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Moa A, Kunasekaran M, Akhtar Z, Costantino V, MacIntyre CR. Systematic review of influenza vaccine effectiveness against laboratory-confirmed influenza among older adults living in aged care facilities. Hum Vaccin Immunother 2023; 19:2271304. [PMID: 37929779 PMCID: PMC10629430 DOI: 10.1080/21645515.2023.2271304] [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: 07/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
We estimated the effectiveness of influenza vaccines in preventing laboratory-confirmed influenza among older adults in aged care. Electronic database searches were conducted using search terms, and studies were selected as per the selection criteria. Fourteen studies were included for final review. The studies exhibited considerable variation in reported vaccine effectiveness (VE) across different seasons. Among the observational studies, VE ranged from 7.2% to 89.8% against laboratory-confirmed influenza across different vaccines. Randomized clinical trials demonstrated a 17% reduction in infection rates with the adjuvanted trivalent vaccine. The limitations include the small number of included studies conducted in different countries or regions, varied seasons, variations in diagnostic testing methods, a focus on the A/H3N2 strain, and few studies available on the effectiveness of enhanced influenza vaccines in aged care settings. Despite challenges associated with achieving optimal protection, the studies showed the benefits of influenza vaccination in the elderly residents.
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Affiliation(s)
- Aye Moa
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Zubair Akhtar
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Valentina Costantino
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
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Doyon-Plourde P, Fortin É, Quach C. Evaluation of influenza case definitions for use in real-world evidence research. Can Commun Dis Rep 2022; 48:392-395. [PMID: 38106645 PMCID: PMC10723760] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Laboratory confirmation of influenza is not routinely done in practice. With the advent of big data, it is tempting to use healthcare administrative databases for influenza vaccine effectiveness studies, which often rely on clinical diagnosis codes. The objective of this article is to compare influenza incidence curves using international case definitions derived from clinical diagnostic codes with influenza surveillance data from the United States (US) Centers for Disease Control and Prevention (CDC). Methods This case series describes influenza incidence by CDC week, defined using International Classification of Disease diagnostic codes over four influenza seasons (2015-2016 to 2018-2019) in a cohort of US individuals three years of age and older who consulted at least once per year between 2015 and 2019. Results were compared to the number of influenza-positive specimens or outpatient visits for influenza-like illness obtained from the CDC flu surveillance data. Results The incidence curves of influenza-related medical encounters were very similar to the CDC's surveillance data for laboratory-confirmed influenza. Conversely, the number of influenza-like illness encounters was high when influenza viruses started to circulate, leading to a discrepancy with CDC-reported data. Conclusion A specific case definition should be prioritized when data for laboratory-confirmed influenza are not available, as a broader case definition would conservatively bias influenza vaccine effectiveness toward the null.
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Affiliation(s)
- Pamela Doyon-Plourde
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montréal, Montréal, QC
- Research Institute–CHU Sainte-Justine, Montréal, QC
| | - Élise Fortin
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montréal, Montréal, QC
- Institut national de santé publique du Québec, Montréal, QC
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montréal, Montréal, QC
- Research Institute–CHU Sainte-Justine, Montréal, QC
- Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, QC
- Infection Prevention & Control, CHU Sainte-Justine, Montréal, QC
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Vasileiou E, Sheikh A, Butler CC, Robertson C, Kavanagh K, Englishby T, Lone NI, von Wissmann B, McMenamin J, Ritchie LD, Schwarze J, Gunson R, Simpson CR. Seasonal Influenza Vaccine Effectiveness in People With Asthma: A National Test-Negative Design Case-Control Study. Clin Infect Dis 2021; 71:e94-e104. [PMID: 31688921 DOI: 10.1093/cid/ciz1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza infection is a trigger of asthma attacks. Influenza vaccination can potentially reduce the incidence of influenza in people with asthma, but uptake remains persistently low, partially reflecting concerns about vaccine effectiveness (VE). METHODS We conducted a test-negative designed case-control study to estimate the effectiveness of influenza vaccine in people with asthma in Scotland over 6 seasons (2010/2011 to 2015/2016). We used individual patient-level data from 223 practices, which yielded 1 830 772 patient-years of data that were linked with virological (n = 5910 swabs) data. RESULTS Vaccination was associated with an overall 55.0% (95% confidence interval [CI], 45.8-62.7) risk reduction of laboratory-confirmed influenza infections in people with asthma over 6 seasons. There were substantial variations in VE between seasons, influenza strains, and age groups. The highest VE (76.1%; 95% CI, 55.6-87.1) was found in the 2010/2011 season, when the A(H1N1) strain dominated and there was a good antigenic vaccine match. High protection was observed against the A(H1N1) (eg, 2010/2011; 70.7%; 95% CI, 32.5-87.3) and B strains (eg, 2010/2011; 83.2%; 95% CI, 44.3-94.9), but there was lower protection for the A(H3N2) strain (eg, 2014/2015; 26.4%; 95% CI, -12.0 to 51.6). The highest VE against all viral strains was observed in adults aged 18-54 years (57.0%; 95% CI, 42.3-68.0). CONCLUSIONS Influenza vaccination gave meaningful protection against laboratory-confirmed influenza in people with asthma across all seasons. Strategies to boost influenza vaccine uptake have the potential to substantially reduce influenza-triggered asthma attacks.
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Affiliation(s)
- Eleftheria Vasileiou
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Chris C Butler
- Nuffield Department of Primary Care Health Sciences, Oxford University, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, United Kingdom and Cardiff University, Institute of Primary Care and Public Health, Cardiff, United Kingdom
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom and Health Protection Scotland, Glasgow, United Kingdom
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Tanya Englishby
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Nazir I Lone
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Beatrix von Wissmann
- Health Protection Scotland, National Health Service (NHS) National Services Scotland, Glasgow, United Kingdom
| | - Jim McMenamin
- Health Protection Scotland, National Health Service (NHS) National Services Scotland, Glasgow, United Kingdom
| | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Jürgen Schwarze
- Centre for Inflammation Research, Queen's Medical Research Institute, Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | - Colin R Simpson
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
- School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand and Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
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Panatto D, Lai PL, Mosca S, Lecini E, Orsi A, Signori A, Castaldi S, Pariani E, Pellegrinelli L, Galli C, Anselmi G, Icardi G. Influenza Vaccination in Italian Healthcare Workers (2018-2019 Season): Strengths and Weaknesses. Results of a Cohort Study in Two Large Italian Hospitals. Vaccines (Basel) 2020; 8:vaccines8010119. [PMID: 32150801 PMCID: PMC7157508 DOI: 10.3390/vaccines8010119] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/31/2020] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Annual vaccination is the most effective way to combat influenza. As influenza viruses evolve, seasonal vaccines are updated annually. Within the European project Development of Robust and Innovative Vaccine Effectiveness (DRIVE), a cohort study involving Italian healthcare workers (HCWs) was carried out during the 2018-2019 season. Two aims were defined: to measure influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza cases and to conduct an awareness-raising campaign to increase vaccination coverage. METHODS Each subject enrolled was followed up from enrollment to the end of the study. Each HCW who developed ILI was swabbed for laboratory confirmation of influenza. Influenza viruses were identified by molecular assays. A Cox regression analysis, crude and adjusted for confounding variables, was performed to estimate the IVE. RESULTS Among the 4483 HCWs enrolled, vaccination coverage was 32.5%, and 308 ILI cases were collected: 23.4% were positive for influenza (54.2% A(H1N1) pdm09; 45.8% A(H3N2)). No influenza B viruses were detected. No overall IVE was observed. Analyzing the subtypes of influenza A viruses, the IVE was estimated as 45% (95% CI: -59 to 81) for A(H1N1) pdm09. CONCLUSIONS Vaccination coverage among HCWs increased. Study difficulties and the circulation of drifted variants of A(H3N2) could partly explain the observed IVE.
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Affiliation(s)
- Donatella Panatto
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
- Correspondence: ; Tel.: +390103538109
| | - Piero Luigi Lai
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Stefano Mosca
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Elvina Lecini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Via F. Sforza 28, 20122 Milano, Italy
| | - Elena Pariani
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Giovanni Anselmi
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy; (S.M.); (E.P.)
| | - CIRI-IT Team
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (P.L.L.); (E.L.); (A.O.); (A.S.); (G.I.)
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milano, Italy; (S.C.); (L.P.); (C.G.); (G.A.)
- Ospedale Policlinico San Martino IRCCS, Largo R. Benzi 10, 16132 Genoa, Italy
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Suárez-Varela MM, Llopis A, Fernandez-Fabrellas E, Sanz F, Perez-Lozano MJ, Martin V, Astray J, Castilla J, Egurrola M, Force L, Toledo D, Domínguez À. Asthma and influenza vaccination in elderly hospitalized patients: Matched case-control study in Spain. J Asthma 2017. [PMID: 28636411 DOI: 10.1080/02770903.2017.1332204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Influenza infection is an exacerbating factor for asthma, and its prevention is critical in managing asthmatic patients. We investigated the effect of influenza vaccination on asthmatic and non-asthmatic patients hospitalized with laboratory-confirmed influenza in Spain. METHODS We made a matched case-control study to assess the frequency of hospitalization for influenza in people aged ≥65 years. Hospitalized patients with unplanned hospital admissions were recruited from 20 hospitals representing seven Spanish regions. Cases were defined as those hospitalized due to a laboratory-confirmed influenza infection and controls were matched by age, sex, and hospital. Data were obtained from clinical records, and patients stratified by clinical asthma history. Vaccination status and asthma due to influenza infection were analyzed according to sociodemographic variables and medical risk conditions. Multivariable analysis was made using conditional logistic regression models. RESULTS 582 hospitalized patients with influenza (15.8% asthmatic) and 1,570 hospitalized patients without influenza (7.9% asthmatic) were included. In the multivariable conditional logistic regression using unvaccinated and non-asthmatic patients as the reference group, vaccination significantly prevented influenza in non-asthmatic patients (aOR = 0.63; 95% CI: 0.45, 0.88) and also showed a trend for a possibly protective effect in asthmatic patients (aOR = 0.79; 95% CI: 0.34, 1.81). CONCLUSION Our results suggest that influenza vaccination could be a protective factor for asthmatic patients, although the results are inconclusive and further research is required. Practically, given the better clinical evolution of vaccinated asthma cases, and the lack of better evidence, the emphasis on vaccination of this group should continue.
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Affiliation(s)
- María Morales Suárez-Varela
- a Área de Medicina Preventiva y Salud Publica, Departamento de Medicina Preventiva , Universidad de Valencia , Burjasot, Valencia , Spain.,b CIBER en Epidemiologia y Salud Pública (CIBERESP) , Madrid , Spain.,c Centro Superior de Investigación en Salud Pública (CSISP) , Valencia , Spain
| | - Agustin Llopis
- a Área de Medicina Preventiva y Salud Publica, Departamento de Medicina Preventiva , Universidad de Valencia , Burjasot, Valencia , Spain.,b CIBER en Epidemiologia y Salud Pública (CIBERESP) , Madrid , Spain.,c Centro Superior de Investigación en Salud Pública (CSISP) , Valencia , Spain
| | | | | | - M Jose Perez-Lozano
- e Servicio de Medicina Preventiva , Hospital Universitario del Valme , Sevilla, Andalucia , Spain
| | - Vicente Martin
- f Área de Medicina Preventiva y Salud Publica, Departamento de Ciencias Biomédicas , Universidad de León , León , Spain
| | - Jenaro Astray
- g Subdirección General de Epidemiologia de la Comunidad de Madrid , Madrid , Spain
| | - Jesús Castilla
- h Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Recinto de Complejo Hospitalario de Navarra C/Irunlarrea , Pamplona, Navarra , Spain
| | - Mikel Egurrola
- i Servicio de Inmunología , Hospital de Galdakao-Usansolo , Usansolo, Vizcaya , Spain
| | - Luis Force
- j Hospital de Mataró , Mataró, Barcelona , Spain
| | - Diana Toledo
- b CIBER en Epidemiologia y Salud Pública (CIBERESP) , Madrid , Spain.,k Departamento de Salud Pública , Universidad de Barcelona , Barcelona , Spain
| | - Àngela Domínguez
- b CIBER en Epidemiologia y Salud Pública (CIBERESP) , Madrid , Spain.,k Departamento de Salud Pública , Universidad de Barcelona , Barcelona , Spain
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Domínguez A, Castilla J, Godoy P, Delgado-Rodríguez M, Saez M, Soldevila N, Astray J, Mayoral JM, Martín V, Quintana JM, González-Candelas F, Galán JC, Tamames S, Castro A, Baricot M, Garín O, Pumarola T. Effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine in preventing hospitalization with laboratory confirmed influenza during the 2009-2010 and 2010-2011 seasons. Hum Vaccin Immunother 2013; 9:865-73. [PMID: 23563516 DOI: 10.4161/hv.23090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 01/22/2023] Open
Abstract
BACKGROUND Since influenza predisposes to bacterial pneumonia caused by Streptococcus pneumoniae, studies have suggested that pneumococcal vaccination might reduce its occurrence during pandemics. We assessed the effectiveness of pneumococcal polysaccharide vaccination alone and in combination with influenza vaccination in preventing influenza hospitalization during the 2009-2010 pandemic wave and 2010-2011 influenza epidemic. RESULTS 1187 cases and 2328 controls were included. The adjusted estimate of effectiveness of pneumococcal vaccination in preventing influenza hospitalization was 41% (95% CI 8-62) in all patients and 43% (95% CI 2-78) in patients aged ≥ 65 y. The adjusted effectiveness of dual PPV23 and influenza vaccination was 81% (95% CI 65-90) in all patients and 76% (95% CI 46-90) in patients aged ≥ 65 y. The adjusted effectiveness of influenza vaccination alone was 58% (95% CI 38-72). METHODS We conducted a multicenter case-control study in 36 Spanish hospitals. We selected patients aged ≥ 18 y hospitalized with confirmed influenza and two hospitalized controls per case, matched according to age, date of hospitalization and province of residence. Multivariate analysis was performed using conditional logistic regression. Subjects were considered vaccinated if they had received the pneumococcal or seasonal influenza vaccine>14 d (or>7 d for pandemic influenza vaccine) before the onset of symptoms (cases) or the onset of symptoms in matched cases (controls). CONCLUSIONS In elderly people and adults with chronic illness, pneumococcal vaccination may reduce hospitalizations during the influenza season. In people vaccinated with both the influenza and pneumococcal vaccines, the benefit in hospitalizations avoided was greater than in those vaccinated only against influenza.
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Affiliation(s)
- Angela Domínguez
- Department de Salut Pública; Universitat de Barcelona; Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
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