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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nham E, Seong H, Hyun H, Yoon JG, Noh JY, Cheong HJ, Kim WJ, Kim E, Choi L, Lee JM, Song JY. Cost-effectiveness of high-dose quadrivalent influenza vaccine versus standard-dose quadrivalent influenza vaccine for older people in a country with high influenza vaccination rate. Hum Vaccin Immunother 2023; 19:2266233. [PMID: 37964587 PMCID: PMC10653759 DOI: 10.1080/21645515.2023.2266233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
The highdose quadrivalent influenza vaccine (QIVHD) has shown improved protection against influenza and its complications in older adults. We aimed to evaluate the costeffectiveness of QIVHD compared with QIVSD among Korean adults aged ≥ 65 years in reducing influenzarelated disease burden. We evaluated the 2016/2017 and 2017/2018 seasons and their average values using a static decision tree model. The difference in efficacy between standard-dose (SD) and high-dose (HD) was calculated based on the results of a clinical trial comparing Fluzone® High-Dose Vaccine and Fluzone® Vaccine in older adults. Incremental cost-effectiveness ratios (ICERs) were assessed from the healthcare system perspective. A discount rate of 4.5% was applied to life-year-gained (LYG) values and utilities. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economic sources of uncertainty. In the analysis of the 2017/2018 season, the QIV-HD strategy generated an excess of 0.00182 life-years (Lys)/person and 0.003953 quality-adjusted life-years (QALYs)/person compared with QIV-SD. The ICER was 6,467.56 United States Dollars (USD)/QALY. In the analysis from the 2016/2017 season, QIV-HD caused a surplus of 0.00117 Lys/person and 0.003272 QALYs/person compared with QIV-SD. ICER was 7,902.46 USD /QALY. From the average data of the 2016/2017 and 2017/2018 seasons, an excess of 0.00147 Lys/person and 0.003561 QALYs/person were generated using QIV-HD compared with QIV-SD, while the ICER was 7,190.44 USD /QALY. From the healthcare system perspective, QIV-HD was a more cost-effective vaccination option in reducing influenza-related disease burden and healthcare costs in Koreans aged ≥ 65 years compared with QIV-SD.
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Affiliation(s)
- Eliel Nham
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Hakjun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
| | - Eugene Kim
- Market Access, Syneos Health Korea, Seoul, Korea
| | - Leejung Choi
- Market Access, Syneos Health Korea, Seoul, Korea
| | | | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- RWE, Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Republic of Korea
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3
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Akhtar Z, Götberg M, Erlinge D, Christiansen EH, Oldroyd KG, Motovska Z, Erglis A, Hlinomaz O, Jakobsen L, Engstrøm T, Jensen LO, Fallesen CO, Jensen SE, Angerås O, Calais F, Kåregren A, Lauermann J, Mokhtari A, Nilsson J, Persson J, Islam AKMM, Rahman A, Malik F, Choudhury S, Collier T, Pocock SJ, Pernow J, MacIntyre CR, Fröbert O. Optimal timing of influenza vaccination among patients with acute myocardial infarction - Findings from the IAMI trial. Vaccine 2023; 41:7159-7165. [PMID: 37925315 DOI: 10.1016/j.vaccine.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Influenza vaccination reduces the risk of adverse cardiovascular events.The IAMI trial randomly assigned 2571 patients with acute myocardial infarction (AMI) to receive influenza vaccine or saline placebo during their index hospital admission. It was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. In this post-hoc exploratory sub-study, we compare the trial outcomes in patients receiving early season vaccination (n = 1188) and late season vaccination (n = 1344).The primary endpoint wasthe composite of all-cause death, myocardial infarction (MI), or stent thrombosis at 12 months. Thecumulative incidence of the primary and key secondary endpoints by randomized treatment and early or late vaccination was estimated using the Kaplan-Meier method. In the early vaccinated group, the primary composite endpoint occurred in 36 participants (6.0%) assigned to influenza vaccine and 49 (8.4%) assigned to placebo (HR 0.69; 95% CI 0.45 to 1.07), compared to 31 participants (4.7%) assigned to influenza vaccine and 42 (6.2%) assigned to placebo (HR 0.74; 95% CI 0.47 to 1.18) in the late vaccinated group (P = 0.848 for interaction on HR scale at 1 year). We observed similar estimates for the key secondary endpoints of all-cause death and CV death. There was no statistically significant difference in vaccine effectiveness against adverse cardiovascular events by timing of vaccination. The effect of vaccination on all-cause death at one year was more pronounced in the group receiving early vaccination (HR 0.50; 95% CI, 0.29 to 0.86) compared late vaccination group (HR 0.75; 35% CI, 0.40 to 1.40) but there was no statistically significant difference between these groups (Interaction P = 0.335). In conclusion,there is insufficient evidence from the trial to establish whether there is a difference in efficacy between early and late vaccinationbut regardless of vaccination timing we strongly recommend influenza vaccination in all patients with cardiovascular diseases.
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Affiliation(s)
- Zubair Akhtar
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia; Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Keith G Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne University Hospital and Masaryk University, Brno, Czech Republic
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Engstrøm
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Oskar Angerås
- Sahlgrenska University Hospital, Gothenburg, Sweden and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Gothenburg, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | | | - Jörg Lauermann
- Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
| | - Arash Mokhtari
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Nilsson
- Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Abu K M M Islam
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Afzalur Rahman
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Fazila Malik
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Sohel Choudhury
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Pernow
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Chandini R MacIntyre
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia; Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden; College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, USA; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Arhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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4
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Rothman E, Olsson O, Christiansen CB, Rööst M, Inghammar M, Karlsson U. Influenza A subtype H3N2 is associated with an increased risk of hospital dissemination - an observational study over six influenza seasons. J Hosp Infect 2023; 139:134-140. [PMID: 37419188 DOI: 10.1016/j.jhin.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Previous studies on hospital-acquired influenza (HAI) have not systematically evaluated the possible impact of different influenza subtypes. HAI has historically been associated with high mortality, but clinical consequences may be less severe in a modern hospital setting. AIMS To identify and quantify HAI for each season, investigate possible associations with varying influenza subtypes, and to determine HAI-associated mortality. METHODS All influenza-PCR-positive adult patients (>18 years old) hospitalized in Skåne County during 2013-2019, were prospectively included in the study. Positive influenza samples were subtyped. Medical records of patients with suspected HAI were examined to confirm a nosocomial origin and to determine 30-day mortality. RESULTS Of 4110 hospitalized patients with a positive influenza PCR, 430 (10.5%) were HAI. Influenza A(H3N2) infections were more often HAI (15.1%) than influenza A(H1N1)pdm09, and influenza B (6.3% and 6.8% respectively, P<0.001). The majority of HAI caused by H3N2 were clustered (73.3 %) and were the cause of all 20 hospital outbreaks consisting of ≥4 affected patients. In contrast, the majority of HAI caused by influenza A(H1N1)pdm09 and influenza B were solitary cases (60% and 63.2%, respectively, P<0.001). Mortality associated with HAI was 9.3% and similar between subtypes. CONCLUSIONS HAI caused by influenza A(H3N2) was associated with an increased risk of hospital dissemination. Our study is relevant for future seasonal influenza infection control preparedness and shows that subtyping of influenza may help to define relevant infection control measures. Mortality in HAI remains substantial in a modern hospital setting.
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Affiliation(s)
- E Rothman
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - O Olsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - C B Christiansen
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden
| | - M Rööst
- Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Clinical Research Centre, Lund University, Malmö, Sweden
| | - M Inghammar
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - U Karlsson
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
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5
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Brestrich G, Angulo FJ, Berger FK, Brösamle C, Hagel S, Leischker A, Lübbert C, Maechler F, Merbecks SS, Minarovic N, Moïsi JC, von Müller L, Reuken PA, Weinke T, Yu H, Mellmann A. Epidemiology of Clostridioides difficile Infections in Germany, 2010-2019: A Review from Four Public Databases. Infect Dis Ther 2023;:1-16. [PMID: 36897556 DOI: 10.1007/s40121-023-00785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is a recognized global threat especially for vulnerable populations. It is of particular concern to healthcare providers as it is found in both hospital and community settings, with severe courses, frequent recurrence, high mortality and substantial financial impact on the healthcare system. The CDI burden in Germany has been described and compared by analysing data from four different public databases. METHODS Data on hospital burden of CDI have been extracted, compared, and discussed from four public databases for the years 2010-2019. Hospital days due to CDI were compared to established vaccine preventable diseases, such as influenza and herpes zoster, and also to CDI hospitalisations in the United States (US). RESULTS All four databases reported comparable incidences and trends. Beginning in 2010, population-based hospitalised CDI incidence increased to a peak of > 137/100,000 in 2013. Then, incidence declined to 81/100,000 in 2019. Hospitalised patients with CDI were predominantly > 50 years of age. The population-based incidence of severe CDI was between 1.4 and 8.4/100,000 per year. Recurrence rates were between 5.9 to 6.5%. More than 1,000 CDI deaths occurred each year, with a peak of 2,666 deaths in 2015. Cumulative CDI patient days (PD) were between 204,596 and 355,466 each year, which exceeded cumulated PD for influenza and herpes zoster in most years, though year-to-year differences were observed. Finally, hospitalized CDI incidence was higher in Germany than in the US, where the disease is well recognized as a public health threat. CONCLUSIONS All four public sources documented a decline in CDI cases since 2013, but the disease burden remains substantial and warrants continued attention as a severe public health challenge.
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6
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O Murchu E, Comber L, Jordan K, Hawkshaw S, Marshall L, O'Neill M, Ryan M, Teljeur C, Carnahan A, Pérez JJ, Robertson AH, Johansen K, Jonge JD, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Harrington P. Systematic review of the efficacy, effectiveness and safety of MF59 ® adjuvanted seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2329. [PMID: 35142401 DOI: 10.1002/rmv.2329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/18/2023]
Abstract
The most effective means of preventing seasonal influenza is through vaccination. In this systematic review, we investigated the efficacy, effectiveness and safety of MF59® adjuvanted trivalent and quadrivalent influenza vaccines to prevent laboratory-confirmed influenza. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials and non-randomised studies of interventions (NRSIs) were eligible for inclusion. The search returned 28,846 records, of which 48 studies on MF59® adjuvanted vaccines met our inclusion criteria. No efficacy trials were identified. In terms of vaccine effectiveness (VE), MF59® adjuvanted trivalent influenza vaccines were effective in preventing laboratory-confirmed influenza in older adults (aged ≥65 years) compared with no vaccination (VE = 45%, 95% confidence interval (CI) 23%-61%, 5 NRSIs across 3 influenza seasons). By subtype, significant effect was found for influenza A(H1N1) (VE = 61%, 95% CI 44%-73%) and B (VE = 29%, 95% CI 5%-46%), but not for A(H3N2). In terms of relative VE, there was no significant difference comparing MF59® adjuvanted trivalent vaccines with either non-adjuvanted trivalent or quadrivalent vaccines. Compared with traditional trivalent influenza vaccines, MF59® adjuvanted trivalent influenza vaccines were associated with a greater number of local adverse events (RR = 1.90, 95% CI 1.50-2.39) and systemic reactions (RR = 1.18, 95% CI 1.02-1.38). In conclusion, MF59® adjuvanted trivalent influenza vaccines were found to be more effective than 'no vaccination'. Based on limited data, there was no significant difference comparing the effectiveness of MF59® adjuvanted vaccines with their non-adjuvanted counterparts.
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Affiliation(s)
- Eamon O Murchu
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura Comber
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | | | - Jaime Jesús Pérez
- General Directorate of Public Health and Addictions, IMIB-Arrixaca. Murcia University, Region of Murcia, Spain
| | - Anna Hayman Robertson
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jorgen de Jonge
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- Pediatric Research Laboratory, School of Health Sciences, Faculty of Nursing National and Kapodistrian University of Athens, Athens, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Marta Soler-Soneira
- Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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Wang F, Wan Z, Wu J, Wang Y, Fu H, Shao H, Qian K, Gao W, Ye J, Qin A. A Cross-Reactive Monoclonal Antibody Against Neuraminidases of Both H9N2 and H3N2 Influenza Viruses Shows Protection in Mice Challenging Models. Front Microbiol 2021; 12:730449. [PMID: 34646249 PMCID: PMC8503672 DOI: 10.3389/fmicb.2021.730449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Neuraminidases (NAs) of H9N2 avian influenza virus (AIV) and H3N2 human seasonal influenza virus (HSIV) share similar antigenic structures. However, there are few reports on epitopes shared by these two NAs. We previously reported a monoclonal antibody (mAb) 1G8 against the NA of H9N2 AIV with neuraminidase inhibition (NI) ability. In this study, 1G8 was shown to cross-react with and inhibit the NA of H3N2 HSIV. In a passive transfer experiment, 1G8 provided protection to mice challenged with rescued H1N2 viruses carrying H9N2 NA or H3N2 NA. Mutation at amino acid position 199 was also selected and proved to be crucial for H3N2 HSIV to escape from mAb 1G8. Moreover, we found that residue 199 contributed to inducing broad protective antibodies without the influence of the N-linked glycosylation at amino acid position 200 in NAs. Residues as residue 199, which are not shielded by glycosylation modification, would form ideal epitopes for developing universal vaccine and protective antibodies.
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Affiliation(s)
- Fei Wang
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
| | - Zhimin Wan
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, Yangzhou University, Yangzhou, China
| | - Jinsen Wu
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
| | - Yajuan Wang
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
| | - Hui Fu
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China
| | - Hongxia Shao
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, Yangzhou University, Yangzhou, China
| | - Kun Qian
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, Yangzhou University, Yangzhou, China
| | - Wei Gao
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, Yangzhou University, Yangzhou, China
| | - Jianqiang Ye
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, Yangzhou University, Yangzhou, China
| | - Aijian Qin
- Ministry of Education Key Lab for Avian Preventive Medicine, Yangzhou University, Yangzhou, China.,Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, Yangzhou University, Yangzhou, China
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8
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Feng S, Sullivan SG, Tchetgen Tchetgen EJ, Cowling BJ. The Causal Interpretation of "Overall Vaccine Effectiveness" in Test-Negative Studies. Am J Epidemiol 2021; 190:1993-1999. [PMID: 33831173 DOI: 10.1093/aje/kwab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 11/14/2022] Open
Abstract
Test-negative studies are commonly used to estimate influenza vaccine effectiveness (VE). In a typical study, an "overall VE" estimate based on data from the entire sample may be reported. However, there may be heterogeneity in VE, particularly by age. Therefore, in this article we discuss the potential for a weighted average of age-specific VE estimates to provide a more meaningful measure of overall VE. We illustrate this perspective first using simulations to evaluate how overall VE would be biased when certain age groups are overrepresented. We found that unweighted overall VE estimates tended to be higher than weighted VE estimates when children were overrepresented and lower when elderly persons were overrepresented. Then we extracted published estimates from the US Flu VE network, in which children are overrepresented, and some discrepancy between unweighted and weighted overall VE was observed. Differences in weighted versus unweighted overall VE estimates could translate to substantial differences in the interpretation of individual risk reduction among vaccinated persons and in the total averted disease burden at the population level. Weighting of overall estimates should be considered in VE studies in the future.
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9
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Hollingsworth R, Palmu A, Pepin S, Dupuy M, Shrestha A, Jokinen J, Syrjänen R, Nealon J, Samson S, De Bruijn I. Effectiveness of the quadrivalent high-dose influenza vaccine for prevention of cardiovascular and respiratory events in people aged 65 years and above: Rationale and design of a real-world pragmatic randomized clinical trial. Am Heart J 2021; 237:54-61. [PMID: 33722585 DOI: 10.1016/j.ahj.2021.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Influenza has been an acknowledged cause of respiratory disease for decades. However, considerable related, and often unappreciated, disease burden stems from cardiovascular complications, exacerbations of underlying medical conditions and secondary respiratory complications, with the highest burden in the elderly. This novel study combines the gold standard method of a randomized controlled trial with real-world data collection through national registries, to assess the relative effectiveness of high-dose (QIV-HD) vs standard-dose quadrivalent influenza vaccine (QIV-SD) in preventing cardio-respiratory hospitalizations in a large cohort of adults aged ≥65 years. METHODS AND RESULTS This trial (NCT04137887) is a Phase III/IV, modified double-blinded, randomized, registry-based trial, conducted by the Finnish Institute for Health and Welfare (THL). Participants (n>120 000) are being enrolled over multiple influenza seasons and randomized (1:1) to receive QIV-HD or QIV-SD. Participant follow-up is based on data collection up to 11 months post-vaccination using Finnish national health registries. The primary objective is to demonstrate the relative superior effectiveness of QIV-HD over QIV-SD in preventing cardio-respiratory hospitalizations up to 6 months post-vaccination. Safety will be assessed using automated online tools throughout the study, with causality assessed using statistical and probabilistic methods; serious adverse reactions and adverse events of special interest will be investigated individually. CONCLUSION This large, real-world, randomized study will provide valuable insight into the contribution of influenza in causing severe cardio-respiratory events, and the role of vaccination with QIV-HD in reducing these outcomes compared to the current standard of care. FUNDING Sanofi Pasteur.
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Affiliation(s)
| | - Arto Palmu
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Stephanie Pepin
- Global Clinical Sciences, Sanofi Pasteur, Marcy L'Etoile, France.
| | - Martin Dupuy
- Biostatistics Sciences, Sanofi Pasteur, Marcy L'Etoile, France
| | - Anju Shrestha
- Global Pharmacovigilance, Sanofi Pasteur, Swiftwater, PA
| | - Jukka Jokinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ritva Syrjänen
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Joshua Nealon
- Vaccines Epidemiology and Modelling, Sanofi Pasteur, Lyon, France
| | | | - Iris De Bruijn
- Global Clinical Sciences, Sanofi Pasteur, Marcy L'Etoile, France
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10
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Martin ET, Cheng C, Petrie JG, Alyanak E, Gaglani M, Middleton DB, Ghamande S, Silveira FP, Murthy K, Zimmerman RK, Monto AS, Trabue C, Talbot HK, Ferdinands JM. Low Influenza Vaccine Effectiveness Against A(H3N2)-Associated Hospitalizations in 2016-2017 and 2017-2018 of the Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). J Infect Dis 2021; 223:2062-2071. [PMID: 33140094 DOI: 10.1093/infdis/jiaa685] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/30/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2016-2017 and 2017-2018 influenza seasons were notable for the high number of hospitalizations for influenza A(H3N2) despite vaccine and circulating strain match. METHODS We evaluated vaccine effectiveness (VE) against hospitalization in the test-negative HAIVEN study. Nasal-throat swabs were tested by quantitative reverse transcription polymerase chain reaction (RT-PCR) for influenza and VE was determined based on odds of vaccination by generalized estimating equations. Vaccine-specific antibody was measured in a subset of enrollees. RESULTS A total of 6129 adults were enrolled from 10 hospitals. Adjusted VE against A(H3N2) was 22.8% (95% confidence interval [CI], 8.3% to 35.0%), pooled across both years and 49.4% (95% CI, 34.3% to 61.1%) against B/Yamagata. In 2017-2018, the A(H3N2) VE point estimate for the cell-based vaccine was 43.0% (95% CI, -36.3% to 76.1%; 56 vaccine recipients) compared to 24.0% (95% CI, 3.9% to 39.9%) for egg-based vaccines. Among 643 with serology data, hemagglutinin antibodies against the egg-based A(H3N2) vaccine strain were increased in influenza-negative individuals. CONCLUSIONS Low VE for the A/Hong Kong/4801/2014 vaccine virus in both A(H3N2) seasons emphasizes concerns for continued changes in H3N2 antigenic epitopes, including changes that may impact glycosylation and ultimately reduce VE.
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Affiliation(s)
- Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caroline Cheng
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elif Alyanak
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA
| | | | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA
| | | | | | | | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Christopher Trabue
- Ascension Saint Thomas, Nashville, Tennessee, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Hill EM, Petrou S, Forster H, de Lusignan S, Yonova I, Keeling MJ. Optimising age coverage of seasonal influenza vaccination in England: A mathematical and health economic evaluation. PLoS Comput Biol 2020; 16:e1008278. [PMID: 33021983 PMCID: PMC7567368 DOI: 10.1371/journal.pcbi.1008278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/16/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
For infectious disease prevention, policy-makers are typically required to base policy decisions in light of operational and monetary restrictions, prohibiting implementation of all candidate interventions. To inform the evidence-base underpinning policy decision making, mathematical and health economic modelling can be a valuable constituent. Applied to England, this study aims to identify the optimal target age groups when extending a seasonal influenza vaccination programme of at-risk individuals to those individuals at low risk of developing complications following infection. To perform this analysis, we utilise an age- and strain-structured transmission model that includes immunity propagation mechanisms which link prior season epidemiological outcomes to immunity at the beginning of the following season. Making use of surveillance data from the past decade in conjunction with our dynamic model, we simulate transmission dynamics of seasonal influenza in England from 2012 to 2018. We infer that modified susceptibility due to natural infection in the previous influenza season is the only immunity propagation mechanism to deliver a non-negligible impact on the transmission dynamics. Further, we discerned case ascertainment to be higher for young infants compared to adults under 65 years old, and uncovered a decrease in case ascertainment as age increased from 65 to 85 years of age. Our health economic appraisal sweeps vaccination age space to determine threshold vaccine dose prices achieving cost-effectiveness under differing paired strategies. In particular, we model offering vaccination to all those low-risk individuals younger than a given age (but no younger than two years old) and all low-risk individuals older than a given age, while maintaining vaccination of at-risk individuals of any age. All posited strategies were deemed cost-effective. In general, the addition of low-risk vaccination programmes whose coverage encompassed children and young adults (aged 20 and below) were highly cost-effective. The inclusion of elder age-groups to the low-risk programme typically lessened the cost-effectiveness. Notably, elderly-centric programmes vaccinating from 65-75 years and above had the least permitted expense per vaccine. Vaccination is an established method to provide protection against seasonal influenza and its complications. Yet, a need to administer an updated vaccine on an annual basis presents significant operational challenges and sizeable costs. Consequently, policy makers typically have to decide how to deploy a finite amount of resource in a cost-effective manner. A combination of mathematical and health economic modelling can be used to address such a question. Here, we developed an age- and strain-structured mathematical model for seasonal influenza transmission dynamics that incorporates mechanisms for immunity propagation, which we used to reconstruct transmission dynamics of seasonal influenza in England from 2012 to 2018. We then performed a health economic evaluation assessing the cost-effectiveness of extending a seasonal influenza vaccination programme of at-risk individuals to also include, for targeted age groups, those individuals at low risk of developing complications following infection. The findings suggest the inclusion of low-risk vaccination programmes whose coverage encompassed children and young adults (aged 20 and below) to be highly cost-effective. In contrast, the inclusion of elder age-groups to the low-risk programme typically lessened the cost-effectiveness.
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Affiliation(s)
- Edward M. Hill
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom
- * E-mail:
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, United Kingdom
| | - Henry Forster
- Government Statistics Service, Department of Health and Social Care, Leeds, LS2 7UE, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, United Kingdom
- Royal College of General Practitioners, London, NW1 2FB, United Kingdom
| | - Ivelina Yonova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, United Kingdom
- Royal College of General Practitioners, London, NW1 2FB, United Kingdom
| | - Matt J. Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom
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13
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Reacher M, Warne B, Reeve L, Verlander NQ, Jones NK, Ranellou K, Christou S, Wright C, Choudhry S, Zambon M, Sander C, Zhang H, Jalal H. Influenza-associated mortality in hospital care: a retrospective cohort study of risk factors and impact of oseltamivir in an English teaching hospital, 2016 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31690364 PMCID: PMC6836682 DOI: 10.2807/1560-7917.es.2019.24.44.1900087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Evidence of an oseltamivir treatment effect on influenza A(H3N2) virus infections in hospitalised patients is incomplete. Aims This cohort study aimed to evaluate risk factors for death among PCR-confirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir. Methods Participants included all 332 PCR-confirmed influenza A(H3N2) cases diagnosed between 30 August 2016 and 17 March 2017 in an English university teaching Hospital. Oseltamivir treatment effect on odds of inpatient death was assessed by backward stepwise multivariable logistic regression analysis. Results The odds of death were reduced by two thirds (odds ratio (OR): 0.32; 95% confidence interval (CI): 0.11–0.93), in inpatients treated with a standard course of oseltamivir 75 mg two times daily for 5 days – compared with those untreated with oseltamivir, after adjustment for age, sex, current excess alcohol intake, receipt of 2016/17 seasonal influenza vaccine, serum haemoglobin and hospital vs community attribution of acquisition of influenza. Conclusions Oseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza.
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Affiliation(s)
- Mark Reacher
- Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom.,Public Health England Field Service, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Ben Warne
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Lucy Reeve
- Public Health England Field Service, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Neville Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, National Infection Service - Data and Analytical Sciences, Public Health England, London, United Kingdom
| | - Nicholas K Jones
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kyriaki Ranellou
- Division of Virology, Department of Pathology, University of Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Silvana Christou
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Callum Wright
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Saher Choudhry
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Maria Zambon
- National Infection Service, Public Health England, London, United Kingdom
| | - Clare Sander
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hongyi Zhang
- Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom
| | - Hamid Jalal
- Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom
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14
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Flannery B, Chung JR, Monto AS, Martin ET, Belongia EA, McLean HQ, Gaglani M, Murthy K, Zimmerman RK, Nowalk MP, Jackson ML, Jackson LA, Rolfes MA, Spencer S, Fry AM. Influenza Vaccine Effectiveness in the United States During the 2016-2017 Season. Clin Infect Dis 2020; 68:1798-1806. [PMID: 30204854 DOI: 10.1093/cid/ciy775] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/06/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In recent influenza seasons, the effectiveness of inactivated influenza vaccines against circulating A(H3N2) virus has been lower than against A(H1N1)pdm09 and B viruses, even when circulating viruses remained antigenically similar to vaccine components. METHODS During the 2016-2017 influenza season, vaccine effectiveness (VE) across age groups and vaccine types was examined among outpatients with acute respiratory illness at 5 US sites using a test-negative design that compared the odds of vaccination among reverse transcription polymerase chain reaction-confirmed influenza positives and negatives. RESULTS Among 7083 enrollees, 1342 (19%) tested positive for influenza A(H3N2), 648 (9%) were positive for influenza B (including B/Yamagata, n = 577), and 5040 (71%) were influenza negative. Vaccine effectiveness was 40% (95% confidence interval [CI], 32% to 46%) against any influenza virus, 33% (95% CI, 23% to 41%) against influenza A(H3N2) viruses, and 53% (95% CI, 43% to 61%) against influenza B viruses. CONCLUSIONS The 2016-2017 influenza vaccines provided moderate protection against any influenza among outpatients but were less protective against influenza A(H3N2) viruses than B viruses. Approaches to improving effectiveness against A(H3N2) viruses are needed.
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Affiliation(s)
- Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessie R Chung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor
| | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Temple.,Texas A&M University Health Science Center College of Medicine, Temple
| | | | | | | | | | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Melissa A Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Top KA, Macartney K, Bettinger JA, Tan B, Blyth CC, Marshall HS, Vaudry W, Halperin SA, McIntyre P. Active surveillance of acute paediatric hospitalisations demonstrates the impact of vaccination programmes and informs vaccine policy in Canada and Australia. ACTA ACUST UNITED AC 2020; 25. [PMID: 32613939 PMCID: PMC7331140 DOI: 10.2807/1560-7917.es.2020.25.25.1900562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sentinel surveillance of acute hospitalisations in response to infectious disease emergencies such as the 2009 influenza A(H1N1)pdm09 pandemic is well described, but recognition of its potential to supplement routine public health surveillance and provide scalability for emergency responses has been limited. We summarise the achievements of two national paediatric hospital surveillance networks relevant to vaccine programmes and emerging infectious diseases in Canada (Canadian Immunization Monitoring Program Active; IMPACT from 1991) and Australia (Paediatric Active Enhanced Disease Surveillance; PAEDS from 2007) and discuss opportunities and challenges in applying their model to other contexts. Both networks were established to enhance capacity to measure vaccine preventable disease burden, vaccine programme impact, and safety, with their scope occasionally being increased with emerging infectious diseases’ surveillance. Their active surveillance has increased data accuracy and utility for syndromic conditions (e.g. encephalitis), pathogen-specific diseases (e.g. pertussis, rotavirus, influenza), and adverse events following immunisation (e.g. febrile seizure), enabled correlation of biological specimens with clinical context and supported responses to emerging infections (e.g. pandemic influenza, parechovirus, COVID-19). The demonstrated long-term value of continuous, rather than incident-related, operation of these networks in strengthening routine surveillance, bridging research gaps, and providing scalable public health response, supports their applicability to other countries.
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Affiliation(s)
- Karina A Top
- These authors contributed equally.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Kristine Macartney
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia.,These authors contributed equally
| | - Julie A Bettinger
- University of British Columbia and Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, Canada
| | - Ben Tan
- University of Saskatchewan, Royal University Hospital, Saskatoon, Canada
| | - Christopher C Blyth
- Telethon Kids Institute and School of Medicine, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and VIRTU Women's and Children's Health Network, Adelaide, Australia
| | - Wendy Vaudry
- University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Peter McIntyre
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia
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- The IMPACT and PAEDS investigators are acknowledged at the end of this article
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16
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Redlberger-Fritz M, Kundi M, Popow-Kraupp T. Heterogeneity of Circulating Influenza Viruses and Their Impact on Influenza Virus Vaccine Effectiveness During the Influenza Seasons 2016/17 to 2018/19 in Austria. Front Immunol 2020; 11:434. [PMID: 32256493 PMCID: PMC7092378 DOI: 10.3389/fimmu.2020.00434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
The constantly changing pattern in the dominance of viral strains and their evolving subclades during the seasons substantially influences influenza vaccine effectiveness (IVE). In order to further substantiate the importance of detailed data of genetic virus characterization for IVE estimates during the seasons, we performed influenza virus type and subtype specific IVE estimates. IVE estimates were assessed using a test-negative case-control design, in the context of the intraseasonal changes of the heterogeneous mix of circulating influenza virus strains for three influenza seasons (2016/17 to 2018/19) in Austria. Adjusted overall IVE over the three seasons 2016/17, 2017/18, and 2018/19 were -26, 39, and 63%, respectively. In accordance with the changing pattern of the circulating strains a broad range of overall and subtype specific IVEs was obtained: A(H3N2) specific IVE ranged between -26% for season 2016/17 to 58% in season 2018/19, A(H1N1)pdm09 specific IVE was 25% for the season 2017/18 and 65% for the season 2018/19 and Influenza B specific IVE for season 2017/18 was 45%. The results obtained in our study over the three seasons demonstrate the increasingly complex dynamic of the ever changing genetic pattern of the circulating influenza viruses and their influence on IVE estimates. This emphasizes the importance of detailed genetic virus surveillance for reliable IVE estimates.
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Affiliation(s)
| | - Michael Kundi
- Department of Environmental Health, Medical University Vienna, Vienna, Austria
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17
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Kim YM, Kang S, Lim JS, Kim DH. Influenza Vaccine Effectiveness among Elementary School Students in Korea during the 2016-2017 Seasons: a Cross-Sectional Survey. J Korean Med Sci 2020; 35:e45. [PMID: 32030923 PMCID: PMC7008068 DOI: 10.3346/jkms.2020.35.e45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Annual vaccination is the principal way to reduce the mortality and morbidity associated with influenza. In the 2016-2017 influenza seasons, the influenza epidemic appeared to exhibit a different pattern from the previous years. Because of the unusual trend, the incidence of influenza-like patients among school-aged children had increased, causing doubts about the effectiveness of the influenza vaccine. Therefore, this study aimed to evaluate the effectiveness of the influenza vaccine among elementary school students in Korea. METHODS The study was conducted in elementary schools in each province of Korea in cooperation with the Student Health Policy Division of the Ministry of Education. Each Provincial Office of Education of Korea, except for Jeju, randomly selected one to two elementary schools for each District Office of Education. A total of 2,739 elementary school students were enrolled and vaccination and influenza infection status were collected from the subjects' parents through questionnaires, from February 13th to 21st in 2017. Vaccine effectiveness was defined as calculating the infection rate of influenza among the vaccinated and unvaccinated groups and determining the decreased infection rate of the vaccinated group relative to the unvaccinated group, while adjusting for time of vaccination and infection. RESULTS Adjusting for the interval between vaccination and infection, vaccine effectiveness of influenza was 17.6% (95% confidence interval [CI], 4.6% to 28.9%), 22.5% (95% CI, 10.3% to 33%), and 28.7% (95% CI, 17.5% to 38.3%) at 2 or more weeks, 3 or more weeks, and 4 or more weeks after vaccination, respectively. CONCLUSION In conclusion, considering the time required for adequate immunogenicity, the 2016-2017 seasonal influenza vaccine effectiveness in Korean elementary school students was 17.6%-28.7%, which was less effective than that of previous years.
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Affiliation(s)
- Yoon Mo Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Sol Kang
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Dong Ho Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
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18
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Galli C, Orsi A, Pariani E, Lai PL, Guarona G, Pellegrinelli L, Ebranati E, Icardi G, Panatto D. In-depth phylogenetic analysis of the hemagglutinin gene of influenza A(H3N2) viruses circulating during the 2016-2017 season revealed egg-adaptive mutations of vaccine strains. Expert Rev Vaccines 2020; 19:115-122. [PMID: 31875483 DOI: 10.1080/14760584.2020.1709827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: The authors conducted an in-depth phylogenetic analysis of the hemagglutinin (HA) gene of A(H3N2) identified during the 2016-2017 season to compare the circulating strains with both the egg-derived and cell-derived 2016-2017 candidate vaccine virus (CVV).Methods: 162 HA1 sequences of H3N2 viruses identified during the 2016-2017 season were phylogenetically analyzed and compared with egg-/cell-derived CVV. The predicted vaccine efficacy (pVE) of egg-/cell-derived CVV against field strains was quantified by Pepitope model.Results: All H3N2 belonged to 3C.2a genetic clade, most (80.2%) to 3C.2a1 sub-clade. Several H3N2 variants circulated in the 2016-2017 season. HA sequences of field H3N2 strains displayed greater identity with cell-derived CVV than with egg-derived CVV. The amino acid substitutions in positions 160 and 194 identified in egg-derived CVV affected the pVE, which was lower for egg-derived CVV than for cell-derived CVV.Conclusions: The results suggested that reduced vaccine effectiveness observed in 2016-2017 season was probably due to changes in the HA of vaccine strains acquired upon adaptation in eggs, which are the basis of most manufacturing systems currently used globally. Egg-free vaccine manufacturing systems would be advisable to improve the effectiveness of influenza vaccines.
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Affiliation(s)
- Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Piero Luigi Lai
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Giulia Guarona
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Erika Ebranati
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Donatella Panatto
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
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19
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Brunner I, Schmedders K, Wolfensberger A, Schreiber PW, Kuster SP. The economic and public health impact of influenza vaccinations: contributions of Swiss pharmacies in the 2016/17 and 2017/18 influenza seasons and implications for vaccination policy. Swiss Med Wkly 2019; 149:w20161. [DOI: 10.57187/smw.2019.20161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS OPF THE STUDY
Healthy adults have had the option to receive prescriptionless vaccination against influenza in pharmacies of several Swiss cantons since the 2015/16 influenza season. We aimed to assess in a cost-benefit analysis the resulting net benefits for the Swiss economy and public health, and the benefits that could be expected if an extension of the current vaccination recommendations was implemented.
METHODS
The proportion of influenza vaccines administered in pharmacies was calculated from data provided by pharmacies entering information in phS-net.ch, data from vaccines covered by insurance companies, and vaccine supply data. The economic and public health impact was estimated in a cost-benefit analysis based on published data.
RESULTS
In the 2016/17 and 2017/18 influenza seasons, 7306 of a total of 1.07 million (0.7%) and 15,617 of a total of 1.15 million (1.4%) influenza vaccine doses, respectively, were administered in pharmacies in Switzerland. The net cost savings for the economy due to vaccination in pharmacies in the 2016/17 and 2017/18 seasons were CHF 66,633 and CHF 143,021, respectively. In the 2017/18 season, this resulted –in a net saving per 100,000 inhabitants of CHF 1918, 94.4 cases of illness, 17.6 visits to primary care physicians, 0.328 hospitalisations, 1.1 hospitalisation days, 0.019 deaths prevented, and 0.353 life-years gained. Influenza vaccination proved to be cost-effective provided that a vaccine efficacy of 59% is exceeded. Extrapolations for the healthy, working-age population revealed that a vaccination coverage rate of 50% and a vaccine efficacy of 70% could save the Swiss economy CHF 18.4 million annually.
CONCLUSIONS
The service allowing citizens to receive influenza vaccination in Swiss pharmacies is sparsely used. Since influenza vaccination is cost-beneficial as soon as vaccine efficacy surpasses a critical threshold, an extension of the vaccine recommendation for healthy, working-age adults should be considered from an economic point of view.
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20
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Machado A, Kislaya I, Larrauri A, Matias Dias C, Nunes B. Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population. BMC Public Health 2019; 19:1690. [PMID: 31842831 PMCID: PMC6916191 DOI: 10.1186/s12889-019-7958-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.
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Affiliation(s)
- Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal. .,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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21
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Wan H, Gao J, Yang H, Yang S, Harvey R, Chen YQ, Zheng NY, Chang J, Carney PJ, Li X, Plant E, Jiang L, Couzens L, Wang C, Strohmeier S, Wu WW, Shen RF, Krammer F, Cipollo JF, Wilson PC, Stevens J, Wan XF, Eichelberger MC, Ye Z. The neuraminidase of A(H3N2) influenza viruses circulating since 2016 is antigenically distinct from the A/Hong Kong/4801/2014 vaccine strain. Nat Microbiol 2019; 4:2216-2225. [PMID: 31406333 PMCID: PMC6879794 DOI: 10.1038/s41564-019-0522-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/24/2019] [Indexed: 11/08/2022]
Abstract
A(H3N2) virus predominated recent influenza seasons, which has resulted in the rigorous investigation of haemagglutinin, but whether neuraminidase (NA) has undergone antigenic change and contributed to the predominance of A(H3N2) virus is unknown. Here, we show that the NA of the circulating A(H3N2) viruses has experienced significant antigenic drift since 2016 compared with the A/Hong Kong/4801/2014 vaccine strain. This antigenic drift was mainly caused by amino acid mutations at NA residues 245, 247 (S245N/S247T; introducing an N-linked glycosylation site at residue 245) and 468. As a result, the binding of the NA of A(H3N2) virus by some human monoclonal antibodies, including those that have broad reactivity to the NA of the 1957 A(H2N2) and 1968 A(H3N2) reference pandemic viruses as well as contemporary A(H3N2) strains, was reduced or abolished. This antigenic drift also reduced NA-antibody-based protection against in vivo virus challenge. X-ray crystallography showed that the glycosylation site at residue 245 is within a conserved epitope that overlaps the NA active site, explaining why it impacts antibody binding. Our findings suggest that NA antigenic drift impacts protection against influenza virus infection, thus highlighting the importance of including NA antigenicity for consideration in the optimization of influenza vaccines.
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MESH Headings
- Animals
- Antibodies, Monoclonal
- Antigens, Viral/genetics
- Antigens, Viral/immunology
- Catalytic Domain
- Crystallography, X-Ray
- Disease Models, Animal
- Genes, Viral/genetics
- Glycosylation
- Hong Kong
- Humans
- Immunogenicity, Vaccine
- Influenza A Virus, H3N2 Subtype/enzymology
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza Vaccines/immunology
- Influenza, Human/prevention & control
- Mice
- Models, Molecular
- Mutation
- Neuraminidase/chemistry
- Neuraminidase/genetics
- Neuraminidase/immunology
- Orthomyxoviridae Infections/immunology
- Protein Conformation
- Sequence Analysis, Protein
- Viral Proteins/chemistry
- Viral Proteins/genetics
- Viral Proteins/immunology
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Affiliation(s)
- Hongquan Wan
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Jin Gao
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Hua Yang
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shuang Yang
- Division of Bacterial, Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Ruth Harvey
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - Yao-Qing Chen
- Department of Medicine, Section of Rheumatology, The University of Chicago, Chicago, IL, USA
| | - Nai-Ying Zheng
- Department of Medicine, Section of Rheumatology, The University of Chicago, Chicago, IL, USA
| | - Jessie Chang
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul J Carney
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xing Li
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Ewan Plant
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Lianlian Jiang
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Laura Couzens
- Division of Biological Standards and Quantity Control, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Carol Wang
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Shirin Strohmeier
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wells W Wu
- Facility for Biotechnology Resources, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Rong-Fong Shen
- Facility for Biotechnology Resources, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John F Cipollo
- Division of Bacterial, Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Patrick C Wilson
- Department of Medicine, Section of Rheumatology, The University of Chicago, Chicago, IL, USA
| | - James Stevens
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiu-Feng Wan
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA
| | - Maryna C Eichelberger
- Division of Biological Standards and Quantity Control, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Zhiping Ye
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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22
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Bremer D, Lüdecke D, von dem Knesebeck O. Social Relationships, Age and the Use of Preventive Health Services: Findings from the German Ageing Survey. Int J Environ Res Public Health 2019; 16:ijerph16214272. [PMID: 31689892 PMCID: PMC6862648 DOI: 10.3390/ijerph16214272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 01/01/2023]
Abstract
This paper investigates the associations between social relationships, age and the use of preventive health services among German adults. Data stem from the German Ageing Survey (10,324 respondents). The use of preventive health services was assessed by asking for regular use of flu vaccination and cancer screening in the past years. Predictors of interest were structural (having a partner, size of the social network) and functional aspects of social relationships (perceived informational support) and age. Logistic regression models were used to measure the associations between preventive health services use and these predictors. Self-perceived health, gender and education were considered as covariates. Having a partner (OR = 1.20, 95% CI: 1.07-1.34) and perceived informational support (OR = 1.38, 95% CI: 1.13-1.69) were associated with a higher probability of getting flu vaccination regularly over the past years. Informational support (OR = 1.42, 95% CI: 1.17-1.72) and having a partner (OR = 1.57, 95% CI: 1.41-1.75) were positively associated with regular cancer screening over the past years. Associations between the size of the social network and use of preventive health services were not statistically significant. Associations between the use of preventive health services and social relationships varied by age. Structural and functional aspects of social relationships may support preventive health behavior. To increase preventive health behavior and the use of preventive health services, it is necessary to integrate information on social relationships into routine care and to strengthen sources of social support.
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Affiliation(s)
- Daniel Bremer
- Department of Medical Psychology & Center for Health Care Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Daniel Lüdecke
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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23
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Zhang L, van der Hoek W, Krafft T, Pilot E, Asten LV, Lin G, Wu S, Duan W, Yang P, Wang Q. Influenza vaccine effectiveness estimates against influenza A(H3N2) and A(H1N1) pdm09 among children during school-based outbreaks in the 2016-2017 season in Beijing, China. Hum Vaccin Immunother 2019; 16:816-822. [PMID: 31596661 DOI: 10.1080/21645515.2019.1677438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Since 2007, trivalent inactivated influenza vaccine (TIV) has been provided free-of-charge to primary, middle school and high school students in Beijing. However, there have been few school-based studies on influenza vaccine effectiveness (VE). In this report, we estimated influenza VE against laboratory-confirmed influenza illness among school children in Beijing, China during the 2016-2017 influenza season.Methods: The VE of 2016-2017 TIV against laboratory-confirmed influenza virus infection among school-age children was assessed through a case-control design. Conditional logistic regression was conducted on matched case-control sets to estimate VE. The effect of prior vaccination on current VE was also examined.Results: All 176 samples tested positive for influenza A virus with the positive rate of 55.5%. The average coverage rate of 2016-2017 TIV among students across the 37 schools was 30.6%. The fully adjusted VE of 2016-2017 TIV against laboratory-confirmed influenza was 69% (95% CI: 51 to 81): 60% (95% CI: -15 to 86) for influenza A(H1N1)pdm09 and 73% (95% CI: 52 to 84) for influenza A(H3N2). The overall VE for receipt of 2015-2016 vaccination only, 2016-2017 vaccination only, and vaccinations in both seasons was 46% (95% CI: -5 to 72), 77% (95% CI: 58 to 87), and 57% (95%CI: 17 to 78), respectively.Conclusions: Our study during school outbreaks found that VE of 2016-2017 TIV was moderate against influenza A(H3N2) as well as A(H1N1)pdm09 viruses.
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Affiliation(s)
- Li Zhang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Research Center for Preventive Medicine, Beijing, China
| | - Wim van der Hoek
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Thomas Krafft
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Eva Pilot
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Liselotte van Asten
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ge Lin
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Shuangsheng Wu
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Research Center for Preventive Medicine, Beijing, China
| | - Wei Duan
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Research Center for Preventive Medicine, Beijing, China
| | - Peng Yang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Research Center for Preventive Medicine, Beijing, China.,School of Public Health, Capital Medical University, Beijing, China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Research Center for Preventive Medicine, Beijing, China
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24
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Hill EM, Petrou S, de Lusignan S, Yonova I, Keeling MJ. Seasonal influenza: Modelling approaches to capture immunity propagation. PLoS Comput Biol 2019; 15:e1007096. [PMID: 31658250 PMCID: PMC6837557 DOI: 10.1371/journal.pcbi.1007096] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/07/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022] Open
Abstract
Seasonal influenza poses serious problems for global public health, being a significant contributor to morbidity and mortality. In England, there has been a long-standing national vaccination programme, with vaccination of at-risk groups and children offering partial protection against infection. Transmission models have been a fundamental component of analysis, informing the efficient use of limited resources. However, these models generally treat each season and each strain circulating within that season in isolation. Here, we amalgamate multiple data sources to calibrate a susceptible-latent-infected-recovered type transmission model for seasonal influenza, incorporating the four main strains and mechanisms linking prior season epidemiological outcomes to immunity at the beginning of the following season. Data pertaining to nine influenza seasons, starting with the 2009/10 season, informed our estimates for epidemiological processes, virological sample positivity, vaccine uptake and efficacy attributes, and general practitioner influenza-like-illness consultations as reported by the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We performed parameter inference via approximate Bayesian computation to assess strain transmissibility, dependence of present season influenza immunity on prior protection, and variability in the influenza case ascertainment across seasons. This produced reasonable agreement between model and data on the annual strain composition. Parameter fits indicated that the propagation of immunity from one season to the next is weaker if vaccine derived, compared to natural immunity from infection. Projecting the dynamics forward in time suggests that while historic immunity plays an important role in determining annual strain composition, the variability in vaccine efficacy hampers our ability to make long-term predictions. Influenza, the flu, is a highly infectious respiratory disease that can cause serious health complications. Characterised by seasonal outbreaks, a key challenge for policy-makers is implementing measures to successfully lessen the public health burden on an annual basis. Seasonal influenza vaccine programmes are an established method to deliver cost-effective prevention against influenza and its complications. Transmission models have been a fundamental component of vaccine programme analysis, informing the efficient use of limited resources. However, these models generally treat each influenza season and each strain circulating within that season in isolation. By developing a mathematical model explicitly including multiple immunity propagation mechanisms, then fit to influenza-related vaccine and epidemiological data from England via statistical methods, we sought to quantify the extent that epidemiological events in the previous influenza season alter susceptibility at the onset of the following season. The findings suggest that susceptibility in the next season to a given influenza strain type is modulated to the greatest extent through natural infection by that strain type in the current season. Residual vaccine immunity has a lesser role. Prospectively, the adoption of influenza transmission modelling frameworks with immunity propagation would provide a comprehensive manner to assess the impact of seasonal vaccination programmes.
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Affiliation(s)
- Edward M. Hill
- Zeeman Institute: Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom
- Mathematics Institute, University of Warwick, Coventry, United Kingdom
- * E-mail:
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Royal College of General Practitioners, London, United Kingdom
| | - Ivelina Yonova
- Royal College of General Practitioners, London, United Kingdom
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Matt J. Keeling
- Zeeman Institute: Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom
- Mathematics Institute, University of Warwick, Coventry, United Kingdom
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
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25
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Castillejos M, Cabello-Gutiérrez C, Alberto Choreño-Parra J, Hernández V, Romo J, Hernández-Sánchez F, Martínez D, Hernández A, Jiménez-Álvarez L, Hernández-Cardenas CM, Becerril-Vargas E, Martínez-Orozco JA, Luis Sandoval-Gutiérrez J, Guadarrama C, Olvera-Masetto E, Alfaro-Ramos L, Cruz-Lagunas A, Ramírez G, Márquez E, Pimentel L, Regino-Zamarripa NE, Mendoza-Milla C, Goodina A, Hernández-Montiel E, Barquera R, Santibañez A, Domínguez-Cherit G, Pérez-Padilla R, Regalado J, Santillán-Doherty P, Salas-Hernández J, Zúñiga J. High performance of rapid influenza diagnostic test and variable effectiveness of influenza vaccines in Mexico. Int J Infect Dis 2019; 89:87-95. [PMID: 31493523 DOI: 10.1016/j.ijid.2019.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/11/2019] [Accepted: 08/28/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the performance of rapid influenza diagnostic tests (RIDT) and influenza vaccines' effectiveness (VE) during an outbreak setting. METHODS We compared the performance of a RIDT with RT-PCR for influenza virus detection in influenza-like illness (ILI) patients enrolled during the 2016/17 season in Mexico City. Using the test-negative design, we estimated influenza VE in all participants and stratified by age, virus subtype, and vaccine type (trivalent vs quadrivalent inactivated vaccines). The protective value of some clinical variables was evaluated by regression analyses. RESULTS We enrolled 592 patients. RT-PCR detected 93 cases of influenza A(H1N1)pdm09, 55 of AH3N2, 141 of B, and 13 A/B virus infections. RIDT showed 90.7% sensitivity and 95.7% specificity for influenza A virus detection, and 91.5% sensitivity and 95.3% specificity for influenza B virus detection. Overall VE was 33.2% (95% CI: 3.0-54.0; p = 0.02) against any laboratory-confirmed influenza infection. VE estimates against influenza B were higher for the quadrivalent vaccine. Immunization and occupational exposure were protective factors against influenza. CONCLUSIONS The RIDT was useful to detect influenza cases during an outbreak setting. Effectiveness of 2016/17 influenza vaccines administered in Mexico was low but significant. Our data should be considered for future local epidemiological policies.
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Affiliation(s)
- Manuel Castillejos
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Carlos Cabello-Gutiérrez
- Department of Research in Virology and Mycology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - José Alberto Choreño-Parra
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Víctor Hernández
- Department of Research in Virology and Mycology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Javier Romo
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Fernando Hernández-Sánchez
- Department of Research in Virology and Mycology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Dina Martínez
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Andrés Hernández
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Luis Jiménez-Álvarez
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Carmen M Hernández-Cardenas
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Eduardo Becerril-Vargas
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - José A Martínez-Orozco
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - José Luis Sandoval-Gutiérrez
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Cristóbal Guadarrama
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Enrique Olvera-Masetto
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Leticia Alfaro-Ramos
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Alfredo Cruz-Lagunas
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Ramírez
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Eduardo Márquez
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Lisa Pimentel
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Nora E Regino-Zamarripa
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Criselda Mendoza-Milla
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Aminadab Goodina
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Erika Hernández-Montiel
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Rodrigo Barquera
- Laboratory of Archeogenomics, Max Planck Institute, Gena, Germany
| | - Alfredo Santibañez
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico; Laboratory of Archeogenomics, Max Planck Institute, Gena, Germany
| | - Guillermo Domínguez-Cherit
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico; Critical Care Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Justino Regalado
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Dirección Médica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Patricio Santillán-Doherty
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Dirección Médica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Jorge Salas-Hernández
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Dirección General, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
| | - Joaquín Zúñiga
- Institutional Influenza Committee, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico.
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Hallmann-Szelińska E, Cieślak K, Szymański K, Kowalczyk D, Korczyńska MR, Paradowska-Stankiewicz I, Brydak LB. Detection of Influenza in the Epidemic Season 2016/2017 Based on I-MOVE+ Project. Adv Exp Med Biol 2018; 1114:77-82. [PMID: 30203342 DOI: 10.1007/5584_2018_230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
In the influenza season 2016/2017 in Europe, the predominant virus was A/H3N2/. In Poland, the percentage of people vaccinated against influenza was 3.33%. European I-MOVE+ project shows how important it is to monitor the effectiveness of influenza vaccine. The project demonstrates that a match between the circulating vaccine strains and those included in the vaccine for the Northern Hemisphere was low-to-moderate. In the present study, there were 379 patients and 296 control subjects examined in hospitals in Poland as part of I-MOVE+ project. The real-time reverse transcription polymerase chain reaction (qRT-PCR) method was used to detect the influenza virus in all subjects. We detected the influenza subtype A/H3N2/ in 59.1% and type B virus in 2.1%. There was one co-infection of subtype A/H3N2/ with subtype A/H1N1/ and eight co-infections of type B with subtype A/H3N2/. No influenza viruses were detected in the control group. Only 19 patients and 22 control subjects were vaccinated during the epidemic season in question. A proportion of people vaccinated against influenza in Poland remains dismally low compared to other European countries.
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Chiu SS, Kwan MYW, Feng S, Wong JSC, Leung CW, Chan ELY, Chan KH, Ng TK, To WK, Cowling BJ, Peiris JSM. Influenza Vaccine Effectiveness Against Influenza A(H3N2) Hospitalizations in Children in Hong Kong in a Prolonged Season, 2016/2017. J Infect Dis 2019; 217:1365-1371. [PMID: 29346614 DOI: 10.1093/infdis/jiy027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/15/2018] [Indexed: 12/22/2022] Open
Abstract
Background Influenza A(H3N2) viruses circulated for 12 consecutive months in Hong Kong in 2016-2017, peaking in late June and July 2017. The objective of our study was to estimate the effectiveness of influenza vaccination in preventing hospitalizations in children in Hong Kong. Methods We conducted a test-negative study between 1 September 2016 and 31 August 2017, enrolling children 6 months to 17 years of age hospitalized for an acute respiratory infection. Influenza was diagnosed by PCR on nasopharyngeal aspirates. Results We enrolled 5514 children, including 3608 children 6 months to 2 years, 1600 children 3-5 years, and 1206 children 6-17 years of age. Influenza-associated hospitalizations occurred throughout the study year but time of vaccination of these children was also wide spread, from September 2016 to May 2017. Influenza vaccine effectiveness (VE) was 39.7% (95% confidence interval [CI], 14.7%-57.3%) against laboratory-confirmed influenza A(H3N2). In analyses stratified by time since vaccination, the VE against influenza A(H3N2) was 52.8% (95% CI, 17.1%-73.2%) within 3 months of vaccination, and 31.2% (95% CI, -6.6% to 55.6%) 4-6 months after vaccination. Conclusions Influenza vaccination was effective in preventing hospitalizations in children in Hong Kong.
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Affiliation(s)
- Susan S Chiu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital and Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Mike Y W Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health
| | - Joshua S C Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital
| | - Chi-Wai Leung
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital
| | - Eunice L Y Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital and Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Kwok-Hung Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Tak-Keung Ng
- Department of Pathology, Princess Margaret Hospital
| | | | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health.,Center of Influenza Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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28
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Bella A, Gesualdo F, Orsi A, Arcuri C, Chironna M, Loconsole D, Napoli C, Orsi GB, Manini I, Montomoli E, Alfonsi V, Castrucci MR, Rizzo C. Effectiveness of the trivalent MF59 adjuvated influenza vaccine in preventing hospitalization due to influenza B and A(H1N1)pdm09 viruses in the elderly in Italy, 2017 - 2018 season. Expert Rev Vaccines 2019; 18:671-679. [PMID: 31159616 DOI: 10.1080/14760584.2019.1627206] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Evidence on influenza vaccine effectiveness (VE) in preventing mortality and morbidity in the elderly is weak. Our aim was to measure the VE against severe outcomes in the elderly. Methods: We conducted a multicentre hospital-based test-negative design (TND) case-control study, during the 2017/18 season, in four Italian hospitals. The study population included individuals aged ≥65 years hospitalized with Severe Acute Respiratory Infections (SARI). Patients were classified as cases and controls based on the results of the PCR influenza testing. We estimated VE by virus subtypes and specific VE for the trivalent adjuvanted vaccine (TIVadj). Results: 502 patients with SARI were enrolled: 118 (23.5%) tested positive (cases) and 384 (76.5%) tested negative (controls) for influenza. The adjusted VE of 48.5% for all vaccines was comparable to the adjusted VE for the TIVadj vaccine (48.3%). Adjusted VE for the TIVadj vaccine was 67.5% for A(H1N1)pdm09 and 44.5% for B viruses. Conclusion: We show a moderate adjusted VE of the TIVadj against all viruses, a good adjusted VE against A(H1N1)pdm09 strains and a moderate adjusted VE against B strains, despite a mismatch between the B circulating lineage and the lineage included in the vaccine. This is likely due to the cross-protection among B strains induced by the TIVadj in elderly patients.
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Affiliation(s)
- Antonino Bella
- a Department of Infectious Diseases , National Institute of Health , Rome , Italy
| | - Francesco Gesualdo
- b Direction of Cinical Department , Bambino Gesù Children's Hospital , Rome , Italy
| | - Andrea Orsi
- c Department of Health Sciences , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Claudia Arcuri
- c Department of Health Sciences , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Maria Chironna
- d Department of Biomedical Science and Medical Oncology of the University of Bari , Bari , Italy
| | - Daniela Loconsole
- d Department of Biomedical Science and Medical Oncology of the University of Bari , Bari , Italy
| | - Christian Napoli
- e Department of Medical-Surgical Sciences and Translational Medicine , University of Rome "Sapienza", Sant'Andrea Hospital , Rome , Italy
| | - Giovanni Battista Orsi
- f Department of Public Health and Infectious Diseases , University of Rome "Sapienza" , Rome , Italy
| | - Ilaria Manini
- g Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Emanuele Montomoli
- g Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Valeria Alfonsi
- a Department of Infectious Diseases , National Institute of Health , Rome , Italy.,e Department of Medical-Surgical Sciences and Translational Medicine , University of Rome "Sapienza", Sant'Andrea Hospital , Rome , Italy
| | - Maria Rita Castrucci
- a Department of Infectious Diseases , National Institute of Health , Rome , Italy
| | - Caterina Rizzo
- b Direction of Cinical Department , Bambino Gesù Children's Hospital , Rome , Italy
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29
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Mira-Iglesias A, López-Labrador FX, Guglieri-López B, Tortajada-Girbés M, Baselga-Moreno V, Cano L, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Díez-Domingo J, Puig-Barberà J. Influenza vaccine effectiveness in preventing hospitalisation of individuals 60 years of age and over with laboratory-confirmed influenza, Valencia Region, Spain, influenza season 2016/17. ACTA ACUST UNITED AC 2019; 23. [PMID: 29486829 PMCID: PMC5829534 DOI: 10.2807/1560-7917.es.2018.23.8.17-00318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Seasonal influenza vaccination is widely recommended for people with risk factors, especially for people who are elderly. However, influenza vaccine effectiveness (IVE) varies year after year because of the variable antigenic composition of the circulating viruses and the vaccine composition. Methods: We summarise the results of IVE and the impact of previous vaccination among subjects 60 years of age and over in a multicentre prospective study in the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI) in Spain. We applied the test-negative design taking laboratory-confirmed influenza as outcome and vaccination status as exposure. Information about potential confounders was obtained from clinical registries or directly from patients. Results: Adjusted IVE was 19% (95% confidence interval (CI): −15 to 43). For patients vaccinated in the current season but not in the two previous seasons, effectiveness was 49% (95% CI: −20 to 78) and for patients vaccinated in the current and any of two previous seasons, effectiveness was 29% (95% CI: −3 to 52). For those patients not vaccinated in the current season but vaccinated in any of the two previous seasons, effectiveness was 53% (95% CI: 8 to 76). Conclusions: Our data show a low vaccine effectiveness for the 2016/17 influenza season.
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Affiliation(s)
- Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - F Xavier López-Labrador
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Beatriz Guglieri-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Laura Cano
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Mario Carballido-Fernández
- Universidad CEU Cardenal Herrera, Castellón, Spain.,Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Joan Puig-Barberà
- Centro de Salud Pública de Castellón, Castellón, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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30
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Baselga-Moreno V, Trushakova S, McNeil S, Sominina A, Nunes MC, Draganescu A, Unal S, Koul P, Kyncl J, Zhang T, Kuatbayeva A, Ben-Salah A, Burtseva E, Puig-Barberà J, Díez-Domingo J. Influenza epidemiology and influenza vaccine effectiveness during the 2016-2017 season in the Global Influenza Hospital Surveillance Network (GIHSN). BMC Public Health 2019; 19:487. [PMID: 31046725 PMCID: PMC6498567 DOI: 10.1186/s12889-019-6713-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/27/2019] [Indexed: 11/25/2022] Open
Abstract
Background The Global Influenza Hospital Surveillance Network (GIHSN) aims to determine the burden of severe influenza disease and Influenza Vaccine Effectiveness (IVE). This is a prospective, active surveillance and hospital-based epidemiological study to collect epidemiological data in the GIHSN. In the 2016–2017 influenza season, 15 sites in 14 countries participated in the GIHSN, although the analyses could not be performed in 2 sites. A common core protocol was used in order to make results comparable. Here we present the results of the GIHSN 2016–2017 influenza season. Methods A RT-PCR test was performed to all patients that accomplished the requirements detailed on a common core protocol. Patients admitted were included in the study after signing the informed consent, if they were residents, not institutionalised, not discharged in the previous 30 days from other hospitalisation with symptoms onset within the 7 days prior to admission. Patients 5 years old or more must also complied the Influenza-Like Illness definition. A test negative-design was implemented to perform IVE analysis. IVE was estimated using a logistic regression model, with the formula IVE = (1-aOR) × 100, where aOR is the adjusted Odds Ratio comparing cases and controls. Results Among 21,967 screened patients, 10,140 (46.16%) were included, as they accomplished the inclusion criteria, and tested, and therefore 11,827 (53.84%) patients were excluded. Around 60% of all patients included with laboratory results were recruited at 3 sites. The predominant strain was A(H3N2), detected in 63.6% of the cases (1840 patients), followed by B/Victoria, in 21.3% of the cases (618 patients). There were 2895 influenza positive patients (28.6% of the included patients). A(H1N1)pdm09 strain was mainly found in Mexico. IVE could only be performed in 6 sites separately. Overall IVE was 27.24 (95% CI 15.62–37.27. Vaccination seemed to confer better protection against influenza B and in people 2–4 years, or 85 years old or older. The aOR for hospitalized and testing positive for influenza was 3.02 (95% CI 1.59–5.76) comparing pregnant with non-pregnant women. Conclusions Vaccination prevented around 1 in 4 hospitalisations with influenza. Sparse numbers didn’t allow estimating IVE in all sites separately. Pregnancy was found a risk factor for influenza, having 3 times more risk of being admitted with influenza for pregnant women. Electronic supplementary material The online version of this article (10.1186/s12889-019-6713-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 21 Cataluña Av, 46020, Valencia, Spain
| | - Svetlana Trushakova
- Ivanovsky Institute of Virology FSBI "N.F. Gamaleya FRCEM" Ministry of Health, Moscow, Russian Federation
| | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
| | - Anna Sominina
- Research Institute of Influenza, WHO National Influenza Centre of Russia, St. Petersburg, Russian Federation
| | - Marta C Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Anca Draganescu
- National Institute of Infectious Diseases "Prof. Dr. Matei Bals", Bucharest (INBI "Prof. Dr. Matei Bals"), București, Romania
| | - Serhat Unal
- Turkish Society of Internal Medicine, Ankara, Turkey
| | - Parvaiz Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, India
| | - Jan Kyncl
- National Institute of Public Health, Prague, Czech Republic
| | | | - Ainagul Kuatbayeva
- Center for Sanitary-Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
| | - Afif Ben-Salah
- Pasteur Institute of Tunis, Tunis, Tunisia.,College of Medicine and Medical Sciences, Manama, Bahrain
| | - Elena Burtseva
- Ivanovsky Institute of Virology FSBI "N.F. Gamaleya FRCEM" Ministry of Health, Moscow, Russian Federation
| | - Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 21 Cataluña Av, 46020, Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 21 Cataluña Av, 46020, Valencia, Spain.
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Navascués A, Casado I, Pérez-García A, Aguinaga A, Martínez-Baz I, Floristán Y, Ezpeleta C, Castilla J. Detection of Respiratory Viruses in Deceased Persons, Spain, 2017. Emerg Infect Dis 2019; 24:1331-1334. [PMID: 29912695 PMCID: PMC6038767 DOI: 10.3201/eid2407.180162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
During the 2016–17 influenza season in Spain, we tested specimens from 57 elderly deceased persons for respiratory viruses. Influenza viruses were detected in 18% of the specimens and any respiratory virus in 47%. Only 7% of participants had received a diagnosis of infection with the detected virus before death.
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32
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Skowronski DM, Chambers C, De Serres G, Dickinson JA, Winter AL, Hickman R, Chan T, Jassem AN, Drews SJ, Charest H, Gubbay JB, Bastien N, Li Y, Krajden M. Early season co-circulation of influenza A(H3N2) and B(Yamagata): interim estimates of 2017/18 vaccine effectiveness, Canada, January 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 29409570 PMCID: PMC5801641 DOI: 10.2807/1560-7917.es.2018.23.5.18-00035] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a test-negative design, we assessed interim vaccine effectiveness (VE) for the 2017/18 epidemic of co-circulating influenza A(H3N2) and B(Yamagata) viruses. Adjusted VE for influenza A(H3N2), driven by a predominant subgroup of clade 3C.2a viruses with T131K + R142K + R261Q substitutions, was low at 17% (95% confidence interval (CI): −14 to 40). Adjusted VE for influenza B was higher at 55% (95% CI: 38 to 68) despite prominent use of trivalent vaccine containing lineage-mismatched influenza B(Victoria) antigen, suggesting cross-lineage protection.
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Affiliation(s)
- Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Québec, Canada.,Laval University, Quebec, Canada.,Institut National de Santé Publique du Québec, Québec, Canada
| | | | | | - Rebecca Hickman
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Agatha N Jassem
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Steven J Drews
- University of Alberta, Edmonton, Canada.,Alberta Provincial Laboratory, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Mel Krajden
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
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Andrew MK, Bowles SK, Pawelec G, Haynes L, Kuchel GA, McNeil SA, McElhaney JE. Influenza Vaccination in Older Adults: Recent Innovations and Practical Applications. Drugs Aging 2019; 36:29-37. [PMID: 30411283 DOI: 10.1007/s40266-018-0597-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Influenza can lead to serious illness, particularly for older adults. In addition to short-term morbidity and mortality during the acute infection, recovery can be prolonged and often incomplete. This may lead to persistent declines in health and function, including catastrophic disability, which has dramatic implications for the well-being and support needs of older adults and their caregivers. All of this means that prevention of infection and effective treatment when illness has occurred are of paramount importance. In this narrative review, we discuss the effectiveness of influenza vaccines for the prevention of influenza illness and serious outcomes in older adults. We review evidence of vaccine effectiveness for older adults in comparison with younger age groups, and also highlight the importance of frailty as a determinant of vaccine effectiveness. We then turn our attention to the question of why older and frailer individuals have poorer vaccine responses, and consider changes in immune function and inflammatory responses. This sets the stage for a discussion of newer influenza vaccine products that have been developed with the aim of enhancing vaccine effectiveness in older adults. We review the available evidence on vaccine efficacy, effectiveness and cost benefits, consider the potential place of these innovations in clinical geriatric practice, and discuss international advisory committee recommendations on influenza vaccination in older adults. Finally, we highlight the importance of influenza prevention to support healthy aging, along with the need to improve vaccine coverage rates using available vaccine products, and to spur development of better influenza vaccines for older adults in the near future.
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Affiliation(s)
- Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, Canada. .,Canadian Center for Vaccinology, Halifax, NS, Canada.
| | - Susan K Bowles
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, Canada.,Canadian Center for Vaccinology, Halifax, NS, Canada.,Department of Pharmacy, Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
| | - Graham Pawelec
- Second Department of Internal Medicine, University of Tübingen, Tübingen, Germany.,Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Laura Haynes
- Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - George A Kuchel
- Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Halifax, NS, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, NS, Canada
| | - Janet E McElhaney
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
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Leung V, Deng YM, Kaye M, Buettner I, Lau H, Leang SK, Gillespie L, Chow M. Annual report on influenza viruses received and tested by the Melbourne WHO Collaborating Centre for Reference and Research on Influenza in 2016. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As part of its role in the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received a total of 4,247 human influenza positive samples during 2016. Viruses were analysed for their antigenic, genetic and antiviral susceptibility properties and also propagated in qualified cells and hens eggs for potential seasonal influenza vaccine virus candidates. In 2016, influenza A(H3) viruses predominated over influenza A(H1)pdm09 and B viruses, accounting for a total of 51% of all viruses analysed. The vast majority of A(H1)pdm09, A(H3) and influenza B viruses analysed at the Centre were found to be antigenically similar to the respective WHO recommended vaccine strains for the Southern Hemisphere in 2016. However, phylogenetic analysis of a selection of viruses indicated that the majority of circulating A(H3) viruses had undergone some genetic drift relative to the WHO recommended strain for 2016. Of more than 3,000 samples tested for resistance to the neuraminidase inhibitors oseltamivir and zanamivir, six A(H1)pdm09 viruses and two B/Victoria lineage viruses showed highly reduced inhibition to oseltamivir.
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Affiliation(s)
- Vivian.k Leung
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Yi-Mo Deng
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Matthew Kaye
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Iwona Buettner
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Hilda Lau
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Sook-Kwan Leang
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Leah Gillespie
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Michelle.K Chow
- WHO Collaborating Centre for Reference and Research on Influenza
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Delespierre T, Josseran L. Issues in Building a Nursing Home Syndromic Surveillance System with Textmining: Longitudinal Observational Study. JMIR Public Health Surveill 2018; 4:e69. [PMID: 30545816 PMCID: PMC6315244 DOI: 10.2196/publichealth.9022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/23/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background New nursing homes (NH) data warehouses fed from residents’ medical records allow monitoring the health of elderly population on a daily basis. Elsewhere, syndromic surveillance has already shown that professional data can be used for public health (PH) surveillance but not during a long-term follow-up of the same cohort. Objective This study aimed to build and assess a national ecological NH PH surveillance system (SS). Methods Using a national network of 126 NH, we built a residents’ cohort, extracted medical and personal data from their electronic health records, and transmitted them through the internet to a national server almost in real time. After recording sociodemographic, autonomic and syndromic information, a set of 26 syndromes was defined using pattern matching with the standard query language-LIKE operator and a Delphi-like technique, between November 2010 and June 2016. We used early aberration reporting system (EARS) and Bayes surveillance algorithms of the R surveillance package (Höhle) to assess our influenza and acute gastroenteritis (AGE) syndromic data against the Sentinelles network data, French epidemics gold standard, following Centers for Disease Control and Prevention surveillance system assessment guidelines. Results By extracting all sociodemographic residents’ data, a cohort of 41,061 senior citizens was built. EARS_C3 algorithm on NH influenza and AGE syndromic data gave sensitivities of 0.482 and 0.539 and specificities of 0.844 and 0.952, respectively, over a 6-year period, forecasting the last influenza outbreak by catching early flu signals. In addition, assessment of influenza and AGE syndromic data quality showed precisions of 0.98 and 0.96 during last season epidemic weeks’ peaks (weeks 03-2017 and 01-2017) and precisions of 0.95 and 0.92 during last summer epidemic weeks’ low (week 33-2016). Conclusions This study confirmed that using syndromic information gives a good opportunity to develop a genuine French national PH SS dedicated to senior citizens. Access to senior citizens’ free-text validated health data on influenza and AGE responds to a PH issue for the surveillance of this fragile population. This database will also make possible new ecological research on other subjects that will improve prevention, care, and rapid response when facing health threats.
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Affiliation(s)
- Tiba Delespierre
- Equipe de recherche (HANDIReSP), UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines et Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Loic Josseran
- Equipe de recherche (HANDIReSP), UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines et Université Paris-Saclay, Montigny-le-Bretonneux, France
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Abstract
H3N2-subtype influenza A viruses are major causes of seasonal influenza epidemics. Emerging H3N2 variants require the annual adjustment of the vaccine strain. Recently, studies addressing the reduced effectiveness of current H3N2 vaccines have identified production-related substitutions in the viral hemagglutinin antigen as a possible cause for reduced vaccine efficacy.
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Fronteau H, Jestin Le Tallec V, Loisel I, Estivin S, Corre R, Marhuenda F, Grudé F, Déniel-Lagadec D. L’état vaccinal des sujets âgés atteints de cancer recevant une chimiothérapie : rappel des recommandations et zoom sur la région Bretagne. ONCOLOGIE 2018. [DOI: 10.3166/onco-2018-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shinjoh M, Sugaya N, Yamaguchi Y, Iibuchi N, Kamimaki I, Goto A, Kobayashi H, Kobayashi Y, Shibata M, Tamaoka S, Nakata Y, Narabayashi A, Nishida M, Hirano Y, Munenaga T, Morita K, Mitamura K, Takahashi T. Inactivated influenza vaccine effectiveness and an analysis of repeated vaccination for children during the 2016/17 season. Vaccine 2018; 36:5510-5518. [DOI: 10.1016/j.vaccine.2018.07.065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 01/13/2023]
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Wu S, Pan Y, Zhang X, Zhang L, Duan W, Ma C, Zhang Y, Zhang M, Sun Y, Yang P, Wang Q, Ma J. Influenza vaccine effectiveness in preventing laboratory-confirmed influenza in outpatient settings: A test-negative case-control study in Beijing, China, 2016/17 season. Vaccine 2018; 36:5774-5780. [DOI: 10.1016/j.vaccine.2018.07.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 01/05/2023]
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Seki Y, Onose A, Murayama T, Koide C, Sugaya N. Influenza vaccine showed a good preventive effect against influenza-associated hospitalization among elderly patients, during the 2016/17 season in Japan. J Infect Chemother 2018; 24:873-80. [PMID: 30100400 DOI: 10.1016/j.jiac.2018.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
Abstract
The 2016/17 influenza season in Japan was characterized by a predominance of influenza A (H3N2) activity; with H3N2 accounting for 85% of all detected influenza virus infections. We assessed the vaccine effectiveness (VE) of an inactivated quadrivalent influenza vaccine (IIV4) in adult patients, using a test-negative case-control design study based on the results of a rapid influenza diagnostic test (RIDT). Between November 2016 and March 2017, a total of 1048 adult patients were enrolled: including 363 RIDT positive for influenza A, 9 RIDT-positive for influenza B, and 676 RIDT-negative. During the 2016/17 season, the overall adjusted VE was 28.8% (95% confidence interval [CI]: 6.3-46%). The adjusted VE against influenza A was 27.4% (95%CI: 4.4-45%). The VE against influenza B could not be estimated because of the very low number of influenza B patients. Twenty-nine patients were hospitalized due to influenza-associated illness-during the present study, all of whom were infected with influenza A virus. The adjusted VE, determined using a case-control study, for preventing hospitalization for influenza A infection was 72.6% (95%CI: 30.7-89.1%). In addition, the VE for preventing hospitalization of influenza patients with comorbidities was 78.2% (95%CI: 41.1-92%). Our study showed that, during the 2016/17season, IIV4 was effective for preventing both the onset of influenza and influenza-associated hospitalization.
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Wang Y, Chen L, Yu J, Pang Y, Zhang J, Zhang T, Zhao G. The effectiveness of influenza vaccination among nursery school children in China during the 2016/17 influenza season. Vaccine 2018; 36:2456-61. [DOI: 10.1016/j.vaccine.2018.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/19/2022]
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Rondy M, Gherasim A, Casado I, Launay O, Rizzo C, Pitigoi D, Mickiene A, Marbus SD, Machado A, Syrjänen RK, Pem-Novose I, Horváth JK, Larrauri A, Castilla J, Vanhems P, Alfonsi V, Ivanciuc AE, Kuliese M, van Gageldonk-Lafeber R, Gomez V, Ikonen N, Lovric Z, Ferenczi A, Moren A. Low 2016/17 season vaccine effectiveness against hospitalised influenza A(H3N2) among elderly: awareness warranted for 2017/18 season. ACTA ACUST UNITED AC 2018; 22. [PMID: 29043961 PMCID: PMC5710120 DOI: 10.2807/1560-7917.es.2017.22.41.17-00645] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a multicentre European hospital study we measured influenza vaccine effectiveness (IVE) against A(H3N2) in 2016/17. Adjusted IVE was 17% (95% confidence interval (CI): 1 to 31) overall; 25% (95% CI: 2 to 43) among 65–79-year-olds and 13% (95% CI: −15 to 30) among those ≥ 80 years. As the A(H3N2) vaccine component has not changed for 2017/18, physicians and public health experts should be aware that IVE could be low where A(H3N2) viruses predominate.
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Affiliation(s)
| | - Alin Gherasim
- CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain.,National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain.,CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, APHP, CIC Cochin-Pasteur, Paris, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), CIC 1417, Paris, France
| | | | - Daniela Pitigoi
- University of Medicine and Pharmacy Carol Davila, National Institute for Research Cantacuzino, Bucharest, Romania
| | - Aukse Mickiene
- Department of Infectious diseases of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sierk D Marbus
- Centre for Epidemiology and surveillance of infectious diseases, Centre for Infectious disease control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ausenda Machado
- Epidemiology Research Unit, Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ritva K Syrjänen
- Impact Assessment Unit, National Institute for Health and Welfare, Tampere, Finland
| | - Iva Pem-Novose
- Epidemiology Service, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Amparo Larrauri
- CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain.,National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain.,CIBER Epidemiología y Salud Pública, Institute of Health Carlos III, Madrid, Spain
| | - Philippe Vanhems
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, Centre National de la Recherche Scientifique (CNRS), UMR5308, Ecole Nationale Supérieure (ENS) de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Infection Control and Epidemiology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), CIC 1417, Paris, France
| | | | - Alina E Ivanciuc
- National Institute for Research Cantacuzino, Bucharest, Romania, Faculty of Biology, Bucharest University
| | - Monika Kuliese
- Department of Infectious diseases of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rianne van Gageldonk-Lafeber
- Centre for Epidemiology and surveillance of infectious diseases, Centre for Infectious disease control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Veronica Gomez
- Epidemiology Research Unit, Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Niina Ikonen
- Unit of Expert Microbiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Zvjezdana Lovric
- Epidemiology Service, Croatian Institute of Public Health, Zagreb, Croatia
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- The members of the I-Move+ hospital working group are listed at the end of the article
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Abstract
BACKGROUND The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years of age. This is an update of a review published in 2011. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions. OBJECTIVES To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in healthy children. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 12), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (1966 to 31 December 2016), Embase (1974 to 31 December 2016), WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017), and ClinicalTrials.gov (1 July 2017). SELECTION CRITERIA Randomised controlled trials comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy children under 16 years. Previous versions of this review included 19 cohort and 11 case-control studies. We are no longer updating the searches for these study designs but have retained the observational studies for historical purposes. DATA COLLECTION AND ANALYSIS Review authors independently assessed risk of bias and extracted data. We used GRADE to rate the certainty of evidence for the key outcomes of influenza, influenza-like illness (ILI), complications (hospitalisation, ear infection), and adverse events. Due to variation in control group risks for influenza and ILI, absolute effects are reported as the median control group risk, and numbers needed to vaccinate (NNVs) are reported accordingly. For other outcomes aggregate control group risks are used. MAIN RESULTS We included 41 clinical trials (> 200,000 children). Most of the studies were conducted in children over the age of two and compared live attenuated or inactivated vaccines with placebo or no vaccine. Studies were conducted over single influenza seasons in the USA, Western Europe, Russia, and Bangladesh between 1984 and 2013. Restricting analyses to studies at low risk of bias showed that influenza and otitis media were the only outcomes where the impact of bias was negligible. Variability in study design and reporting impeded meta-analysis of harms outcomes.Live attenuated vaccinesCompared with placebo or do nothing, live attenuated influenza vaccines probably reduce the risk of influenza infection in children aged 3 to 16 years from 18% to 4% (risk ratio (RR) 0.22, 95% confidence interval (CI) 0.11 to 0.41; 7718 children; moderate-certainty evidence), and they may reduce ILI by a smaller degree, from 17% to 12% (RR 0.69, 95% CI 0.60 to 0.80; 124,606 children; low-certainty evidence). Seven children would need to be vaccinated to prevent one case of influenza, and 20 children would need to be vaccinated to prevent one child experiencing an ILI. Acute otitis media is probably similar following vaccine or placebo during seasonal influenza, but this result comes from a single study with particularly high rates of acute otitis media (RR 0.98, 95% CI 0.95 to 1.01; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. Vaccinating children may lead to fewer parents taking time off work, although the CI includes no effect (RR 0.69, 95% CI 0.46 to 1.03; low-certainty evidence). Data on the most serious consequences of influenza complications leading to hospitalisation were not available. Data from four studies measuring fever following vaccination varied considerably, from 0.16% to 15% in children who had live vaccines, while in the placebo groups the proportions ranged from 0.71% to 22% (very low-certainty evidence). Data on nausea were not reported.Inactivated vaccinesCompared with placebo or no vaccination, inactivated vaccines reduce the risk of influenza in children aged 2 to 16 years from 30% to 11% (RR 0.36, 95% CI 0.28 to 0.48; 1628 children; high-certainty evidence), and they probably reduce ILI from 28% to 20% (RR 0.72, 95% CI 0.65 to 0.79; 19,044 children; moderate-certainty evidence). Five children would need to be vaccinated to prevent one case of influenza, and 12 children would need to be vaccinated to avoid one case of ILI. The risk of otitis media is probably similar between vaccinated children and unvaccinated children (31% versus 27%), although the CI does not exclude a meaningful increase in otitis media following vaccination (RR 1.15, 95% CI 0.95 to 1.40; 884 participants; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. We identified no data on parental working time lost, hospitalisation, fever, or nausea.We found limited evidence on secondary cases, requirement for treatment of lower respiratory tract disease, and drug prescriptions. One brand of monovalent pandemic vaccine was associated with a sudden loss of muscle tone triggered by the experience of an intense emotion (cataplexy) and a sleep disorder (narcolepsy) in children. Evidence of serious harms (such as febrile fits) was sparse. AUTHORS' CONCLUSIONS In children aged between 3 and 16 years, live influenza vaccines probably reduce influenza (moderate-certainty evidence) and may reduce ILI (low-certainty evidence) over a single influenza season. In this population inactivated vaccines also reduce influenza (high-certainty evidence) and may reduce ILI (low-certainty evidence). For both vaccine types, the absolute reduction in influenza and ILI varied considerably across the study populations, making it difficult to predict how these findings translate to different settings. We found very few randomised controlled trials in children under two years of age. Adverse event data were not well described in the available studies. Standardised approaches to the definition, ascertainment, and reporting of adverse events are needed. Identification of all global cases of potential harms is beyond the scope of this review.
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Affiliation(s)
- Tom Jefferson
- University of OxfordCentre for Evidence Based MedicineOxfordUKOX2 6GG
| | - Alessandro Rivetti
- ASL CN2 Alba BraDipartimento di Prevenzione ‐ S.Pre.S.A.LVia Vida 10AlbaPiemonteItaly12051
| | - Carlo Di Pietrantonj
- Local Health Unit Alessandria‐ ASL ALRegional Epidemiology Unit SeREMIVia Venezia 6AlessandriaAlessandriaItaly15121
| | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL ALServizio Regionale di Riferimento per l'Epidemiologia, SSEpi‐SeREMIVia Venezia 6AlessandriaPiemonteItaly15121
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44
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Abstract
BACKGROUND The consequences of influenza in the elderly (those age 65 years or older) are complications, hospitalisations, and death. The primary goal of influenza vaccination in the elderly is to reduce the risk of death among people who are most vulnerable. This is an update of a review published in 2010. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions. OBJECTIVES To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in the elderly. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 11), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1966 to 31 December 2016); Embase (1974 to 31 December 2016); Web of Science (1974 to 31 December 2016); CINAHL (1981 to 31 December 2016); LILACS (1982 to 31 December 2016); WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017); and ClinicalTrials.gov (1 July 2017). SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs assessing efficacy against influenza (laboratory-confirmed cases) or effectiveness against influenza-like illness (ILI) or safety. We considered any influenza vaccine given independently, in any dose, preparation, or time schedule, compared with placebo or with no intervention. Previous versions of this review included 67 cohort and case-control studies. The searches for these trial designs are no longer updated. DATA COLLECTION AND ANALYSIS Review authors independently assessed risk of bias and extracted data. We rated the certainty of evidence with GRADE for the key outcomes of influenza, ILI, complications (hospitalisation, pneumonia), and adverse events. We have presented aggregate control group risks to illustrate the effect in absolute terms. We used them as the basis for calculating the number needed to vaccinate to prevent one case of each event for influenza and ILI outcomes. MAIN RESULTS We identified eight RCTs (over 5000 participants), of which four assessed harms. The studies were conducted in community and residential care settings in Europe and the USA between 1965 and 2000. Risk of bias reduced our certainty in the findings for influenza and ILI, but not for other outcomes.Older adults receiving the influenza vaccine may experience less influenza over a single season compared with placebo, from 6% to 2.4% (risk ratio (RR) 0.42, 95% confidence interval (CI) 0.27 to 0.66; low-certainty evidence). We rated the evidence as low certainty due to uncertainty over how influenza was diagnosed. Older adults probably experience less ILI compared with those who do not receive a vaccination over the course of a single influenza season (3.5% versus 6%; RR 0.59, 95% CI 0.47 to 0.73; moderate-certainty evidence). These results indicate that 30 people would need to be vaccinated to prevent one person experiencing influenza, and 42 would need to be vaccinated to prevent one person having an ILI.The study providing data for mortality and pneumonia was underpowered to detect differences in these outcomes. There were 3 deaths from 522 participants in the vaccination arm and 1 death from 177 participants in the placebo arm, providing very low-certainty evidence for the effect on mortality (RR 1.02, 95% CI 0.11 to 9.72). No cases of pneumonia occurred in one study that reported this outcome (very low-certainty evidence). No data on hospitalisations were reported. Confidence intervaIs around the effect of vaccines on fever and nausea were wide, and we do not have enough information about these harms in older people (fever: 1.6% with placebo compared with 2.5% after vaccination (RR 1.57, 0.92 to 2.71; moderate-certainty evidence)); nausea (2.4% with placebo compared with 4.2% after vaccination (RR 1.75, 95% CI 0.74 to 4.12; low-certainty evidence)). AUTHORS' CONCLUSIONS Older adults receiving the influenza vaccine may have a lower risk of influenza (from 6% to 2.4%), and probably have a lower risk of ILI compared with those who do not receive a vaccination over the course of a single influenza season (from 6% to 3.5%). We are uncertain how big a difference these vaccines will make across different seasons. Very few deaths occurred, and no data on hospitalisation were reported. No cases of pneumonia occurred in one study that reported this outcome. We do not have enough information to assess harms relating to fever and nausea in this population.The evidence for a lower risk of influenza and ILI with vaccination is limited by biases in the design or conduct of the studies. Lack of detail regarding the methods used to confirm the diagnosis of influenza limits the applicability of this result. The available evidence relating to complications is of poor quality, insufficient, or old and provides no clear guidance for public health regarding the safety, efficacy, or effectiveness of influenza vaccines for people aged 65 years or older. Society should invest in research on a new generation of influenza vaccines for the elderly.
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Affiliation(s)
- Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Via Venezia 6, Alessandria, Piemonte, Italy, 15121
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Rabensteiner A, Buja A, Regele D, Fischer M, Baldo V. Healthcare worker’s attitude to seasonal influenza vaccination in the South Tyrolean province of Italy: barriers and facilitators. Vaccine 2018; 36:535-544. [DOI: 10.1016/j.vaccine.2017.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
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Suntronwong N, Klinfueng S, Vichiwattana P, Korkong S, Thongmee T, Vongpunsawad S, Poovorawan Y. Genetic and antigenic divergence in the influenza A(H3N2) virus circulating between 2016 and 2017 in Thailand. PLoS One 2017; 12:e0189511. [PMID: 29252990 DOI: 10.1371/journal.pone.0189511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
Influenza virus evolves rapidly due to the accumulated genetic variations on the viral sequence. Unlike in North America and Europe, influenza season in the tropical Southeast Asia spans both the rainy and cool seasons. Thus, influenza epidemiology and viral evolution sometimes differ from other regions, which affect the ever-changing efficacy of the vaccine. To monitor the current circulating influenza viruses in this region, we determined the predominant influenza virus strains circulating in Thailand between January 2016 and June 2017 by screening 7,228 samples from patients with influenza-like illness. During this time, influenza A(H3N2) virus was the predominant influenza virus detected. We then phylogenetically compared the hemagglutinin (HA) gene from a subset of these A(H3N2) strains (n = 62) to the reference sequences and evaluated amino acid changes in the dominant antigenic epitopes on the HA protein structure. The divergence of the circulating A(H3N2) from the A/Hong Kong/4801/2014 vaccine strain formed five genetic groups (designated I to V) within the 3C.2a clade. Our results suggest a marked drift of the current circulating A(H3N2) strains in Thailand, which collectively contributed to the declining predicted vaccine effectiveness (VE) from 74% in 2016 down to 48% in 2017.
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Masse S, Capai L, Falchi A. Epidemiology of Respiratory Pathogens among Elderly Nursing Home Residents with Acute Respiratory Infections in Corsica, France, 2013-2017. Biomed Res Int 2017; 2017:1423718. [PMID: 29392127 DOI: 10.1155/2017/1423718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/25/2017] [Accepted: 11/16/2017] [Indexed: 12/02/2022]
Abstract
Background The current study aims to describe the demographical and clinical characteristics of elderly nursing home (NH) residents with acute respiratory infections (ARIs) during four winter seasons (2013/2014–2016/2017), as well as the microbiological etiology of these infections. Methods Seventeen NHs with at least one ARI resident in Corsica, France, were included. An ARI resident was defined as a resident developing a sudden onset of any constitutional symptoms in addition to any respiratory signs. Nasopharyngeal swabs from ARI residents were screened for the presence of 21 respiratory agents, including seasonal influenza viruses. Results Of the 107 ARI residents enrolled from NHs, 61 (57%) were positive for at least one of the 21 respiratory pathogens. Forty-one (38.3%) of the 107 ARI residents had influenza: 38 (92%) were positive for influenza A (100% A(H3N2)) and three (8%) for influenza B/Victoria. Axillary fever (≥38°C) was significantly more common among patients infected with influenza A(H3N2). Conclusion The circulation of seasonal respiratory viruses other than influenza A(H3N2) seems to be sporadic among elderly NH residents. Investigating the circulation of respiratory viruses in nonwinter seasons seems to be important in order to understand better the dynamic of their year-round circulation in NHs.
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Stein Y, Mandelboim M, Sefty H, Pando R, Mendelson E, Shohat T, Glatman-Freedman A, Muhamed A, Arkadi A, Yoav A, Shlomo A, Galab A, Lev D, Akiva F, Michael G, Ali HD, Kamil H, Yael H, Ella K, Angela K, Yoseph L, Tali L, Alexander L, Nadia MW, Nir M, Oded M, Idit M, Margarita N, Shiri PM, Karen R, Nirit S, Eva S, Rephael S, Paul S, Ronen Y, Ran Z. Seasonal Influenza Vaccine Effectiveness in Preventing Laboratory-Confirmed Influenza in Primary Care in Israel, 2016–2017 Season: Insights Into Novel Age-Specific Analysis. Clin Infect Dis 2017; 66:1383-1391. [DOI: 10.1093/cid/cix1013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/13/2017] [Indexed: 01/24/2023] Open
Affiliation(s)
- Yaniv Stein
- Israel Center for Disease Control, Israel Ministry of Health, Tel-Hashomer, Tel Aviv University, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Israel Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hanna Sefty
- Israel Center for Disease Control, Israel Ministry of Health, Tel-Hashomer, Tel Aviv University, Israel
| | - Rakefet Pando
- Central Virology Laboratory, Israel Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Israel Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Tel-Hashomer, Tel Aviv University, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Aharona Glatman-Freedman
- Israel Center for Disease Control, Israel Ministry of Health, Tel-Hashomer, Tel Aviv University, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Departments of Pediatrics and Family and Community Medicine, New York Medical College, Valhalla
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49
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Pebody R, Warburton F, Ellis J, Andrews N, Potts A, Cottrell S, Reynolds A, Gunson R, Thompson C, Galiano M, Robertson C, Gallagher N, Sinnathamby M, Yonova I, Correa A, Moore C, Sartaj M, de Lusignan S, McMenamin J, Zambon M. End-of-season influenza vaccine effectiveness in adults and children, United Kingdom, 2016/17. Euro Surveill 2017; 22:17-00306. [PMID: 29113630 PMCID: PMC5710133 DOI: 10.2807/1560-7917.es.2017.22.44.17-00306] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IntroductionThe United Kingdom is in the fourth season of introducing a universal childhood influenza vaccine programme. The 2016/17 season saw early influenza A(H3N2) virus circulation with care home outbreaks and increased excess mortality particularly in those 65 years or older. Virus characterisation data indicated emergence of genetic clusters within the A(H3N2) 3C.2a group which the 2016/17 vaccine strain belonged to. Methods: The test-negative case-control (TNCC) design was used to estimate vaccine effectiveness (VE) against laboratory confirmed influenza in primary care. Results: Adjusted end-of-season vaccine effectiveness (aVE) estimates were 39.8% (95% confidence interval (CI): 23.1 to 52.8) against all influenza and 40.6% (95% CI: 19.0 to 56.3) in 18-64-year-olds, but no significant aVE in ≥ 65-year-olds. aVE was 65.8% (95% CI: 30.3 to 83.2) for 2-17-year-olds receiving quadrivalent live attenuated influenza vaccine. Discussion: The findings continue to provide support for the ongoing roll-out of the paediatric vaccine programme, with a need for ongoing evaluation. The importance of effective interventions to protect the ≥ 65-year-olds remains.
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Affiliation(s)
| | | | | | | | - Alison Potts
- Health Protection Scotland, Glasgow, United Kingdom
| | | | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | | | | | | | - Naomh Gallagher
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | - Ivelina Yonova
- University of Surrey, Guildford, United Kingdom,Royal College of General Practitioners, London, United Kingdom
| | - Ana Correa
- University of Surrey, Guildford, United Kingdom
| | | | - Muhammad Sartaj
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Simon de Lusignan
- University of Surrey, Guildford, United Kingdom,Royal College of General Practitioners, London, United Kingdom
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50
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Vestergaard LS, Nielsen J, Krause TG, Espenhain L, Tersago K, Bustos Sierra N, Denissov G, Innos K, Virtanen MJ, Fouillet A, Lytras T, Paldy A, Bobvos J, Domegan L, O'Donnell J, Scortichini M, de Martino A, England K, Calleja N, van Asten L, Teirlinck AC, Tønnessen R, White RA, P Silva S, Rodrigues AP, Larrauri A, Leon I, Farah A, Junker C, Sinnathamby M, Pebody RG, Reynolds A, Bishop J, Gross D, Adlhoch C, Penttinen P, Mølbak K. Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017. ACTA ACUST UNITED AC 2017; 22:30506. [PMID: 28424146 PMCID: PMC5388126 DOI: 10.2807/1560-7917.es.2017.22.14.30506] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022]
Abstract
Since December 2016, excess all-cause mortality was observed in many European countries, especially among people aged ≥ 65 years. We estimated all-cause and influenza-attributable mortality in 19 European countries/regions. Excess mortality was primarily explained by circulation of influenza virus A(H3N2). Cold weather snaps contributed in some countries. The pattern was similar to the last major influenza A(H3N2) season in 2014/15 in Europe, although starting earlier in line with the early influenza season start.
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Affiliation(s)
| | | | | | | | | | | | - Gleb Denissov
- National Institute for Health Development, Tallinn, Estonia
| | - Kaire Innos
- National Institute for Health Development, Tallinn, Estonia
| | | | - Anne Fouillet
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Theodore Lytras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Anna Paldy
- National Public Health Center, Budapest, Hungary
| | - Janos Bobvos
- National Public Health Center, Budapest, Hungary
| | - Lisa Domegan
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | - Liselotte van Asten
- National Institute of Public Health and the Environment (RIVM), The Netherlands
| | - Anne C Teirlinck
- National Institute of Public Health and the Environment (RIVM), The Netherlands
| | | | | | - Susana P Silva
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ana P Rodrigues
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Amparo Larrauri
- CIBER Epidemiología y Salud Pública (CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Leon
- CIBER Epidemiología y Salud Pública (CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
| | - Ahmed Farah
- The Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | | | | | | | - Diane Gross
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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