A randomized, multicenter, double-blind, active-controlled phase III, non-inferiority trial. Vaccine 2022; 40:4933-4941. [PMID: 35810063 DOI: 10.1016/j.vaccine.2022.06.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
Subunit influenza vaccine only formulated with surface antigen proteins has better safety profiles relative to split-virion influenza vaccine. Compared to the traditional quadrivalent split-virion influenza vaccine, a novel quadrivalent subunit influenza vaccine is urgently needed in China. We completed a phase 3, randomized, double-blind, active-controlled, non-inferiority clinical study at two sites in Henan Province, China. Eligible volunteers were split into four age cohorts (3-8 years, 9-17 years, 18-64 years, and ≥ 65 years, based on their dates of birth) and randomly assigned (1:1) to the subunit and the split-virion ecNAIIV4 groups. All volunteers were intramuscularly administered a single vaccine dose at baseline, and children aged 3-8 years received a boosting dose at day 28. And the immune response was evaluated by measuring hemagglutinin-inhibition antibody titers against the four vaccine strains in blood samples. Safety profiles had nonsignificant differences between the study groups in ≥ 3 years cohort. Most adverse reactions post-vaccination, both local and systemic, were mild to moderate and resolved within 3 days. And no serious adverse events occurred. The immunogenicity of the trial vaccine was non-inferior to the comparator. Further, a two-dose vaccine series can provide better seroprotection than that of a one-dose series in children aged 3-8 years, with clinically acceptable safety profiles. Clinical Trials Registration. ChiCTR2100049934.
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Affiliation(s)
| | - Yanxia Wang
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | | | | | - Wei Zhang
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | - Qin Li
- Ab&b Biotec Co., Ltd, Taizhou, China.
| | | | | | - Lili Huang
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | - Zhiqiang Xie
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | | | - Wangyang You
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | - Rui An
- Ab&b Biotec Co., Ltd, Taizhou, China.
| | | | - Xue Zhao
- Ab&b Biotec Co., Ltd, Taizhou, China.
| | | | - Jiebing Tan
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | - Weiyang Cui
- Puyang Centre for Disease Control and Prevention, Henan, China.
| | - Feilong Gao
- Kaifeng Municipal Centre for Disease Control and Prevention, Henan, China.
| | - Weifeng Lu
- Kaifeng Municipal Centre for Disease Control and Prevention, Henan, China.
| | - Yuping Wang
- Puyang Centre for Disease Control and Prevention, Henan, China.
| | - Yongli Yang
- Department of Epidemiology and Public Health, College of Public Health, Zhengzhou University, Zhenzhou, China.
| | - Shengli Xia
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, China.
| | - Shuai Wang
- Ab&b Biotec Co., Ltd, Taizhou, China; Yither Biotech Co., Ltd, Shanghai, China.
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8
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Gaglani M, Vasudevan A, Raiyani C, Murthy K, Chen W, Reis M, Belongia EA, McLean HQ, Jackson ML, Jackson LA, Zimmerman RK, Nowalk MP, Monto AS, Martin ET, Chung JR, Spencer S, Fry AM, Flannery B. Effectiveness of Trivalent and Quadrivalent Inactivated Vaccines Against Influenza B in the United States, 2011-2012 to 2016-2017. Clin Infect Dis 2021; 72:1147-1157. [PMID: 32006430 PMCID: PMC8028105 DOI: 10.1093/cid/ciaa102] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background Since 2013, quadrivalent influenza vaccines containing 2 B viruses gradually replaced trivalent vaccines in the United States. We compared the vaccine effectiveness of quadrivalent to trivalent inactivated vaccines (IIV4 to IIV3, respectively) against illness due to influenza B during the transition, when IIV4 use increased rapidly. Methods The US Influenza Vaccine Effectiveness (Flu VE) Network analyzed 25 019 of 42 600 outpatients aged ≥6 months who enrolled within 7 days of illness onset during 6 seasons from 2011–2012. Upper respiratory specimens were tested for the influenza virus type and B lineage. Using logistic regression, we estimated IIV4 or IIV3 effectiveness by comparing the odds of an influenza B infection overall and the odds of B lineage among vaccinated versus unvaccinated participants. Over 4 seasons from 2013–2014, we compared the relative odds of an influenza B infection among IIV4 versus IIV3 recipients. Results Trivalent vaccines included the predominantly circulating B lineage in 4 of 6 seasons. During 4 influenza seasons when both IIV4 and IIV3 were widely used, the overall effectiveness against any influenza B was 53% (95% confidence interval [CI], 45–59) for IIV4 versus 45% (95% CI, 34–54) for IIV3. IIV4 was more effective than IIV3 against the B lineage not included in IIV3, but comparative effectiveness against illnesses related to any influenza B favored neither vaccine valency. Conclusions The uptake of quadrivalent inactivated influenza vaccines was not associated with increased protection against any influenza B illness, despite the higher effectiveness of quadrivalent vaccines against the added B virus lineage. Public health impact and cost-benefit analyses are needed globally.
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Affiliation(s)
- Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Anupama Vasudevan
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Chandni Raiyani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Wencong Chen
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Michael Reis
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Richard K Zimmerman
- University of Pittsburgh, Schools of Health Sciences, Pittsburgh, Pennsylvania, USA
| | - Mary Patricia Nowalk
- University of Pittsburgh, Schools of Health Sciences, Pittsburgh, Pennsylvania, USA
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jessie R Chung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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Papaioannou A, Konstantinidi AE, Primikiri E, Asimakopoulou F, Aravantinos D, Mavromichali Z. Influenza vaccination rate among high risk group patients in primary health care in Greece. Cent Eur J Public Health 2021; 28:297-301. [PMID: 33338366 DOI: 10.21101/cejph.a5237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 08/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Seasonal influenza vaccination is the main method for influenza prevention. The main objective of this study is to estimate the frequency of vaccinations in patients with chronic illnesses presented to a primary health care (PHC) centre. METHODS This cross-sectional study was performed in patients admitted to the Kapandriti Health Centre. Their vaccination status with an influenza vaccine and their underlying diseases were recorded. RESULTS 34.8% of the subjects had been vaccinated against seasonal influenza. Vaccination coverage was found to be 53.9% in pulmonary, 55.6% in chronic kidney disease, 43.7% in cardiovascular disorders, 40.6% in diabetes, 40.6% in any kind of malignancy, and finally 33.3% in neurological patients. The most significant predictors for vaccination were the age group of 60 to 79 years (OR = 3.08, 95% CI: 1.79-5.29), age over 80 years (OR = 2.91, 95% CI: 1.58-5.36), respiratory disease (OR = 2.25, 95% CI: 1.33-3.76), cardiovascular disorder (OR = 1.46, 95% CI: 1.02-2.10), and 3 to 5 visits to the unit annually (OR = 1.57, 95% CI: 1.12-2.24). Finally, it was discovered that coexistence of one to three diseases reduced the likelihood ratio for vaccine uptake (OR = 0.15, 95% CI: 0.03-0.79, p < 0.05). CONCLUSIONS The influenza vaccination rate for the population of the present study has been found higher than that reported previously in literature. We believe that there is a need to implement new and more effective strategies such as educating vulnerable groups on the benefits of vaccination and so reducing the incidence of influenza and its complications especially in vulnerable groups.
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Affiliation(s)
- Anastasia Papaioannou
- Health Centre of Nea Makri, Athens, Greece.,Health Centre of Kapandriti, Athens, Greece
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10
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Scholz SM, Weidemann F, Damm O, Ultsch B, Greiner W, Wichmann O. Cost-Effectiveness of Routine Childhood Vaccination Against Seasonal Influenza in Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:32-40. [PMID: 33431151 DOI: 10.1016/j.jval.2020.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In Germany, routine influenza vaccination with quadrivalent influenza vaccines (QIV) is recommended and reimbursed for individuals ≥60 years of age and individuals with underlying chronic conditions. The present study examines the cost-effectiveness of a possible extension of the recommendation to include strategies of childhood vaccination against seasonal influenza using QIV. METHODS A dynamic transmission model was used to examine the epidemiological impact of different childhood vaccination strategies. The outputs were used in a health economic decision tree to calculate the costs per quality-adjusted life year (QALY) gained from a societal and a third-party payer (TPP) perspective. Strain-specific epidemiology, vaccine uptake, and vaccine efficacy data from the 10 non-pandemic seasons from 2003/2004 to 2013/2014 were used, and cost data were drawn mainly from a health insurance claims data analysis and supplemented by estimates from literature. Uncertainty is explored via scenario, deterministic, and probabilistic sensitivity analyses. RESULTS Vaccinating 2- to 9-year-olds with QIV assuming a vaccine uptake of 40% is cost-saving with a benefit-cost ratio of 1.66 from a societal perspective and an incremental cost-effectiveness ratio of €998/QALY from a TPP perspective. Lower and higher vaccine uptakes show marginal effects, while extending the target group to 2- to 17-year-olds further increases the health benefits while still being below the willingness-to-pay (WTP) threshold. Assuming no vaccine-induced herd protection has a negative effect on the cost-effectiveness ratio, but childhood vaccination remains cost-effective. CONCLUSION Routine childhood vaccination against seasonal influenza in Germany is most likely to be cost-saving from a societal perspective and highly cost-effective from a TPP perspective.
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Affiliation(s)
- Stefan M Scholz
- Immunization Unit, Robert Koch-Institute, Berlin, Germany; School of Public Health, Bielefeld University, Bielefeld, Germany.
| | | | - Oliver Damm
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Wolfgang Greiner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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11
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Machado A, Mazagatos C, Dijkstra F, Kislaya I, Gherasim A, McDonald SA, Kissling E, Valenciano M, Meijer A, Hooiveld M, Nunes B, Larrauri A. Impact of influenza vaccination programmes among the elderly population on primary care, Portugal, Spain and the Netherlands: 2015/16 to 2017/18 influenza seasons. ACTA ACUST UNITED AC 2020; 24. [PMID: 31718740 PMCID: PMC6852314 DOI: 10.2807/1560-7917.es.2019.24.45.1900268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background To increase the acceptability of influenza vaccine, it is important to quantify the overall benefits of the vaccination programme. Aim To assess the impact of influenza vaccination in Portugal, Spain and the Netherlands, we estimated the number of medically attended influenza-confirmed cases (MAICC) in primary care averted in the seasons 2015/16 to 2017/18 among those ≥ 65 years. Methods We used an ecological approach to estimate vaccination impact. We compared the number of observed MAICC (n) to the estimated number that would have occurred without the vaccination programme (N). To estimate N, we used: (i) MAICC estimated from influenza surveillance systems, (ii) vaccine coverage, (iii) pooled (sub)type-specific influenza vaccine effectiveness estimates for seasons 2015/16 to 2017/18, weighted by the proportion of virus circulation in each season and country. We estimated the number of MAICC averted (NAE) and the prevented fraction (PF) by the vaccination programme. Results The annual average of NAE in the population ≥ 65 years was 33, 58 and 204 MAICC per 100,000 in Portugal, Spain and the Netherlands, respectively. On average, influenza vaccination prevented 10.7%, 10.9% and 14.2% of potential influenza MAICC each season in these countries. The lowest PF was in 2016/17 (4.9–6.1%) with an NAE ranging from 24 to 69 per 100,000. Conclusions Our results suggest that influenza vaccination programmes reduced a substantial number of MAICC. Together with studies on hospitalisations and deaths averted by influenza vaccination programmes, this will contribute to the evaluation of the impact of vaccination strategies and strengthen public health communication.
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Affiliation(s)
- Ausenda Machado
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,These authors contributed equally.,National Institute for Health Doutor Ricardo Jorge, Epidemiology department, Lisbon, Portugal
| | - Clara Mazagatos
- National Centre of Epidemiology, Carlos III Health Institute, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,These authors contributed equally
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,These authors contributed equally
| | - Irina Kislaya
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,National Institute for Health Doutor Ricardo Jorge, Epidemiology department, Lisbon, Portugal
| | - Alin Gherasim
- National Centre of Epidemiology, Carlos III Health Institute, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Scott A McDonald
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mariëtte Hooiveld
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Baltazar Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,National Institute for Health Doutor Ricardo Jorge, Epidemiology department, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, Carlos III Health Institute, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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12
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Kissling E, Pozo F, Buda S, Vilcu AM, Gherasim A, Brytting M, Domegan L, Gómez V, Meijer A, Lazar M, Vučina VV, Dürrwald R, van der Werf S, Larrauri A, Enkirch T, O'Donnell J, Guiomar R, Hooiveld M, Petrović G, Stoian E, Penttinen P, Valenciano M. Low 2018/19 vaccine effectiveness against influenza A(H3N2) among 15-64-year-olds in Europe: exploration by birth cohort. ACTA ACUST UNITED AC 2020; 24. [PMID: 31796152 PMCID: PMC6891946 DOI: 10.2807/1560-7917.es.2019.24.48.1900604] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction Influenza A(H3N2) clades 3C.2a and 3C.3a co-circulated in Europe in 2018/19. Immunological imprinting by first childhood influenza infection may induce future birth cohort differences in vaccine effectiveness (VE). Aim The I-MOVE multicentre primary care test-negative study assessed 2018/19 influenza A(H3N2) VE by age and genetic subgroups to explore VE by birth cohort. Methods We measured VE against influenza A(H3N2) and (sub)clades. We stratified VE by usual age groups (0–14, 15–64, ≥ 65-years). To assess the imprint-regulated effect of vaccine (I-REV) hypothesis, we further stratified the middle-aged group, notably including 32–54-year-olds (1964–86) sharing potential childhood imprinting to serine at haemagglutinin position 159. Results Influenza A(H3N2) VE among all ages was −1% (95% confidence interval (CI): −24 to 18) and 46% (95% CI: 8–68), −26% (95% CI: −66 to 4) and 20% (95% CI: −20 to 46) among 0–14, 15–64 and ≥ 65-year-olds, respectively. Among 15–64-year-olds, VE against clades 3C.2a1b and 3C.3a was 15% (95% CI: −34 to 50) and −74% (95% CI: −259 to 16), respectively. VE was −18% (95% CI: −140 to 41), −53% (95% CI: −131 to −2) and −12% (95% CI: −74 to 28) among 15–31-year-olds (1987–2003), 32–54-year-olds (1964–86) and 55–64-year-olds (1954–63), respectively. Discussion The lowest 2018/19 influenza A(H3N2) VE was against clade 3C.3a and among those born 1964–86, corresponding to the I-REV hypothesis. The low influenza A(H3N2) VE in 15–64-year-olds and the public health impact of the I-REV hypothesis warrant further study.
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Affiliation(s)
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Alin Gherasim
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain
| | - Mia Brytting
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Lisa Domegan
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Health Service Executive- Health Protection Surveillance Centre, Dublin, Ireland
| | - Verónica Gómez
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mihaela Lazar
- "Cantacuzino" National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Vesna Višekruna Vučina
- Croatian Institute of Public Health, Division for epidemiology of communicable diseases, Zagreb, Croatia
| | - Ralf Dürrwald
- Robert Koch Institute, National Reference Center for Influenza, Germany
| | - Sylvie van der Werf
- CNR des virus des infections respiratoires, WHO National Influenza Center, Institut Pasteur, Paris, France.,Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France
| | - Amparo Larrauri
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain
| | | | - Joan O'Donnell
- Health Service Executive- Health Protection Surveillance Centre, Dublin, Ireland
| | - Raquel Guiomar
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Mariëtte Hooiveld
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Goranka Petrović
- Croatian Institute of Public Health, Division for epidemiology of communicable diseases, Zagreb, Croatia
| | - Elena Stoian
- "Cantacuzino" National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The I-MOVE primary care study team members are listed at the end of the article
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13
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Okoli GN, Racovitan F, Righolt CH, Mahmud SM. Variations in Seasonal Influenza Vaccine Effectiveness due to Study Characteristics: A Systematic Review and Meta-analysis of Test-Negative Design Studies. Open Forum Infect Dis 2020; 7:ofaa177. [PMID: 32704509 PMCID: PMC7367680 DOI: 10.1093/ofid/ofaa177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/19/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Study characteristics influence vaccine effectiveness (VE) estimation. We examined the influence of some of these on seasonal influenza VE estimates from test-negative design (TND) studies. METHODS We systematically searched bibliographic databases and websites for full-text publications of TND studies on VE against laboratory-confirmed seasonal influenza in outpatients after the 2009 pandemic influenza. We followed the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We examined influence of source of vaccination information, respiratory specimen swab time, and covariate adjustment on VE. We calculated pooled adjusted VE against H1N1 and H3N2 influenza subtypes, influenza B, and all influenza using an inverse-variance random-effects model. RESULTS We included 70 full-text articles. Pooled VE against H1N1 and H3N2 influenza subtypes, influenza B, and all influenza was higher for studies that used self-reported vaccination than for those that used medical records. Pooled VE was higher with respiratory specimen collection within ≤7 days vs ≤4 days of symptom onset, but the opposite was observed for H1N1. Pooled VE was higher for studies that adjusted for age but not for medical conditions compared with those that adjusted for both. There was, however, a lack of statistical significance in almost all differences in pooled VE between compared groups. CONCLUSIONS The available evidence is not strong enough to conclude that influenza VE from TND studies varies by source of vaccination information, respiratory specimen swab time, or adjustment for age/medical conditions. The evidence is, however, indicative that these factors ought to be considered while designing or evaluating TND studies of influenza VE.
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Affiliation(s)
- George N Okoli
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Florentin Racovitan
- Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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14
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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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15
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Godoy P, Romero A, Soldevila N, Torner N, Jané M, Martínez A, Caylà JA, Rius C, Domínguez A. Influenza vaccine effectiveness in reducing severe outcomes over six influenza seasons, a case-case analysis, Spain, 2010/11 to 2015/16. ACTA ACUST UNITED AC 2019; 23. [PMID: 30376915 PMCID: PMC6208006 DOI: 10.2807/1560-7917.es.2018.23.43.1700732] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction When influenza vaccination is ineffective in preventing influenza virus infection, it may still reduce the severity of influenza-associated disease. Here, we estimate the effect of influenza vaccination in preventing severe outcomes e.g. intensive care unit (ICU) admission and death, even though it did not prevent influenza virus infection and subsequent hospitalisation. Methods An observational case–case epidemiological study was carried out in 12 sentinel hospitals in Catalonia (Spain) over six influenza seasons 2010/11–2015/16. Cases were individuals with severe laboratory-confirmed influenza virus infection and aged 18 years and older. For each reported case we collected demographic, virological and clinical characteristics. Logistic regression was used to estimate the crude, adjusted odd ratios (aOR) and 95% confidence intervals (CI). Results Of 1,727 hospitalised patients included in the study, 799 were female (46.7%), 591 (34.2%) were admitted to the ICU and 223 (12.9%) died. Influenza vaccination uptake was lower in cases that required ICU admission or died (21.2% vs 29.7%, p < 0.001). The adjusted influenza vaccination effectiveness in preventing ICU admission or death was 23% (95% CI: 1 to 40). In an analysis restricted to sex, age group and antiviral treatment, influenza vaccination had a positive effect on disease severity in all age groups and categories. Conclusions We found that influenza vaccination reduced the severity of disease even in cases where it did not prevent infection and influenza-associated hospitalisation. Therefore, increased vaccination uptake may reduce complications, ICU admission and death.
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Affiliation(s)
- Pere Godoy
- IRBLleida. Institut de Recerca Biomèdica de Lleida, Lleida, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Núria Soldevila
- Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Nuria Torner
- Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Mireia Jané
- CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Ana Martínez
- CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Joan A Caylà
- TB Research Unit Foundation (fuiTB), Barcelona, Spain
| | - Cristina Rius
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Angela Domínguez
- Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain
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16
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Kissling E, Pozo F, Buda S, Vilcu AM, Rizzo C, Gherasim A, Horváth JK, Brytting M, Domegan L, Meijer A, Paradowska-Stankiewicz I, Machado A, Vučina VV, Lazar M, Johansen K, Dürrwald R, van der Werf S, Bella A, Larrauri A, Ferenczi A, Zakikhany K, O'Donnell J, Dijkstra F, Bogusz J, Guiomar R, Filipović SK, Pitigoi D, Penttinen P, Valenciano M. Effectiveness of influenza vaccine against influenza A in Europe in seasons of different A(H1N1)pdm09 and the same A(H3N2) vaccine components (2016-17 and 2017-18). Vaccine X 2019; 3:100042. [PMID: 31660536 PMCID: PMC6807025 DOI: 10.1016/j.jvacx.2019.100042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022] Open
Abstract
Influenza A(H3N2) circulated in Europe in 2016–17 and 2017–18 and A(H1N1)pdm09 in 2017–18. Changed A(H1N1)pdm09 vaccine component VE was 58% against A(H1N1)pdm09 in 2017–18. A(H3N2) VE was 13% and 28% among all ages in 2016–17 and 2017–18, respectively.
Introduction Influenza A(H3N2) viruses predominated in Europe in 2016–17. In 2017–18 A(H3N2) and A(H1N1)pdm09 viruses co-circulated. The A(H3N2) vaccine component was the same in both seasons; while the A(H1N1)pdm09 component changed in 2017–18. In both seasons, vaccine seed A(H3N2) viruses developed adaptations/alterations during propagation in eggs, impacting antigenicity. Methods We used the test-negative design in a multicentre primary care case-control study in 12 European countries to measure 2016–17 and 2017–18 influenza vaccine effectiveness (VE) against laboratory-confirmed influenza A(H1N1)pdm09 and A(H3N2) overall and by age group. Results During the 2017–18 season, the overall VE against influenza A(H1N1)pdm09 was 59% (95% CI: 47–69). Among those aged 0–14, 15–64 and ≥65 years, VE against A(H1N1)pdm09 was 64% (95% CI: 37–79), 50% (95% CI: 28–66) and 66% (95% CI: 42–80), respectively. Overall VE against influenza A(H3N2) was 28% (95% CI: 17–38) in 2016–17 and 13% (95% CI: −15 to 34) in 2017–18. Among 0–14-year-olds VE against A(H3N2) was 28% (95%CI: −10 to 53) and 29% (95% CI: −87 to 73), among 15–64-year-olds 34% (95% CI: 18–46) and 33% (95% CI: −3 to 56) and among those aged ≥65 years 15% (95% CI: −10 to 34) and −9% (95% CI: −74 to 32) in 2016–17 and 2017–18, respectively. Conclusions Our study suggests the new A(H1N1)pdm09 vaccine component conferred good protection against circulating strains, while VE against A(H3N2) was <35% in 2016–17 and 2017–18. The egg propagation derived antigenic mismatch of the vaccine seed virus with circulating strains may have contributed to this low effectiveness. A(H3N2) seed viruses for vaccines in subsequent seasons may be subject to the same adaptations; in years with lower than expected VE, recommendations of preventive measures other than vaccination should be given in a timely manner.
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Affiliation(s)
- Esther Kissling
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Caterina Rizzo
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.,Bambino Gesù Children's Hospital, Rome, Italy
| | - Alin Gherasim
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | - Mia Brytting
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Mihaela Lazar
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Kari Johansen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Ralf Dürrwald
- Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany
| | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France.,CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Amparo Larrauri
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joanna Bogusz
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Raquel Guiomar
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal
| | | | - Daniela Pitigoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Marta Valenciano
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
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17
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Price OH, Carville KS, Sullivan SG. Right sizing for vaccine effectiveness studies: how many is enough for reliable estimation? Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The precision of vaccine effectiveness (VE) estimates is dependent on sample size and sampling methods. In Victoria, participating general practitioners (GPs) are not limited by the number of influenza-like illness (ILI) patients they collect respiratory samples (swabs) from in sentinel surveillance. However, in the context of scarce resources it is of interest to determine the minimum sample size needed for reliable estimates. Methods Following the test-negative design, patients with ILI were recruited by GPs and tested for influenza. Descriptive analyses were conducted to assess possible selection bias introduced by GPs. VE was calculated by logistic regression as [1 – odds ratio] x 100% and adjusted for week of presentation and age. Random 20% and 50% samples were selected without replacement to estimate the effect of swab rates on VE estimates. Results GPs swabbed a smaller proportion of patients aged ≥65 years (45.9%, n=238) than those <5 (75.6%, n=288), 5–17 (67.9%, n=547) and 18–64 (75.6%, n=2662) years. Decreasing the swab rate did not alter VE point estimates significantly. However, it reduced the precision of estimates and in some instances resulted in too small a sample size to estimate VE. Conclusion Imposing a 20% or 50% swabbing rate produces less robust VE estimates. The number of swabs required per year to produce precise estimates should be dictated by seasonal severity, rather than an arbitrary rate. It would be beneficial for GPs to swab patients systematically by age group to ensure there are sufficient data to investigate VE against a particular subtype in a given age group.
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Affiliation(s)
- Olivia H Price
- 1-WHO Collaborating Centre for Reference and Research on Influenza, at the Peter Doherty Institute for Infection and Immunity, Victoria 3000 Australia 2- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kylie S Carville
- Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Victoria 3000 Australia
| | - Sheena G Sullivan
- 1-WHO Collaborating Centre for Reference and Research on Influenza, at the Peter Doherty Institute for Infection and Immunity, Victoria 3000 Australia 2-School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Castilla J, Martínez-Baz I, Navascués A, Casado I, Aguinaga A, Díaz-González J, Delfrade J, Guevara M, Ezpeleta C. Comparison of influenza vaccine effectiveness in preventing outpatient and inpatient influenza cases in older adults, northern Spain, 2010/11 to 2015/16. ACTA ACUST UNITED AC 2019; 23. [PMID: 29338809 PMCID: PMC5770851 DOI: 10.2807/1560-7917.es.2018.23.2.16-00780] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We compared trivalent inactivated influenza vaccine effectiveness (VE) in preventing outpatient and inpatient influenza cases in Navarre, Spain. Methods: During seasons 2010/11 to 2015/16, community-dwelling patients with influenza-like illness aged 50 years or older were tested for influenza when attended by sentinel general practitioners or admitted to hospitals. The test–negative design was used to estimate and compare the VE by healthcare setting. Results: We compared 1,242 laboratory-confirmed influenza cases (557 outpatient and 685 inpatient cases) and 1,641 test-negative controls. Influenza VE was 34% (95% confidence interval (CI): 6 to 54) in outpatients and 32% (95% CI: 15 to 45) in inpatients. VE in outpatients and inpatients was, respectively, 41% (95% CI: –1 to 65) and 36% (95% CI: 12 to 53) against A(H1N1)pdm09, 5% (95% CI: –58 to 43) and 22% (95% CI: –9 to 44) against A(H3N2), and 49% (95% CI, 6 to 73) and 37% (95% CI: 2 to 59) against influenza B. Trivalent inactivated influenza vaccine was not associated with a different probability of hospitalisation among influenza cases, apart from a 54% (95% CI: 10 to 76) reduction in hospitalisation of influenza A(H3N2) cases. Conclusions: On average, influenza VE was moderate and similar in preventing outpatient and inpatient influenza cases over six influenza seasons in patients above 50 years of age. In some instances of low VE, vaccination may still reduce the risk of hospitalisation in older adults with vaccine failure.
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Affiliation(s)
- Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Iván Martínez-Baz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Ana Navascués
- Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Itziar Casado
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Aitziber Aguinaga
- Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Jorge Díaz-González
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Josu Delfrade
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Marcela Guevara
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Carmen Ezpeleta
- Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
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- The members of the networks are listed at the end of the article
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- The members of the networks are listed at the end of the article
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19
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Casado I, Domínguez Á, Toledo D, Chamorro J, Astray J, Egurrola M, Fernández-Sierra MA, Martín V, Morales-Suárez-Varela M, Godoy P, Castilla J. Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: a multicentre case-control study. CMAJ 2018; 190:E3-E12. [PMID: 29311098 DOI: 10.1503/cmaj.170910] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. RESULTS We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). INTERPRETATION Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults.
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Affiliation(s)
- Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Ángela Domínguez
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Diana Toledo
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Judith Chamorro
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Jenaro Astray
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Mikel Egurrola
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - María Amelia Fernández-Sierra
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Vicente Martín
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - María Morales-Suárez-Varela
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Pere Godoy
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Ma C, Pan Y, Zhang L, Zhang Y, Wu S, Sun Y, Duan W, Zhang M, Wang Q, Yang P. Influenza vaccine effectiveness against medically attended influenza illness in Beijing, China, 2014/15 season. Hum Vaccin Immunother 2018; 13:2379-2384. [PMID: 28846480 DOI: 10.1080/21645515.2017.1359364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Influenza vaccination is the most effective way of preventing influenza infections but its coverage is extremely low in China. Poor influenza vaccine effectiveness (VE) was reported in the 2014/15 season in some Northern Hemisphere countries with a predominance of H3N2 viruses belonging to the 3C.2a clade. However, there is limited information regarding the preventive effect of influenza vaccination for the same season in China, in which H3N2 viruses belonging to the 3C.3a clade predominated. Through influenza virological surveillance in Beijing, China during the 2014/15 season, we estimated the influenza VE against medically attended influenza-like illness (ILI) associated with laboratory-confirmed influenza virus infection using a test-negative design, and the effect of prior vaccination on current vaccination was examined. In total, 9297 patients with ILI were enrolled in this study. Among them, 3434 (36.9%) tested positive for influenza viruses: 2167 (63.1%) for A(H3N2), 1261 (36.7%) for influenza B, and 3 (0.1%) for A(H1N1)pdm09. The adjusted VE was estimated as -25% (95% CI: -70%, 8%) against A(H3N2) and -8% (95% CI: -50%, 23%) against B, with an overall VE of -18% (95% CI: -49%, 6%). The overall VE estimate for patients who received 2014/15 vaccination only was -12% (-57%, 20%), while VE for patients who received both 2013/14 and 2014/15 vaccinations was -27% (-72%, 7%). There was no evidence that the influenza vaccine protected vaccinees against medically attended influenza in Beijing, China during the 2014/15 season.
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Affiliation(s)
- Chunna Ma
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Yang Pan
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China.,c School of Public Health, Capital Medical University , Beijing , China
| | - Li Zhang
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Yi Zhang
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Shuangsheng Wu
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Ying Sun
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Wei Duan
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Man Zhang
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Quanyi Wang
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China
| | - Peng Yang
- a Beijing Center for Disease Prevention and Control , Beijing , China.,b Beijing Research Center for Preventive Medicine , Beijing , China.,c School of Public Health, Capital Medical University , Beijing , China
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21
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Summary of the NACI literature review on the comparative effectiveness of subunit and split virus inactivated influenza vaccines in older adults. ACTA ACUST UNITED AC 2018; 44:129-133. [PMID: 31015805 DOI: 10.14745/ccdr.v44i06a02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Subunit and split virus inactivated influenza vaccines (IIV) are two commonly used types of seasonal influenza vaccines in Canada. The comparative effectiveness of these two formulations is particularly relevant for older adults, as older adults have reduced influenza vaccine effectiveness and experience more severe influenza than younger adults. Objective To compare the vaccine effectiveness and immunogenicity of unadjuvanted, standard-dose subunit IIVs versus unadjuvanted, standard-dose split virus IIVs in adults 65 years of age and older. Methods An a priori written protocol based on rapid review methods was developed that included studies published in 2007 or later in the EMBASE, MEDLINE and ClinicalTrials.gov databases with terms used in the objective. Due to the small number of records returned, hand searches of reference lists were completed, the publication date limit was removed, three additional databases (the Cochrane Central Register of Controlled Trials, Scopus and Web of Science) were searched, and studies including adults 60 years of age and older were included. Data from included studies were extracted into evidence tables and quality assessments were completed. The results were synthesized narratively. Results Eight eligible studies were identified. In the three studies that assessed vaccine effectiveness of subunit and split virus IIVs, there were no statistically significant differences in vaccine effectiveness in adults 65 years of age and older against laboratory-confirmed infection with any influenza virus strain, or against laboratory-confirmed infection with influenza A(H1N1), A(H3N2) or B virus, specifically. In the five studies that assessed immunogenicity, the findings were not consistent and the overall quality of immunogenicity evidence was weak. Conclusion The National Advisory Committee on Immunization (NACI) concludes that there is insufficient evidence to determine significant differences in the vaccine effectiveness or immunogenicity of unadjuvanted, standard-dose subunit and split virus IIVs in adults 65 years of age and older (Grade I evidence).
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22
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Kissling E, Valenciano M, Pozo F, Vilcu AM, Reuss A, Rizzo C, Larrauri A, Horváth JK, Brytting M, Domegan L, Korczyńska M, Meijer A, Machado A, Ivanciuc A, Višekruna Vučina V, van der Werf S, Schweiger B, Bella A, Gherasim A, Ferenczi A, Zakikhany K, O Donnell J, Paradowska-Stankiewicz I, Dijkstra F, Guiomar R, Lazar M, Kurečić Filipović S, Johansen K, Moren A. 2015/16 I-MOVE/I-MOVE+ multicentre case-control study in Europe: Moderate vaccine effectiveness estimates against influenza A(H1N1)pdm09 and low estimates against lineage-mismatched influenza B among children. Influenza Other Respir Viruses 2018; 12:423-437. [PMID: 29125681 PMCID: PMC6005601 DOI: 10.1111/irv.12520] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/31/2022] Open
Abstract
Background During the 2015/16 influenza season in Europe, the cocirculating influenza viruses were A(H1N1)pdm09 and B/Victoria, which was antigenically distinct from the B/Yamagata component in the trivalent influenza vaccine. Methods We used the test‐negative design in a multicentre case‐control study in twelve European countries to measure 2015/16 influenza vaccine effectiveness (VE) against medically attended influenza‐like illness (ILI) laboratory‐confirmed as influenza. General practitioners swabbed a systematic sample of consulting ILI patients and a random sample of influenza‐positive swabs was sequenced. We calculated adjusted VE against influenza A(H1N1)pdm09, A(H1N1)pdm09 genetic group 6B.1 and influenza B overall and by age group. Results We included 11 430 ILI patients, of which 2272 were influenza A(H1N1)pdm09 and 2901 were influenza B cases. Overall VE against influenza A(H1N1)pdm09 was 32.9% (95% CI: 15.5‐46.7). Among those aged 0‐14, 15‐64 and ≥65 years, VE against A(H1N1)pdm09 was 31.9% (95% CI: −32.3 to 65.0), 41.4% (95% CI: 20.5‐56.7) and 13.2% (95% CI: −38.0 to 45.3), respectively. Overall VE against influenza A(H1N1)pdm09 genetic group 6B.1 was 32.8% (95% CI: −4.1 to 56.7). Among those aged 0‐14, 15‐64 and ≥65 years, VE against influenza B was −47.6% (95% CI: −124.9 to 3.1), 27.3% (95% CI: −4.6 to 49.4) and 9.3% (95% CI: −44.1 to 42.9), respectively. Conclusions Vaccine effectiveness (VE) against influenza A(H1N1)pdm09 and its genetic group 6B.1 was moderate in children and adults, and low among individuals ≥65 years. Vaccine effectiveness (VE) against influenza B was low and heterogeneous among age groups. More information on effects of previous vaccination and previous infection is needed to understand the VE results against influenza B in the context of a mismatched vaccine.
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Affiliation(s)
| | | | - Francisco Pozo
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana-Maria Vilcu
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Annicka Reuss
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Caterina Rizzo
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Amparo Larrauri
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Mia Brytting
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Lisa Domegan
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Monika Korczyńska
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Adam Meijer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ausenda Machado
- Instituto Nacional de Saúde, Dr Ricardo Jorge, Lisbon, Portugal
| | - Alina Ivanciuc
- Development for Microbiology and Immunology, Cantacuzino Institute, National Institute of Research, Bucharest, Romania
| | | | | | - Brunhilde Schweiger
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Antonino Bella
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Alin Gherasim
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Joan O Donnell
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Frederika Dijkstra
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Raquel Guiomar
- Instituto Nacional de Saúde, Dr Ricardo Jorge, Lisbon, Portugal
| | - Mihaela Lazar
- Development for Microbiology and Immunology, Cantacuzino Institute, National Institute of Research, Bucharest, Romania
| | | | - Kari Johansen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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23
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Foppa IM, Ferdinands JM, Chaves SS, Haber MJ, Reynolds SB, Flannery B, Fry AM. The case test-negative design for studies of the effectiveness of influenza vaccine in inpatient settings. Int J Epidemiol 2018; 45:2052-2059. [PMID: 26979985 PMCID: PMC5025336 DOI: 10.1093/ije/dyw022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 01/11/2023] Open
Abstract
Background: The test-negative design (TND) to evaluate influenza vaccine effectiveness is based on patients seeking care for acute respiratory infection, with those who test positive for influenza as cases and the test-negatives serving as controls. This design has not been validated for the inpatient setting where selection bias might be different from an outpatient setting. Methods: We derived mathematical expressions for vaccine effectiveness (VE) against laboratory-confirmed influenza hospitalizations and used numerical simulations to verify theoretical results exploring expected biases under various scenarios. We explored meaningful interpretations of VE estimates from inpatient TND studies. Results: VE estimates from inpatient TND studies capture the vaccine-mediated protection of the source population against laboratory-confirmed influenza hospitalizations. If vaccination does not modify disease severity, these estimates are equivalent to VE against influenza virus infection. If chronic cardiopulmonary individuals are enrolled because of non-infectious exacerbation, biased VE estimates (too high) will result. If chronic cardiopulmonary disease status is adjusted for accurately, the VE estimates will be unbiased. If chronic cardiopulmonary illness cannot be adequately be characterized, excluding these individuals may provide unbiased VE estimates. Conclusions: The inpatient TND offers logistic advantages and can provide valid estimates of influenza VE. If highly vaccinated patients with respiratory exacerbation of chronic cardiopulmonary conditions are eligible for study inclusion, biased VE estimates will result unless this group is well characterized and the analysis can adequately adjust for it. Otherwise, such groups of subjects should be excluded from the analysis.
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Affiliation(s)
- Ivo M Foppa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael J Haber
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sue B Reynolds
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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24
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The impact of selection bias on vaccine effectiveness estimates from test-negative studies. Vaccine 2018; 36:751-757. [DOI: 10.1016/j.vaccine.2017.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 11/23/2022]
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25
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Estimating vaccine effectiveness against laboratory-confirmed influenza among children and adolescents in Lower Saxony and Saxony-Anhalt, 2012–2016. Epidemiol Infect 2017; 146:78-88. [DOI: 10.1017/s0950268817002709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYInfluenza vaccine effectiveness (VE) has to be estimated anew for every season to explore vaccines’ protective effect in the population. We report VE estimates against laboratory-confirmed influenza A(H1N1)pdm09, A(H3N2) and influenza B among children aged 2–17 years, using test-negative design. Pooled data from two German federal states’ surveillance systems for acute respiratory illness from week 40/2012 to 20/2016 was used, yielding a total of 10 627 specimens. Odds ratios and 95% confidence intervals (95% CIs) for the association between laboratory-confirmed influenza and vaccination status were calculated by multivariate logistic regression adjusting for age, sex, illness onset and federal state. VE was estimated as 1-Odds Ratio. Overall adjusted VE was 33% (95% CI: 24·3–40·7). A strong variation of VE between the seasons and subtypes was observed: highest season- and subtype-specific VE of 86·2% (95% CI: 41·3–96·7) was found against A(H1N1)pdm09 in 7–17-year-olds in 2015/16. Low estimates of VE were observed against A(H3N2) in any season, e.g. 1·5% (95% CI: −39·3–30·3) in 2014/15. Estimates showed a tendency to higher VE among 7–17-year-old children, but differences were not statistically significant. Although our findings are common in studies estimating influenza VE, we discussed several explanations for observed low VE.
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26
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Buchan SA, Chung H, Campitelli MA, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson D, Richardson SE, Rosella LC, Simor A, Smieja M, Tran D, Zahariadis G, Kwong JC. Vaccine effectiveness against laboratory-confirmed influenza hospitalizations among young children during the 2010-11 to 2013-14 influenza seasons in Ontario, Canada. PLoS One 2017; 12:e0187834. [PMID: 29149183 PMCID: PMC5693284 DOI: 10.1371/journal.pone.0187834] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Uncertainty remains regarding the magnitude of effectiveness of influenza vaccines for preventing serious outcomes, especially among young children. We estimated vaccine effectiveness (VE) against laboratory-confirmed influenza hospitalizations among children aged 6-59 months. We used the test-negative design in hospitalized children in Ontario, Canada during the 2010-11 to 2013-14 influenza seasons. We used logistic regression models adjusted for age, season, and time within season to calculate VE estimates by vaccination status (full vs. partial), age group, and influenza season. We also assessed VE incorporating prior history of influenza vaccination. We included specimens from 9,982 patient hospitalization episodes over four seasons, with 12.8% testing positive for influenza. We observed variation in VE by vaccination status, age group, and influenza season. For the four seasons combined, VE was 60% (95%CI, 44%-72%) for full vaccination and 39% (95%CI, 17%-56%) for partial vaccination. VE for full vaccination was 67% (95%CI, 48%-79%) for children aged 24-59 months, 48% (95%CI, 12%-69%) for children aged 6-23 months, 77% (95%CI, 47%-90%) for 2010-11, 59% (95%CI, 13%-81%) for 2011-12, 33% (95%CI, -18% to 62%) for 2012-13, and 72% (95%CI, 42%-86%) for 2013-14. VE in children aged 24-59 months appeared similar between those vaccinated in both the current and previous seasons and those vaccinated in the current season only, with the exception of 2012-13, when VE was lower for those vaccinated in the current season only. Influenza vaccination is effective in preventing pediatric laboratory-confirmed influenza hospitalizations during most seasons.
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Affiliation(s)
- Sarah A. Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Chung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Natasha S. Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B. Gubbay
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
| | - Allison J. McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | | | | | - Susan E. Richardson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Andrew Simor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Dat Tran
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - George Zahariadis
- London Health Sciences Centre, London, Ontario, Canada
- Newfoundland & Labrador Public Health Laboratory, St. John’s, Newfoundland & Labrador, Canada
| | - Jeffrey C. Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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27
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Ainslie KEC, Shi M, Haber M, Orenstein WA. On the bias of estimates of influenza vaccine effectiveness from test-negative studies. Vaccine 2017; 35:7297-7301. [PMID: 29146382 DOI: 10.1016/j.vaccine.2017.10.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 12/22/2022]
Abstract
Estimates of the effectiveness of influenza vaccines are commonly obtained from a test-negative design (TND) study, where cases and controls are patients seeking care for an acute respiratory illness who test positive and negative, respectively, for influenza infection. Vaccine effectiveness (VE) estimates from TND studies are usually interpreted as vaccine effectiveness against medically-attended influenza (MAI). However, it is also important to estimate VE against any influenza illness (symptomatic influenza (SI)) as individuals with SI are still a public health burden even if they do not seek medical care. We present a numerical method to evaluate the bias of TND-based estimates of influenza VE with respect to MAI and SI. We consider two sources of bias: (a) confounding bias due to a (possibly unobserved) covariate that is associated with both vaccination and the probability of the outcome of interest and (b) bias resulting from the effect of vaccination on the probability of seeking care. Our results indicate that (a) VE estimates may suffer from substantial confounding bias when a confounder has a different effect on the probabilities of influenza and non-influenza ARI, and (b) when vaccination reduces the probability of seeking care against influenza ARI, then estimates of VE against MAI may be unbiased while estimates of VE against SI may be have a substantial positive bias.
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Affiliation(s)
- Kylie E C Ainslie
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Meng Shi
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Michael Haber
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA.
| | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 1462 Clifton Rd., Atlanta, GA 30322, USA
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28
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Kissling E, Rondy M. Early 2016/17 vaccine effectiveness estimates against influenza A(H3N2): I-MOVE multicentre case control studies at primary care and hospital levels in Europe. ACTA ACUST UNITED AC 2017; 22:30464. [PMID: 28230524 PMCID: PMC5322188 DOI: 10.2807/1560-7917.es.2017.22.7.30464] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Abstract
We measured early 2016/17 season influenza vaccine effectiveness (IVE) against influenza A(H3N2) in Europe using multicentre case control studies at primary care and hospital levels. IVE at primary care level was 44.1%, 46.9% and 23.4% among 0–14, 15–64 and ≥ 65 year-olds, and 25.7% in the influenza vaccination target group. At hospital level, IVE was 2.5%, 7.9% and 2.4% among ≥ 65, 65–79 and ≥ 80 year-olds. As in previous seasons, we observed suboptimal IVE against influenza A(H3N2).
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Affiliation(s)
- Esther Kissling
- EpiConcept, Paris, France.,Both authors have contributed equally to the study and manuscript writing
| | - Marc Rondy
- EpiConcept, Paris, France.,Both authors have contributed equally to the study and manuscript writing
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- The members of I-MOVE/I-MOVE+ study team are listed at the end of the article
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29
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van Doorn E, Darvishian M, Dijkstra F, Donker GA, Overduin P, Meijer A, Hak E. Influenza vaccine effectiveness estimates in the Dutch population from 2003 to 2014: The test-negative design case-control study with different control groups. Vaccine 2017; 35:2831-2839. [PMID: 28412077 PMCID: PMC7126814 DOI: 10.1016/j.vaccine.2017.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
Information about influenza vaccine effectiveness (IVE) is important for vaccine strain selection and immunization policy decisions. The test-negative design (TND) case-control study is commonly used to obtain IVE estimates. However, the definition of the control patients may influence IVE estimates. We have conducted a TND study using the Dutch Sentinel Practices of NIVEL Primary Care Database which includes data from patients who consulted the General Practitioner (GP) for an episode of acute influenza-like illness (ILI) or acute respiratory infection (ARI) with known influenza vaccination status. Cases were patients tested positive for influenza virus. Controls were grouped into those who tested (1) negative for influenza virus (all influenza negative), (2) negative for influenza virus, but positive for respiratory syncytial virus, rhinovirus or enterovirus (non-influenza virus positive), and (3) negative for these four viruses (pan-negative). We estimated the IVE over all epidemic seasons from 2003/2004 through 2013/2014, pooled IVE for influenza vaccine partial/full matched and mismatched seasons and the individual seasons using generalized linear mixed-effect and multiple logistic regression models. The overall IVE adjusted for age, GP ILI/ARI diagnosis, chronic disease and respiratory allergy was 35% (95% CI: 15-48), 64% (95% CI: 49-75) and 21% (95% CI: -1 to 39) for all influenza negative, non-influenza virus positive and pan-negative controls, respectively. In both the main and subgroup analyses IVE estimates were the highest using non-influenza virus positive controls, likely due to limiting inclusion of controls without laboratory-confirmation of a virus causing the respiratory disease.
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Affiliation(s)
- Eva van Doorn
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Maryam Darvishian
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederika Dijkstra
- Infectious Disease Epidemiology and Surveillance, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gé A Donker
- Sentinel Practices, NIVEL Primary Care Database, Utrecht, The Netherlands
| | - Pieter Overduin
- Infectious Disease Research, Diagnostics and Screening, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Adam Meijer
- Infectious Disease Research, Diagnostics and Screening, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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30
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Weidemann F, Remschmidt C, Buda S, Buchholz U, Ultsch B, Wichmann O. Is the impact of childhood influenza vaccination less than expected: a transmission modelling study. BMC Infect Dis 2017; 17:258. [PMID: 28399801 PMCID: PMC5387286 DOI: 10.1186/s12879-017-2344-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reduce the burden of severe influenza, most industrialized countries target specific risk-groups with influenza vaccines, e.g. the elderly or individuals with comorbidities. Since children are the main spreaders, some countries have recently implemented childhood vaccination programs to reduce overall virus transmission and thereby influenza disease in the whole population. The introduction of childhood vaccination programs was often supported by modelling studies that predicted substantial incidence reductions. We developed a mathematical transmission model to examine the potential impact of childhood influenza vaccination in Germany, while also challenging established modelling assumptions. METHODS We developed an age-stratified SEIR-type transmission model to reproduce the epidemic influenza seasons between 2003/04 and 2013/14. The model was built upon German population counts, contact patterns, and vaccination history and was fitted to seasonal data on influenza-attributable medically attended acute respiratory infections (I-MAARI) and strain distribution using Bayesian methods. As novelties we (i) implemented a stratified model structure enabling seasonal variability and (ii) deviated from the commonly assumed mass-action-principle by employing a phenomenological transmission rate. RESULTS According to the model, by vaccinating primarily the elderly over ten seasons 4 million (95% prediction interval: 3.84 - 4.19) I-MAARI were prevented which corresponds to an 8.6% (8.3% - 8.9%) reduction compared to a no-vaccination scenario and a number-needed-to-vaccinate (NNV) to prevent one I-MAARI of 37.1 (35.5 - 38.7). Additional vaccination of 2-10 year-old children at 40% coverage would have led to an overall I-MAARI reduction of 17.8% (17.1 - 18.7%) mostly due to indirect effects with a NNV of 20.7 (19.6 - 21.6). When employing the traditional mass-action-principle, the model predicted a more than 3-fold higher I-MAARI reduction (55.6%) due to childhood vaccination. CONCLUSION In Germany, the introduction of routine childhood influenza vaccination could considerably reduce I-MAARI among all age-groups and improve the NNV. However, the predicted impact is much lower compared to previous studies, which is primarily caused by our phenomenological approach to modelling influenza virus transmission.
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Affiliation(s)
- Felix Weidemann
- Immunization Unit, Robert Koch-Institute, Seestr. 10, 13359, Berlin, Germany
| | | | - Silke Buda
- Respiratory Disease Unit, Robert Koch-Institute, Seestr. 10, 13359, Berlin, Germany
| | - Udo Buchholz
- Respiratory Disease Unit, Robert Koch-Institute, Seestr. 10, 13359, Berlin, Germany
| | - Bernhard Ultsch
- Immunization Unit, Robert Koch-Institute, Seestr. 10, 13359, Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Seestr. 10, 13359, Berlin, Germany.
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31
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Leung VK, Cowling BJ, Feng S, Sullivan SG. Concordance of interim and final estimates of influenza vaccine effectiveness: a systematic review. ACTA ACUST UNITED AC 2017; 21:30202. [PMID: 27124573 DOI: 10.2807/1560-7917.es.2016.21.16.30202] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/25/2016] [Indexed: 11/20/2022]
Abstract
The World Health Organization's Global Influenza Surveillance and Response System meets twice a year to generate a recommendation for the composition of the seasonal influenza vaccine. Interim vaccine effectiveness (VE) estimates provide a preliminary indication of influenza vaccine performance during the season and may be useful for decision making. We reviewed 17 pairs of studies reporting 33 pairs of interim and final estimates using the test-negative design to evaluate whether interim estimates can reliably predict final estimates. We examined features of the study design that may be correlated with interim estimates being substantially different from their final estimates and identified differences related to change in study period and concomitant changes in sample size, proportion vaccinated and proportion of cases. An absolute difference of no more than 10% between interim and final estimates was found for 18 of 33 reported pairs of estimates, including six of 12 pairs reporting VE against any influenza, six of 10 for influenza A(H1N1)pdm09, four of seven for influenza A(H3N2) and two of four for influenza B. While we identified inconsistencies in the methods, the similarities between interim and final estimates support the utility of generating and disseminating preliminary estimates of VE while virus circulation is ongoing.
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Affiliation(s)
- Vivian K Leung
- World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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32
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Kissling E, Nunes B, Robertson C, Valenciano M, Reuss A, Larrauri A, Cohen JM, Oroszi B, Rizzo C, Machado A, Pitigoi D, Domegan L, Paradowska-Stankiewicz I, Buchholz U, Gherasim A, Daviaud I, Horváth JK, Bella A, Lupulescu E, O Donnell J, Korczyńska M, Moren A. I-MOVE multicentre case-control study 2010/11 to 2014/15: Is there within-season waning of influenza type/subtype vaccine effectiveness with increasing time since vaccination? ACTA ACUST UNITED AC 2017; 21:30201. [PMID: 27124420 DOI: 10.2807/1560-7917.es.2016.21.16.30201] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Abstract
Since the 2008/9 influenza season, the I-MOVE multicentre case-control study measures influenza vaccine effectiveness (VE) against medically-attended influenza-like-illness (ILI) laboratory confirmed as influenza. In 2011/12, European studies reported a decline in VE against influenza A(H3N2) within the season. Using combined I-MOVE data from 2010/11 to 2014/15 we studied the effects of time since vaccination on influenza type/subtype-specific VE. We modelled influenza type/subtype-specific VE by time since vaccination using a restricted cubic spline, controlling for potential confounders (age, sex, time of onset, chronic conditions). Over 10,000 ILI cases were included in each analysis of influenza A(H3N2), A(H1N1)pdm09 and B; with 4,759, 3,152 and 3,617 influenza positive cases respectively. VE against influenza A(H3N2) reached 50.6% (95% CI: 30.0-65.1) 38 days after vaccination, declined to 0% (95% CI: -18.1-15.2) from 111 days onwards. At day 54 VE against influenza A(H1N1)pdm09 reached 55.3% (95% CI: 37.9-67.9) and remained between this value and 50.3% (95% CI: 34.8-62.1) until season end. VE against influenza B declined from 70.7% (95% CI: 51.3-82.4) 44 days after vaccination to 21.4% (95% CI: -57.4-60.8) at season end. To assess if vaccination campaign strategies need revising more evidence on VE by time since vaccination is urgently needed.
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33
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Darvishian M, van den Heuvel ER, Bissielo A, Castilla J, Cohen C, Englund H, Gefenaite G, Huang WT, la Bastide-van Gemert S, Martinez-Baz I, McAnerney JM, Ntshoe GM, Suzuki M, Turner N, Hak E. Effectiveness of seasonal influenza vaccination in community-dwelling elderly people: an individual participant data meta-analysis of test-negative design case-control studies. THE LANCET RESPIRATORY MEDICINE 2017; 5:200-211. [PMID: 28189522 DOI: 10.1016/s2213-2600(17)30043-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Several aggregate data meta-analyses have provided estimates of the effectiveness of influenza vaccination in community-dwelling elderly people. However, these studies ignored the effects of patient-level confounders such as sex, age, and chronic diseases that could bias effectiveness estimates. We aimed to assess the confounder-adjusted effectiveness of influenza vaccines on laboratory-confirmed influenza among elderly people by conducting a global individual participant data meta-analysis. METHODS In this individual participant data meta-analysis, we considered studies included in a previously conducted aggregate data meta-analysis that included test-negative design case-control studies published up to July 13, 2014. We contacted all authors of the included studies on Dec 1, 2014, to request individual participant data. Patients were excluded if their unique identifier was missing, their vaccination status was unknown, their outcome status was unknown, or they had had suspected influenza infection more than once in the same influenza season. Cases were patients with influenza-like illness symptoms who tested positive for at least one of A H1N1, A H1N1 pdm09, A H3N2, or B viruses; controls were patients with influenza-like illness symptoms who tested negative for these virus types or subtypes. Influenza vaccine effectiveness against overall and subtype-specific laboratory-confirmed influenza were the primary and secondary outcomes. We used a generalised linear mixed model to calculate adjusted vaccine effectiveness according to vaccine match to the circulating strains of influenza virus and intensity of the virus activity (epidemic or non-epidemic). Vaccine effectiveness was defined as the relative reduction in risk of laboratory-confirmed influenza in vaccinated patients compared with unvaccinated patients. We did subgroup analyses to estimate vaccine effectiveness according to hemisphere, age category, and health status. FINDINGS We received 23 of the 53 datasets included in the aggregate data meta-analysis. Furthermore, six additional datasets were provided by data collaborators, which resulted in individual participant data for a total of 5210 participants. A total of 4975 patients had the required data for analysis. Of these, 3146 (63%) were controls and 1829 (37%) were cases. Influenza vaccination was significantly effective during epidemic seasons irrespective of vaccine match status (matched adjusted vaccine effectiveness 44·38%, 95% CI 22·63-60·01; mismatched adjusted vaccine effectiveness 20·00%, 95% CI 3·46-33·68; analyses in the imputed dataset). Seasonal influenza vaccination did not show significant effectiveness during non-epidemic seasons. We found substantial variation in vaccine effectiveness across virus types and subtypes, with the highest estimate for A H1N1 pdm09 (53·19%, 10·25-75·58) and the lowest estimate for B virus types (-1·52%, -39·58 to 26·16). Although we observed no significant differences between subgroups in each category (hemisphere, age, and health status), influenza vaccination showed a protective effect among elderly people with cardiovascular disease, lung disease, or aged 75 years and younger. INTERPRETATION Influenza vaccination is moderately effective against laboratory-confirmed influenza in elderly people during epidemic seasons. More research is needed to investigate factors affecting vaccine protection (eg, brand-specific or type-specific vaccine effectiveness and repeated annual vaccination) in elderly people. FUNDING University Medical Center Groningen.
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Affiliation(s)
- Maryam Darvishian
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Unit of Pharmacoepidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands; British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | | | - Ange Bissielo
- Institute of Environmental Science and Research, Wallaceville, New Zealand
| | - Jesus Castilla
- Instituto de Salud Pública, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helene Englund
- Unit for Vaccination Programs, Department of Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Sacha la Bastide-van Gemert
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Iván Martinez-Baz
- Instituto de Salud Pública, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Johanna M McAnerney
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Genevie M Ntshoe
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Japan
| | - Nikki Turner
- Department of General Practice and Primary Care, University of Auckland, New Zealand
| | - Eelko Hak
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Unit of Pharmacoepidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands
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Saito N, Komori K, Suzuki M, Morimoto K, Kishikawa T, Yasaka T, Ariyoshi K. Negative impact of prior influenza vaccination on current influenza vaccination among people infected and not infected in prior season: A test-negative case-control study in Japan. Vaccine 2016; 35:687-693. [PMID: 28043738 DOI: 10.1016/j.vaccine.2016.11.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accumulating evidences indicate that repeated influenza vaccination has negative impact on the vaccine effectiveness (VE). However no published studies considered past influenza infection when assessing the VE of repeated vaccination. METHODS Prospective surveillance was conducted from 2009 to 2012 at a community hospital on a small island in Japan. The study included all outpatients with an influenza-like illness (ILI) who attended the hospital, and a rapid diagnostic test (RDT) was used to diagnose influenza A/B infection. The VE of trivalent inactivated influenza vaccine (TIV) against medically attended influenza A (MA-fluA) was estimated using a test-negative case-control study design. The influence of TIV in the prior season on VE in the current season was investigated in the context of MA-fluA during the prior season. RESULTS During the three influenza seasons, 5838 ILI episodes (4127 subjects) were analysed. Subjects who had an episode of MA-fluA in the prior season were at a significantly lower risk of MA-fluA in the current season (adjusted odds ratio: 0.38, 95% CI: 0.30-0.50). The overall adjusted VE was 28% (95% CI, 14-40). VE was substantially lower in subjects vaccinated in the prior season compared to those who had not been vaccinated in prior season (19%; 95% CI: 0-35 vs 46%; 95% CI: 26-60, test for interaction, P value <0.05). In subjects who did not have MA-fluA in the prior season showed the attenuation of VE due to repeated vaccination (13%; 95% CI: -7 to 30 vs 44%; 95% CI: 24-59, test for interaction, P<0.05). However this effect was not detected in subjects who had contracted MA-fluA in the prior season. CONCLUSIONS Negative effects of repeated vaccination were significant among those without history of MA-fluA in the prior season.
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Affiliation(s)
- Nobuo Saito
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan
| | - Kounosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan
| | | | | | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Leval A, Hergens MP, Persson K, Örtqvist Å. Real-time real-world analysis of seasonal influenza vaccine effectiveness: method development and assessment of a population-based cohort in Stockholm County, Sweden, seasons 2011/12 to 2014/15. ACTA ACUST UNITED AC 2016; 21:30381. [PMID: 27813473 PMCID: PMC5114721 DOI: 10.2807/1560-7917.es.2016.21.43.30381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
Real-world estimates of seasonal influenza vaccine effectiveness (VE) are important for early detection of vaccine failure. We developed a method for evaluating real-time in-season vaccine effectiveness (IVE) and overall seasonal VE. In a retrospective, register-based, cohort study including all two million individuals in Stockholm County, Sweden, during the influenza seasons from 2011/12 to 2014/15, vaccination status was obtained from Stockholm’s vaccine register. Main outcomes were hospitalisation or primary care visits for influenza (International Classification of Disease (ICD)-10 codes J09-J11). VE was assessed using Cox multivariate stratified and non-stratified analyses adjusting for age, sex, socioeconomic status, comorbidities and previous influenza vaccinations. Stratified analyses showed moderate VE in prevention of influenza hospitalisations among chronically ill adults ≥ 65 years in two of four seasons, and lower but still significant VE in one season; 53% (95% confidence interval (CI): 33–67) in 2012/13, 55% (95% CI: 25–73) in 2013/14 and 18% (95% CI: 3–31) in 2014/15. In conclusion, seasonal influenza vaccination was associated with substantial reductions in influenza-specific hospitalisation, particularly in adults ≥ 65 years with underlying chronic conditions. With the use of population-based patient register data on influenza-specific outcomes it will be possible to obtain real-time estimates of seasonal influenza VE.
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Affiliation(s)
- Amy Leval
- Department of Communicable Disease Control and Prevention for Stockholm County, Stockholm, Sweden
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36
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Broberg E, Hungnes O, Schweiger B, Prosenc K, Daniels R, Guiomar R, Ikonen N, Kossyvakis A, Pozo F, Puzelli S, Thomas I, Waters A, Wiman Å, Meijer A. Improving influenza virological surveillance in Europe: strain-based reporting of antigenic and genetic characterisation data, 11 European countries, influenza season 2013/14. ACTA ACUST UNITED AC 2016; 21:30370. [PMID: 27762211 PMCID: PMC5073191 DOI: 10.2807/1560-7917.es.2016.21.41.30370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/25/2016] [Indexed: 11/20/2022]
Abstract
Influenza antigenic and genetic characterisation data are crucial for influenza vaccine composition decision making. Previously, aggregate data were reported to the European Centre for Disease Prevention and Control by European Union/European Economic Area (EU/EEA) countries. A system for collecting case-specific influenza antigenic and genetic characterisation data was established for the 2013/14 influenza season. In a pilot study, 11 EU/EEA countries reported through the new mechanism. We demonstrated feasibility of reporting strain-based antigenic and genetic data and ca 10% of influenza virus-positive specimens were selected for further characterisation. Proportions of characterised virus (sub)types were similar to influenza virus circulation levels. The main genetic clades were represented by A/StPetersburg/27/2011(H1N1)pdm09 and A/Texas/50/2012(H3N2). A(H1N1)pdm09 viruses were more prevalent in age groups (by years) < 1 (65%; p = 0.0111), 20–39 (50%; p = 0.0046) and 40–64 (55%; p = 0.00001) while A(H3N2) viruses were most prevalent in those ≥ 65 years (62%*; p = 0.0012). Hospitalised patients in the age groups 6–19 years (67%; p = 0.0494) and ≥ 65 years (52%; p = 0.0005) were more frequently infected by A/Texas/50/2012 A(H3N2)-like viruses compared with hospitalised cases in other age groups. Strain-based reporting enabled deeper understanding of influenza virus circulation among hospitalised patients and substantially improved the reporting of virus characterisation data. Therefore, strain-based reporting of readily available data is recommended to all reporting countries within the EU/EEA.
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Affiliation(s)
- Eeva Broberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Spruijt IT, de Lange MMA, Dijkstra F, Donker GA, van der Hoek W. Long-Term Correlation between Influenza Vaccination Coverage and Incidence of Influenza-Like Illness in 14 European Countries. PLoS One 2016; 11:e0163508. [PMID: 27684558 PMCID: PMC5042488 DOI: 10.1371/journal.pone.0163508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/09/2016] [Indexed: 01/26/2023] Open
Abstract
We aimed to examine the long-term correlation between influenza vaccination coverage and the incidence of influenza-like illness (ILI) in the total and elderly populations of European countries for which data was available on at least six consecutive influenza seasons. We graphically visualised vaccination coverage and ILI incidence trends and calculated Spearman rank correlation coefficients. Additionally, we fitted a negative binomial regression model to estimate the change in ILI incidence per percentage point change in vaccination coverage. We found significant negative correlations for the total population of the Netherlands (ρ = -0.60, p-value = 0.003) and for the elderly populations of England (ρ = -0.80, p-value < 0.001) and Germany (ρ = -0.57, p-value = 0.04). However, results were not consistent, and for some countries we observed significant positive correlations. Only for the elderly in England was there a significant decline in incidence rate per percentage point increase in vaccination coverage (incidence rate ratio = 0.93; 95% confidence interval 0.88–0.99). Based on this ecological study it is not possible to provide evidence for a negative correlation between influenza vaccination coverage and ILI incidence. For future, aetiological studies to assess impact of influenza vaccinations on the population, there is a need for high quality data over long periods of time, on proportion of ILI caused by influenza virus infection, on severe outcome measures such as hospitalisation for influenza, and on other factors that potentially affect influenza transmission.
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Affiliation(s)
- Ineke T. Spruijt
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marit M. A. de Lange
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- * E-mail:
| | - Frederika Dijkstra
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gé A. Donker
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Valenciano M, Kissling E, Reuss A, Rizzo C, Gherasim A, Horváth JK, Domegan L, Pitigoi D, Machado A, Paradowska-Stankiewicz IA, Bella A, Larrauri A, Ferenczi A, Lazar M, Pechirra P, Korczyńska MR, Pozo F, Moren A. Vaccine effectiveness in preventing laboratory-confirmed influenza in primary care patients in a season of co-circulation of influenza A(H1N1)pdm09, B and drifted A(H3N2), I-MOVE Multicentre Case-Control Study, Europe 2014/15. ACTA ACUST UNITED AC 2016; 21:pii=30139. [PMID: 26924024 DOI: 10.2807/1560-7917.es.2016.21.7.30139] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/25/2015] [Indexed: 11/20/2022]
Abstract
Influenza A(H3N2), A(H1N1)pdm09 and B viruses co-circulated in Europe in 2014/15. We undertook a multicentre case-control study in eight European countries to measure 2014/15 influenza vaccine effectiveness (VE) against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. General practitioners swabbed all or a systematic sample of ILI patients. We compared the odds of vaccination of ILI influenza positive patients to negative patients. We calculated adjusted VE by influenza type/subtype, and age group. Among 6,579 ILI patients included, 1,828 were A(H3N2), 539 A(H1N1)pdm09 and 1,038 B. VE against A(H3N2) was 14.4% (95% confidence interval (CI): -6.3 to 31.0) overall, 20.7% (95%CI: -22.3 to 48.5), 10.9% (95%CI -30.8 to 39.3) and 15.8% (95% CI: -20.2 to 41.0) among those aged 0-14, 15-59 and ≥60 years, respectively. VE against A(H1N1)pdm09 was 54.2% (95%CI: 31.2 to 69.6) overall, 73.1% (95%CI: 39.6 to 88.1), 59.7% (95%CI: 10.9 to 81.8), and 22.4% (95%CI: -44.4 to 58.4) among those aged 0-14, 15-59 and ≥60 years respectively. VE against B was 48.0% (95%CI: 28.9 to 61.9) overall, 62.1% (95%CI: 14.9 to 83.1), 41.4% (95%CI: 6.2 to 63.4) and 50.4% (95%CI: 14.6 to 71.2) among those aged 0-14, 15-59 and ≥60 years respectively. VE against A(H1N1)pdm09 and B was moderate. The low VE against A(H3N2) is consistent with the reported mismatch between circulating and vaccine strains.
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Li X, Deem MW. Influenza evolution and H3N2 vaccine effectiveness, with application to the 2014/2015 season. Protein Eng Des Sel 2016; 29:309-15. [PMID: 27313229 PMCID: PMC4955871 DOI: 10.1093/protein/gzw017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 01/14/2023] Open
Abstract
Influenza A is a serious disease that causes significant morbidity and mortality, and vaccines against the seasonal influenza disease are of variable effectiveness. In this article, we discuss the use of the pepitope method to predict the dominant influenza strain and the expected vaccine effectiveness in the coming flu season. We illustrate how the effectiveness of the 2014/2015 A/Texas/50/2012 [clade 3C.1] vaccine against the A/California/02/2014 [clade 3C.3a] strain that emerged in the population can be estimated via pepitope In addition, we show by a multidimensional scaling analysis of data collected through 2014, the emergence of a new A/New Mexico/11/2014-like cluster [clade 3C.2a] that is immunologically distinct from the A/California/02/2014-like strains.
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MESH Headings
- Evolution, Molecular
- Hemagglutinin Glycoproteins, Influenza Virus/chemistry
- Hemagglutinin Glycoproteins, Influenza Virus/metabolism
- Humans
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/metabolism
- Influenza A Virus, H3N2 Subtype/physiology
- Influenza Vaccines/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Models, Molecular
- Models, Statistical
- Phylogeny
- Protein Conformation
- Seasons
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Affiliation(s)
- Xi Li
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Michael W Deem
- Department of Bioengineering, Rice University, Houston, TX 77005, USA Department of Physics and Astronomy, Rice University, Houston, TX 77005, USA Center for Theoretical Biological Physics, Rice University, Houston, TX 77005, USA
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Variable influenza vaccine effectiveness by subtype: a systematic review and meta-analysis of test-negative design studies. THE LANCET. INFECTIOUS DISEASES 2016; 16:942-51. [DOI: 10.1016/s1473-3099(16)00129-8] [Citation(s) in RCA: 420] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 02/20/2016] [Accepted: 02/23/2016] [Indexed: 01/04/2023]
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Pujol J, Godoy P, Soldevila N, Castilla J, González-Candelas F, Mayoral JM, Astray J, García S, Martín V, Tamames S, Delgado M, García ÁD. Effect of Occupational Exposure on A(H1N1)pdm09 Infection and Hospitalization. ANNALS OF OCCUPATIONAL HYGIENE 2016; 60:1009-19. [DOI: 10.1093/annhyg/mew044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/15/2016] [Indexed: 12/30/2022]
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Influenza vaccine effectiveness in Italy: Age, subtype-specific and vaccine type estimates 2014/15 season. Vaccine 2016; 34:3102-3108. [DOI: 10.1016/j.vaccine.2016.04.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 11/21/2022]
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Martínez-Baz I, Navascués A, Pozo F, Chamorro J, Albeniz E, Casado I, Reina G, Cenoz MG, Ezpeleta C, Castilla J. Influenza vaccine effectiveness in preventing inpatient and outpatient cases in a season dominated by vaccine-matched influenza B virus. Hum Vaccin Immunother 2016; 11:1626-33. [PMID: 25996366 DOI: 10.1080/21645515.2015.1038002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Studies that have evaluated the influenza vaccine effectiveness (VE) to prevent laboratory-confirmed influenza B cases are uncommon, and few have analyzed the effect in preventing hospitalized cases. We have evaluated the influenza VE in preventing outpatient and hospitalized cases with laboratory-confirmed influenza in the 2012-2013 season, which was dominated by a vaccine-matched influenza B virus. In the population covered by the Navarra Health Service, all hospitalized patients with influenza-like illness (ILI) and all ILI patients attended by a sentinel network of general practitioners were swabbed for influenza testing, and all were included in a test-negative case-control analysis. VE was calculated as (1-odds ratio) × 100. Among 744 patients tested, 382 (51%) were positive for influenza virus: 70% for influenza B, 24% for A(H1N1)pdm09, and 5% for A(H3N2). The overall estimate of VE in preventing laboratory-confirmed influenza was 63% (95% confidence interval (CI): 34 to 79), 55% (1 to 80) in outpatients and 74% (33 to 90) in hospitalized patients. The VE was 70% (41 to 85) against influenza B and 43% (-45 to 78) against influenza A. The VE against virus B was 87% (52 to 96) in hospitalized patients and 56% in outpatients (-5 to 81). Adjusted comparison of vaccination status between inpatient and outpatient cases with influenza B did not show statistically significant differences (odds ratio: 1.13; p = 0.878). These results suggest a high protective effect of the vaccine in the 2012-2013 season, with no differences found for the effect between outpatient and hospitalized cases.
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Abstract
Data were pooled from three Australian sentinel general practice influenza surveillance networks to estimate Australia-wide influenza vaccine coverage and effectiveness against community presentations for laboratory-confirmed influenza for the 2012, 2013 and 2014 seasons. Patients presenting with influenza-like illness at participating GP practices were swabbed and tested for influenza. The vaccination odds of patients testing positive were compared with patients testing negative to estimate influenza vaccine effectiveness (VE) by logistic regression, adjusting for age group, week of presentation and network. Pooling of data across Australia increased the sample size for estimation from a minimum of 684 to 3,683 in 2012, from 314 to 2,042 in 2013 and from 497 to 3,074 in 2014. Overall VE was 38% [95% confidence interval (CI) 24-49] in 2012, 60% (95% CI 45-70) in 2013 and 44% (95% CI 31-55) in 2014. For A(H1N1)pdm09 VE was 54% (95% CI-28 to 83) in 2012, 59% (95% CI 33-74) in 2013 and 55% (95% CI 39-67) in 2014. For A(H3N2), VE was 30% (95% CI 14-44) in 2012, 67% (95% CI 39-82) in 2013 and 26% (95% CI 1-45) in 2014. For influenza B, VE was stable across years at 56% (95% CI 37-70) in 2012, 57% (95% CI 30-73) in 2013 and 54% (95% CI 21-73) in 2014. Overall VE against influenza was low in 2012 and 2014 when A(H3N2) was the dominant strain and the vaccine was poorly matched. In contrast, overall VE was higher in 2013 when A(H1N1)pdm09 dominated and the vaccine was a better match. Pooling data can increase the sample available and enable more precise subtype- and age group-specific estimates, but limitations remain.
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Waning protection of influenza vaccine against mild laboratory confirmed influenza A(H3N2) and B in Spain, season 2014–15. Vaccine 2016; 34:2371-7. [DOI: 10.1016/j.vaccine.2016.03.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/29/2016] [Accepted: 03/14/2016] [Indexed: 11/21/2022]
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Redlberger-Fritz M, Kundi M, Popow-Kraupp T. Detailed Report on 2014/15 Influenza Virus Characteristics, and Estimates on Influenza Virus Vaccine Effectiveness from Austria's Sentinel Physician Surveillance Network. PLoS One 2016; 11:e0149916. [PMID: 26975056 PMCID: PMC4790898 DOI: 10.1371/journal.pone.0149916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is influenced by the antigenic similarity between vaccine- and circulating strains. MATERIAL AND METHODS This paper presents data obtained by the Austrian sentinel surveillance system on the evolution of influenza viruses during the season 2014/15 and its impact on influenza vaccine effectiveness in primary care in Austria as estimated by a test-negative case control design. VE estimates were performed for each influenza virus type/subtype, stratified by underlying diseases and adjusted for age, sex and calendar week of infection. RESULTS Detailed genetic and antigenic analyses showed that circulating A(H3N2) viruses were genetically distinct from the 2014/15 A(H3N2) vaccine component indicating a profound vaccine mismatch. The Influenza A(H1N1)pdm09 viruses were antigenically conserved and matched the respective vaccine component. Influenza B viruses were lineage-matched B/Yamagata viruses with a clade-level variation. Consistent with substantial vaccine mismatch for the A(H3N2) viruses a crude overall VE of only 47% was estimated, whereas the VE estimates for A(H1N1)pdm09 were 84% and for influenza B viruses 70%. Increased VE estimates were obtained after stratification by underlying diseases and adjustment for the covariates sex and age, whereby the adjustment for the calendar week of infection was the covariate exerting the highest influence on adjusted VE estimates. CONCLUSION In summary, VE data obtained in this study underscore the importance to perform VE estimates in the context of detailed characterization of the contributing viruses and also demonstrate that the calendar week of influenza virus infection is the most important confounder of VE estimates.
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Affiliation(s)
| | - Michael Kundi
- Institute of Environmental Health, Center for Public Health, Medical University Vienna, Vienna, Austria
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McGuire A, Drummond M, Keeping S. Childhood and adolescent influenza vaccination in Europe: A review of current policies and recommendations for the future. Expert Rev Vaccines 2016; 15:659-70. [DOI: 10.1586/14760584.2016.1138861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Domínguez A, Godoy P, Torner N. The Effectiveness of Influenza Vaccination in Different Groups. Expert Rev Vaccines 2016; 15:751-64. [PMID: 26775669 DOI: 10.1586/14760584.2016.1142878] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Annual administration of the seasonal influenza vaccine, especially to persons known to be at elevated risk for developing serious complications, is the focus of current efforts to reduce the impact of influenza. The main factors influencing estimated inactivated influenza vaccine efficacy and effectiveness, the results obtained in different population groups, current vaccination strategies and the possible advantages of new vaccines are discussed. The available evidence suggests that influenza vaccines are less effective in the elderly than in young adults, but vaccination is encouraged by public health institutions due to higher mortality and complications. There is no consensus on universal vaccination of children yet economic studies suggest that yearly paediatric vaccination is cost saving. The benefits of herd immunity generated by paediatric vaccination require further study. Newer vaccines should be more and more-broadly protective, stable, easy to manufacture and administer and highly immunogenic across all population groups.
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Affiliation(s)
- Angela Domínguez
- a Department de Salut Pública , Universitat de Barcelona , Barcelona , Spain.,b CIBER Epidemiologia y Salut Pública (CIBERESP) , Madrid , Spain
| | - Pere Godoy
- b CIBER Epidemiologia y Salut Pública (CIBERESP) , Madrid , Spain.,c Agencia de Salut Pública de Catalunya , Generalitat de Catalunya , Barcelona , Spain
| | - Nuria Torner
- a Department de Salut Pública , Universitat de Barcelona , Barcelona , Spain.,b CIBER Epidemiologia y Salut Pública (CIBERESP) , Madrid , Spain.,c Agencia de Salut Pública de Catalunya , Generalitat de Catalunya , Barcelona , Spain
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Castilla J, Navascués A, Fernández-Alonso M, Reina G, Pozo F, Casado I, Guevara M, Martínez-Baz I, Barricarte A, Ezpeleta C. Effectiveness of subunit influenza vaccination in the 2014-2015 season and residual effect of split vaccination in previous seasons. Vaccine 2016; 34:1350-7. [PMID: 26854911 DOI: 10.1016/j.vaccine.2016.01.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/08/2016] [Accepted: 01/26/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Navarra, Spain, subunit vaccine was first used in the 2014-2015 season, whereas trivalent split-virion influenza vaccines had been used in previous seasons. We estimate the effectiveness of the subunit vaccine in the current season and split vaccine in the two previous seasons against laboratory-confirmed influenza in the 2014-2015 season. METHODS Patients with influenza-like illness hospitalized or attended by sentinel general practitioners were swabbed for influenza testing. The previous and current vaccine status of laboratory-confirmed cases was compared to test-negative controls. RESULTS Among 1213 patients tested, 619 (51%) were confirmed for influenza virus: 52% influenza A(H3N2), 46% influenza B, and 2% A(H1N1)pdm09. The overall effectiveness for subunit vaccination in the current season was 19% (95% confidence interval [CI]: -13 to 42), 2% (95%CI: -47 to 35) against influenza A(H3N2) and 32% (95%CI: -4 to 56) against influenza B. The effectiveness against any influenza was 67% (95%CI: 17-87) for 2012-2013 and 2013-2014 vaccination only, 42% (95%CI: -31 to 74) for 2014-2015 vaccination only, and 38% (95%CI: 8-58) for vaccination in the 2012-2013, 2013-2014 and 2014-2015 seasons. The same estimates against influenza A(H3N2) were 47% (95%CI: -60 to 82), -54% (95%CI: -274 to 37) and 28% (95%CI: -17 to 56), and against influenza B were 82% (95%CI: 19-96), 93% (95%CI: 45-99) and 43% (95%CI: 5-66), respectively. CONCLUSION These results suggest a considerable residual protection of split vaccination in previous seasons, low overall effectiveness of current season subunit vaccination, and possible interference between current subunit and previous split vaccines.
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Affiliation(s)
- Jesús Castilla
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Ana Navascués
- Complejo Hospitalario de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Mirian Fernández-Alonso
- Clínica Universidad de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel Reina
- Clínica Universidad de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Francisco Pozo
- Centro Nacional de Microbiología (WHO National Influenza Centre-Madrid), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Aurelio Barricarte
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carmen Ezpeleta
- Complejo Hospitalario de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
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50
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Lane CR, Carville KS, Pierse N, Kelly HA. Seasonal influenza vaccine effectiveness estimates: Development of a parsimonious case test negative model using a causal approach. Vaccine 2016; 34:1070-6. [PMID: 26795366 DOI: 10.1016/j.vaccine.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is increasingly estimated using the case-test negative study design. Cases have a symptom complex consistent with influenza and test positive for influenza, while non-cases have the same symptom complex but test negative. We aimed to determine a parsimonious logistic regression model for this study design when applied to patients in the community. METHODS To determine the minimum covariate set required, we used a previously published systematic review to find covariates and restriction criteria commonly included in case-test negative logistic regression models. Covariates were assessed for inclusion using a directed acyclic graph. We used data from the Victorian Influenza Sentinel Practice Network from 2007 to 2013, excluding the pandemic year of 2009, to test the model. VE was estimated as (1-adjusted OR) * 100%. Changes in model fit from addition of specified covariates were examined. Restriction criteria were examined using change in VE estimate. VE was estimated for each year, all years aggregated, and for influenza type and sub-type. RESULTS Using publicly available software, the directed acyclic graph indicated that covariates specifying age, time within the influenza season, immunocompromising comorbid conditions and year or study site, where applicable, were required for closure. The inclusion of sex was not required. Inclusions and exclusions were validated when testing the variables (when collected) with our data. Restriction by time between onset and swab was supported by the data. VE for all years aggregated was estimated as 53% (95%CI 38, 64). VE was estimated as 42% (95%CI 19, 59) for H3N2, 75% (95%CI 51, 88) for H1N1pdm09 and 63% (95%CI 38, 79) for influenza B. CONCLUSION Theoretical covariates specified by the directed acyclic graph were validated when tested against surveillance data. A parsimonious model using the case test negative design allows regular estimates of VE and aggregated estimates by year.
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Affiliation(s)
- C R Lane
- Epidemiology Unit, Victorian Infectious Disease Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - K S Carville
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - N Pierse
- University of Otago, Wellington, New Zealand.
| | - H A Kelly
- Epidemiology Unit, Victorian Infectious Disease Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
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