51
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Kwong JC, Chung H, Jung JK, Buchan SA, Campigotto A, Campitelli MA, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Schwartz KL, Simor A, Smieja M, Zahariadis G, On Behalf Of The Canadian Immunization Research Network Cirn Investigators. The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada. ACTA ACUST UNITED AC 2020; 25. [PMID: 31937397 PMCID: PMC6961264 DOI: 10.2807/1560-7917.es.2020.25.1.1900245] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Annual influenza vaccination is recommended for older adults, but evidence regarding the impact of repeated vaccination has been inconclusive. Aim We investigated vaccine effectiveness (VE) against laboratory-confirmed influenza and the impact of repeated vaccination over 10 previous seasons on current season VE among older adults. Methods We conducted an observational test-negative study in community-dwelling adults aged > 65 years in Ontario, Canada for the 2010/11 to 2015/16 seasons by linking laboratory and health administrative data. We estimated VE using multivariable logistic regression. We assessed the impact of repeated vaccination by stratifying by previous vaccination history. Results We included 58,304 testing episodes for respiratory viruses, with 11,496 (20%) testing positive for influenza and 31,004 (53%) vaccinated. Adjusted VE against laboratory-confirmed influenza for the six seasons combined was 21% (95% confidence interval (CI): 18 to 24%). Patients who were vaccinated in the current season, but had received no vaccinations in the previous 10 seasons, had higher current season VE (34%; 95%CI: 9 to 52%) than patients who had received 1–3 (26%; 95%CI: 13 to 37%), 4–6 (24%; 95%CI: 15 to 33%), 7–8 (13%; 95%CI: 2 to 22%), or 9–10 (7%; 95%CI: −4 to 16%) vaccinations (trend test p = 0.001). All estimates were higher after correcting for misclassification of current season vaccination status. For patients who were not vaccinated in the current season, residual protection rose significantly with increasing numbers of vaccinations received previously. Conclusions Although VE appeared to decrease with increasing numbers of previous vaccinations, current season vaccination likely provides some protection against influenza regardless of the number of vaccinations received over the previous 10 influenza seasons.
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Affiliation(s)
- Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | - Sarah A Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Aaron Campigotto
- Hospital for Sick Children, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | | | - Natasha S Crowcroft
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- Sinai Health System, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J Dayre McNally
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Andrew Simor
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - George Zahariadis
- Newfoundland & Labrador Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada.,London Health Sciences Centre, London, Ontario, Canada
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52
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Ng TWY, Perera RAPM, Fang VJ, Yau EM, Peiris JSM, Tam YH, Cowling BJ. The Effect of Influenza Vaccination History on Changes in Hemagglutination Inhibition Titers After Receipt of the 2015-2016 Influenza Vaccine in Older Adults in Hong Kong. J Infect Dis 2020; 221:33-41. [PMID: 31282541 DOI: 10.1093/infdis/jiz327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Immune responses to influenza vaccination can be weaker in older adults than in other age groups. We hypothesized that antibody responses would be particularly weak among repeat vaccinees when the current and prior season vaccine components are the same. METHODS An observational study was conducted among 827 older adults (aged ≥75 years) in Hong Kong. Serum samples were collected immediately before and 1 month after receipt of the 2015-2016 quadrivalent inactivated influenza vaccine. We measured antibody titers with the hemagglutination inhibition assay and compared the mean fold rise from prevaccination to postvaccination titers and the proportions with postvaccination titers ≥40 or ≥160. RESULTS Participants who reported receipt of vaccination during either of the previous 2 years had a lower mean fold rise against all strains than with those who did not. Mean fold rises for A(H3N2) and B/Yamagata were particularly weak after repeated vaccination with the same vaccine strain, but we did not generally find significant differences in the proportions of participants with postvaccination titers ≥40 and ≥160. CONCLUSIONS Overall, we found that reduced antibody responses in repeat vaccinees were particularly reduced among older adults who had received vaccination against the same strains in preceding years.
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Affiliation(s)
- Tiffany W Y Ng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ranawaka A P M Perera
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Emily M Yau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yat Hung Tam
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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53
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Mira-Iglesias A, López-Labrador FX, Baselga-Moreno V, Tortajada-Girbés M, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J, On Behalf Of The Valencia Hospital Network For The Study Of Influenza And Respiratory Viruses Disease. Influenza vaccine effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, Spain, 2017/18 influenza season. ACTA ACUST UNITED AC 2020; 24. [PMID: 31387672 PMCID: PMC6685101 DOI: 10.2807/1560-7917.es.2019.24.31.1800461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Influenza immunisation is recommended for elderly people each season. The influenza vaccine effectiveness (IVE) varies annually due to influenza viruses evolving and the vaccine composition. Aim To estimate, in inpatients ≥ 60 years old, the 2017/18 trivalent IVE, overall, by vaccine type and by strain. The impact of vaccination in any of the two previous seasons (2016/17 and 2015/16) on current (2017/18) IVE was also explored. Methods This was a multicentre prospective observational study within the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI, Spain). The test-negative design was applied taking laboratory-confirmed influenza as outcome and vaccination status as main exposure. Information about potential confounders was obtained from clinical registries and/or by interviewing patients; vaccine information was only ascertained by registries. Results Overall, 2017/18 IVE was 9.9% (95% CI: −15.5 to 29.6%), and specifically, 48.3% (95% CI: 13.5% to 69.1%), −29.9% (95% CI: −79.1% to 5.8%) and 25.7% (95% CI: −8.8% to 49.3%) against A(H1N1)pdm09, A(H3N2) and B/Yamagata lineage, respectively. For the adjuvanted and non-adjuvanted vaccines, overall IVE was 10.0% (95% CI: −24.4% to 34.9%) and 7.8% (95% CI: −23.1% to 31.0%) respectively. Prior vaccination significantly protected against influenza B/Yamagata lineage (IVE: 50.2%; 95% CI: 2.3% to 74.6%) in patients not vaccinated in the current season. For those repeatedly vaccinated against influenza A(H1N1)pdm09, IVE was 46.4% (95% CI: 6.8% to 69.2%). Conclusion Our data revealed low vaccine effectiveness against influenza in hospitalised patients ≥60 years old in 2017/18. Prior vaccination protected against influenza A(H1N1)pdm09 and B/Yamagata-lineage.
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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
| | - Víctor Baselga-Moreno
- 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
| | | | - 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
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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Arevalo P, McLean HQ, Belongia EA, Cobey S. Earliest infections predict the age distribution of seasonal influenza A cases. eLife 2020; 9:e50060. [PMID: 32633233 PMCID: PMC7367686 DOI: 10.7554/elife.50060] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 06/29/2020] [Indexed: 12/02/2022] Open
Abstract
Seasonal variation in the age distribution of influenza A cases suggests that factors other than age shape susceptibility to medically attended infection. We ask whether these differences can be partly explained by protection conferred by childhood influenza infection, which has lasting impacts on immune responses to influenza and protection against new influenza A subtypes (phenomena known as original antigenic sin and immune imprinting). Fitting a statistical model to data from studies of influenza vaccine effectiveness (VE), we find that primary infection appears to reduce the risk of medically attended infection with that subtype throughout life. This effect is stronger for H1N1 compared to H3N2. Additionally, we find evidence that VE varies with both age and birth year, suggesting that VE is sensitive to early exposures. Our findings may improve estimates of age-specific risk and VE in similarly vaccinated populations and thus improve forecasting and vaccination strategies to combat seasonal influenza.
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Affiliation(s)
- Philip Arevalo
- Department of Ecology and Evolutionary Biology, University of ChicagoChicagoUnited States
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research InstituteMarshfieldUnited States
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research InstituteMarshfieldUnited States
| | - Sarah Cobey
- Department of Ecology and Evolutionary Biology, University of ChicagoChicagoUnited States
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55
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Thompson MG, Kwong JC, Regan AK, Katz MA, Drews SJ, Azziz-Baumgartner E, Klein NP, Chung H, Effler PV, Feldman BS, Simmonds K, Wyant BE, Dawood FS, Jackson ML, Fell DB, Levy A, Barda N, Svenson LW, Fink RV, Ball SW, Naleway A. Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010-2016. Clin Infect Dis 2020; 68:1444-1453. [PMID: 30307490 DOI: 10.1093/cid/ciy737] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy. METHODS The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada (Alberta and Ontario), Israel, and the United States (California, Oregon, and Washington). Sites identified pregnant women aged 18 through 50 years whose pregnancies overlapped with local influenza seasons from 2010 through 2016. Administrative data were used to identify hospitalizations with acute respiratory or febrile illness (ARFI) and clinician-ordered real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for influenza viruses. Overall IVE was estimated using the test-negative design and adjusting for site, season, season timing, and high-risk medical conditions. RESULTS Among 19450 hospitalizations with an ARFI discharge diagnosis (across 25 site-specific study seasons), only 1030 (6%) of the pregnant women were tested for influenza viruses by rRT-PCR. Approximately half of these women had pneumonia or influenza discharge diagnoses (54%). Influenza A or B virus infections were detected in 598/1030 (58%) of the ARFI hospitalizations with influenza testing. Across sites and seasons, 13% of rRT-PCR-confirmed influenza-positive pregnant women were vaccinated compared with 22% of influenza-negative pregnant women; the adjusted overall IVE was 40% (95% confidence interval = 12%-59%) against influenza-associated hospitalization during pregnancy. CONCLUSION Between 2010 and 2016, influenza vaccines offered moderate protection against laboratory-confirmed influenza-associated hospitalizations during pregnancy, which may further inform the benefits of maternal influenza vaccination programs.
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Affiliation(s)
- Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences.,Public Health Ontario.,Department of Family and Community Medicine, University of Toronto.,Dalla Lana School of Public Health, University of Toronto.,University Health Network, Toronto, Ontario, Canada
| | - Annette K Regan
- School of Public Health, Curtin University, Perth.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, Western Australia, Australia
| | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv.,School of Public Health, Medical School for International Health, Ben Gurion University, Bersheva, Israel.,University of Michigan School of Public Health, Ann Arbor
| | - Steven J Drews
- University of Alberta.,ProvLab Alberta, Edmonton, Canada
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland
| | | | - Paul V Effler
- Communicable Disease Control Directorate, Department of Health Western Australia, Perth, Australia
| | - Becca S Feldman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Kimberley Simmonds
- Cumming School of Medicine, University of Calgary.,Alberta Health, Edmonton, Canada
| | | | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Deshayne B Fell
- Institute for Clinical Evaluative Sciences.,School of Epidemiology and Public Health, University of Ottawa.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Avram Levy
- Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Noam Barda
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Lawrence W Svenson
- Alberta Health, Edmonton, Canada.,Division of Preventive Medicine.,School of Public Health, University of Alberta, Edmonton.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Allison Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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56
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Stacey HD, Miller MS. Repeated Seasonal Influenza Vaccination: How Much Is Too Much of a Good Thing? J Infect Dis 2020; 222:173-175. [PMID: 31504654 DOI: 10.1093/infdis/jiz434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hannah D Stacey
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Matthew S Miller
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
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57
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McLean HQ, King JP, Talley P, Flannery B, Spencer S, Levine MZ, Friedrich TC, Belongia EA. Effect of Previous-Season Influenza Vaccination on Serologic Response in Children During 3 Seasons, 2013-2014 Through 2015-2016. J Pediatric Infect Dis Soc 2020; 9:173-180. [PMID: 30759228 PMCID: PMC7192403 DOI: 10.1093/jpids/piz001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The effects of repeated influenza vaccination in children are not well understood. In this study, we evaluated previous vaccination effects on antibody response after vaccination with trivalent inactivated influenza vaccine (IIV) or quadrivalent live-attenuated influenza vaccine (LAIV) among school-aged children (5-17 years) across 3 seasons. METHODS Children were enrolled in the fall of 2013, 2014, and 2015. The participants received IIV or LAIV according to parent preference (2013-2014) or our randomization scheme (2014-2015). All study children received IIV in 2015-2016. Hemagglutination-inhibition assays measured antibody response to egg-grown vaccine strains from prevaccination and postvaccination serum samples. Geometric mean titers (GMTs) and increases in GMTs from before to after vaccination (geometric mean fold rise [GMFR]) were estimated from repeated-measures linear mixed models. RESULTS We enrolled 161 children in 2013-2014, 128 in 2014-2015, and 126 in 2015-2016. Among the IIV recipients, responses to the influenza A(H1N1)pdm09 and B vaccine strains were lowest among children who had received a previous-season IIV. The GMFRs for strains A(H1N1)pdm09 and B were 1.5 to 2.3 for previous-season IIV and 4.3 to 12.9 for previous-season LAIV or no previous vaccine. GMFRs were lower for strain A(H3N2), and differences according to previous-season vaccination history were smaller and not significant in most seasons. Most children had a post-IIV vaccination titer of ≥40 for vaccine strains in all seasons, regardless of previous-season vaccination history. Little to no increase in antibody levels was observed after vaccination with LAIV. CONCLUSIONS Serologic response to vaccination was greatest for IIV, but previous-season vaccination modified IIV response to A(H1N1)pdm09 and B. Influenza A(H3N2) responses were low in all groups, and LAIV generated minimal serologic response against all strains.
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Affiliation(s)
- Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Wisconsin
| | - Jennifer P King
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Wisconsin
| | - Pamela Talley
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, St Paul
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas C Friedrich
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine and Wisconsin National Primate Research Center, Madison
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Wisconsin
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58
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Wesley MG, Soto G, Arriola CS, Gonzales M, Newes-Adeyi G, Romero C, Veguilla V, Levine MZ, Silva M, Ferdinands JM, Dawood FS, Reynolds SB, Hirsch A, Katz M, Matos E, Ticona E, Castro J, Castillo M, Bravo E, Cheung A, Phadnis R, Martin ET, Tinoco Y, Neyra Quijandria JM, Azziz-Baumgartner E, Thompson MG. Prospective cohort study of influenza vaccine effectiveness among healthcare personnel in Lima, Peru: Estudio Vacuna de Influenza Peru, 2016-2018. Influenza Other Respir Viruses 2020; 14:391-402. [PMID: 32249553 PMCID: PMC7298283 DOI: 10.1111/irv.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
Background The Estudio Vacuna de Influenza Peru (VIP) cohort aims to describe the frequency of influenza virus infection, identify predictors of vaccine acceptance, examine the effects of repeated influenza vaccination on immunogenicity, and evaluate influenza vaccine effectiveness among HCP. Methods The VIP cohort prospectively followed HCP in Lima, Peru, during the 2016‐2018 influenza seasons; a fourth year is ongoing. Participants contribute blood samples before and after the influenza season and after influenza vaccination (for vaccinees). Weekly surveillance is conducted to identify acute respiratory or febrile illnesses (ARFI). When an ARFI is identified, participants self‐collect nasal swabs that are tested for influenza viruses by real‐time reverse transcriptase‐polymerase chain reaction. Influenza vaccination status and 5‐year vaccination history are ascertained. We analyzed recruitment and enrollment results for 2016‐2018 and surveillance participation for 2016‐2017. Results In the first 3 years of the cohort, VIP successfully contacted 92% of potential participants, enrolled 76% of eligible HCP, and retained >90% of participants across years. About half of participants are medical assistants (54%), and most provide “hands‐on” medical care (76%). Sixty‐nine percent and 52% of participants completed surveillance for >70% of weeks in years 1 and 2, respectively. Fewer weeks of completed surveillance was associated with older age (≥50 years), being a medical assistant, self‐rated health of fair or poor, and not receiving the influenza vaccine during the current season (P‐values < .05). Conclusions The VIP cohort provides an opportunity to address knowledge gaps about influenza virus infection, vaccination uptake, effectiveness and immunogenicity among HCP.
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Affiliation(s)
- Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Candice Romero
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Vic Veguilla
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Silva
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sue B Reynolds
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Avital Hirsch
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Mark Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | | | | | - Juan Castro
- Hospital Nacional Daniel Alcides Carrion, Lima, Peru
| | - Maria Castillo
- Instituto Nacional de Salud del Niño, Lima, Peru.,Medical School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduar Bravo
- Medical School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | - Yeny Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | | | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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59
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Skowronski DM, Leir S, Sabaiduc S, Chambers C, Zou M, Rose C, Olsha R, Dickinson JA, Winter AL, Jassem A, Gubbay JB, Drews SJ, Charest H, Chan T, Hickman R, Bastien N, Li Y, Krajden M, De Serres G. Influenza vaccine effectiveness by A(H3N2) phylogenetic sub-cluster and prior vaccination history: 2016-17 and 2017-18 epidemics in Canada. J Infect Dis 2020; 225:1387-1398. [PMID: 32215564 PMCID: PMC9016427 DOI: 10.1093/infdis/jiaa138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/23/2020] [Indexed: 12/29/2022] Open
Abstract
Background The influenza A(H3N2) vaccine was updated from clade 3C.3a in 2015–2016 to 3C.2a for 2016–2017 and 2017–2018. Circulating 3C.2a viruses showed considerable hemagglutinin glycoprotein diversification and the egg-adapted vaccine also bore mutations. Methods Vaccine effectiveness (VE) in 2016–2017 and 2017–2018 was assessed by test-negative design, explored by A(H3N2) phylogenetic subcluster and prior season’s vaccination history. Results In 2016–2017, A(H3N2) VE was 36% (95% confidence interval [CI], 18%–50%), comparable with (43%; 95% CI, 24%–58%) or without (33%; 95% CI, −21% to 62%) prior season’s vaccination. In 2017–2018, VE was 14% (95% CI, −8% to 31%), lower with (9%; 95% CI, −18% to 30%) versus without (45%; 95% CI, −7% to 71%) prior season’s vaccination. In 2016–2017, VE against predominant clade 3C.2a1 viruses was 33% (95% CI, 11%–50%): 18% (95% CI, −40% to 52%) for 3C.2a1a defined by a pivotal T135K loss of glycosylation; 60% (95% CI, 19%–81%) for 3C.2a1b (without T135K); and 31% (95% CI, 2%–51%) for other 3C.2a1 variants (with/without T135K). VE against 3C.2a2 viruses was 45% (95% CI, 2%–70%) in 2016–2017 but 15% (95% CI, −7% to 33%) in 2017–2018 when 3C.2a2 predominated. VE against 3C.2a1b in 2017–2018 was 37% (95% CI, −57% to 75%), lower at 12% (95% CI, −129% to 67%) for a new 3C.2a1b subcluster (n = 28) also bearing T135K. Conclusions Exploring VE by phylogenetic subcluster and prior vaccination history reveals informative heterogeneity. Pivotal mutations affecting glycosylation sites, and repeat vaccination using unchanged antigen, may reduce VE.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Siobhan Leir
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Macy Zou
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | | | | | | | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Steven J Drews
- Provincial Laboratory for Public Health, Edmonton, Alberta.,University of Alberta, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Rebecca Hickman
- British Columbia Centre for Disease Control, Vancouver, 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
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Québec, Canada.,Laval University, Quebec, Canada.,Centre Hospitalier Universitaire de Québec, Québec, Canada
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60
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Hsu PS, Lian IB, Chao DY. A Population-Based Propensity Score-Matched Study to Assess the Impact of Repeated Vaccination on Vaccine Effectiveness for Influenza-Associated Hospitalization Among the Elderly. Clin Interv Aging 2020; 15:301-312. [PMID: 32184579 PMCID: PMC7060795 DOI: 10.2147/cia.s238786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background Influenza is a major cause of morbidity and mortality in the elderly worldwide. Influenza vaccination can prevent morbidity/mortality from influenza infection. A gap of 1–2 years, before an epidemic strain is recommended by the World Health Organization (WHO) to be the vaccine strain in Southeast Asia, has been reported; this results in a high rate of vaccine mismatch and excess influenza-associated morbidity. The aim of the current study was to evaluate the effect of repeated vaccination on vaccine effectiveness (VE) among the elderly in Taiwan, during years with and without early appearance of antigenically drifted strains. Methods A historical cohort study was conducted to evaluate the impact of repeated vaccination on the reduction of influenza-associated hospitalization among persons older than 64 years over two influenza seasons: 2007–08, with all circulating virus strains mismatched, and 2008–09, with all virus strains matched with the vaccine strains, considering four exposure effects, namely current vaccine effect, sequential vaccination effect, residual protection effect and no vaccination effect. Propensity score matching on vaccination status was performed to ensure similar baseline characteristics between the groups that received and did not receive vaccination. Results Only current-year vaccination in combination with prior history of annual revaccination significantly reduced the risk of hospitalization, with adjusted hazard ratios of 0.68 (95% CI: 0.54, 0.85) and 0.74 (95% CI: 0.57, 0.95) during the 2007–08 and 2008–09 influenza seasons, respectively. Further stratification showed that even during the 2007–08 influenza season, when all vaccinations were mismatched with the circulating strains, sequential vaccinations still significantly reduced influenza-associated hospitalization in the female population aged 68–74 and 75–84 years, with adjusted VE of 25.2% (95% CI: −9.6, 49.0%) and 36.9% (95% CI: 17.1, 52.0%), respectively. Conclusion Our study supports the recommendation of annual revaccination against influenza in the elderly, even though the circulating strain of influenza virus was antigenically mismatched with the vaccine strains.
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Affiliation(s)
- Pi-Shan Hsu
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Ie-Bin Lian
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan.,Department of Applied Math, National Chung-Hsing University, Taichung, Taiwan
| | - Day-Yu Chao
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan
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61
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Matrajt L, Halloran ME, Antia R. Successes and Failures of the Live-attenuated Influenza Vaccine: Can We Do Better? Clin Infect Dis 2020; 70:1029-1037. [PMID: 31056675 PMCID: PMC7319054 DOI: 10.1093/cid/ciz358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/30/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The effectiveness of the live-attenuated influenza vaccine (LAIV) can vary widely, ranging from 0% to 50%. The reasons for these discrepancies remain largely unclear. METHODS We use mathematical models to explore how the efficacy of LAIV is affected by the degree of mismatch with the currently circulating influenza strain and interference with pre-existing immunity. The models incorporate 3 key antigenic distances: the distances between the vaccine strain, pre-existing immunity, and the challenge strain. RESULTS Our models show that an LAIV that is matched with the currently circulating strain is likely to have only modest efficacy. Our results suggest that the efficacy of the vaccine would be increased (optimized) if, rather than being matched to the circulating strain, it is antigenically slightly further from pre-existing immunity than the circulating strain. The models also suggest 2 regimes in which LAIV that is matched to circulating strains may be protective: in children before they have built immunity to circulating strains and in response to novel strains (such as antigenic shifts) which are at substantial antigenic distance from previously circulating strains. We provide an explanation for the variation in vaccine effectiveness between studies and countries of vaccine effectiveness observed during the 2014-2015 influenza season. CONCLUSIONS LAIV is offered to children across the world; however, its effectiveness significantly varies between studies. Here, we propose a mechanistic explanation to understand these differences. We further propose a way to select the LAIV strain that would have a higher chance of being protective.
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Affiliation(s)
- Laura Matrajt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center
- Department of Biostatistics, University of Washington, Seattle
| | - Rustom Antia
- Department of Biology, Emory University, Atlanta, Georgia
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Rose AMC, Kissling E, Gherasim A, Casado I, Bella A, Launay O, Lazăr M, Marbus S, Kuliese M, Syrjänen R, Machado A, Kurečić Filipović S, Larrauri A, Castilla J, Alfonsi V, Galtier F, Ivanciuc A, Meijer A, Mickiene A, Ikonen N, Gómez V, Lovrić Makarić Z, Moren A, Valenciano M. Vaccine effectiveness against influenza A(H3N2) and B among laboratory-confirmed, hospitalised older adults, Europe, 2017-18: A season of B lineage mismatched to the trivalent vaccine. Influenza Other Respir Viruses 2020; 14:302-310. [PMID: 32022450 PMCID: PMC7182608 DOI: 10.1111/irv.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/22/2023] Open
Abstract
Background Influenza A(H3N2), A(H1N1)pdm09 and B viruses co‐circulated in Europe in 2017‐18, predominated by influenza B. WHO‐recommended, trivalent vaccine components were lineage‐mismatched for B. The I‐MOVE hospital network measured 2017‐18 seasonal influenza vaccine effectiveness (IVE) against influenza A(H3N2) and B among hospitalised patients (≥65 years) in Europe. Methods Following the same generic protocol for test‐negative design, hospital teams in nine countries swabbed patients ≥65 years with recent onset (≤7 days) severe acute respiratory infection (SARI), collecting information on demographics, vaccination status and underlying conditions. Cases were RT‐PCR positive for influenza A(H3N2) or B; controls: negative for any influenza. “Vaccinated” patients had SARI onset >14 days after vaccination. We measured pooled IVE against influenza, adjusted for study site, age, sex, onset date and chronic conditions. Results We included 3483 patients: 376 influenza A(H3N2) and 928 B cases, and 2028 controls. Most (>99%) vaccinated patients received the B lineage‐mismatched trivalent vaccine. IVE against influenza A(H3N2) was 24% (95% CI: 2 to 40); 35% (95% CI: 6 to 55) in 65‐ to 79‐year‐olds and 14% (95% CI: −22 to 39) in ≥80‐year‐olds. Against influenza B, IVE was 30% (95% CI: 16 to 41); 37% (95% CI: 19 to 51) in 65‐ to 79‐year‐olds and 19% (95% CI: −7 to 38) in ≥80‐year‐olds. Conclusions IVE against influenza B was similar to A(H3N2) in hospitalised older adults, despite trivalent vaccine and circulating B lineage mismatch, suggesting some cross‐protection. IVE was lower in those ≥80 than 65‐79 years. We reinforce the importance of influenza vaccination in older adults as, even with a poorly matched vaccine, it still protects one in three to four of this population from severe influenza.
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Affiliation(s)
| | | | - Alin Gherasim
- National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain
| | - Itziar Casado
- Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC Cochin Pasteur, université Paris Descartes, Sorbonne Paris Cité, hôpital Cochin, AP-HP, Paris, France
| | - Mihaela Lazăr
- National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Sierk Marbus
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Monika Kuliese
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ritva Syrjänen
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Ausenda Machado
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sanja Kurečić Filipović
- Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain
| | - Jesús Castilla
- Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain
| | - Valeria Alfonsi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Florence Galtier
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CHU de Montpellier, Inserm CIC 1411, Hôpital Saint-Eloi, Montpellier, France
| | - Alina Ivanciuc
- National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Adam Meijer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aukse Mickiene
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Niina Ikonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Verónica Gómez
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Zvjezdana Lovrić Makarić
- Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia
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Castilla J, Portillo ME, Casado I, Pozo F, Navascués A, Adelantado M, Gómez Ibáñez C, Ezpeleta C, Martínez-Baz I. Effectiveness of the current and prior influenza vaccinations in Northern Spain, 2018–2019. Vaccine 2020; 38:1925-1932. [DOI: 10.1016/j.vaccine.2020.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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Chua H, Feng S, Lewnard JA, Sullivan SG, Blyth CC, Lipsitch M, Cowling BJ. The Use of Test-negative Controls to Monitor Vaccine Effectiveness: A Systematic Review of Methodology. Epidemiology 2020; 31:43-64. [PMID: 31609860 PMCID: PMC6888869 DOI: 10.1097/ede.0000000000001116] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The test-negative design is an increasingly popular approach for estimating vaccine effectiveness (VE) due to its efficiency. This review aims to examine published test-negative design studies of VE and to explore similarities and differences in methodological choices for different diseases and vaccines. METHODS We conducted a systematic search on PubMed, Web of Science, and Medline, for studies reporting the effectiveness of any vaccines using a test-negative design. We screened titles and abstracts and reviewed full texts to identify relevant articles. We created a standardized form for each included article to extract information on the pathogen of interest, vaccine(s) being evaluated, study setting, clinical case definition, choices of cases and controls, and statistical approaches used to estimate VE. RESULTS We identified a total of 348 articles, including studies on VE against influenza virus (n = 253), rotavirus (n = 48), pneumococcus (n = 24), and nine other pathogens. Clinical case definitions used to enroll patients were similar by pathogens of interest but the sets of symptoms that defined them varied substantially. Controls could be those testing negative for the pathogen of interest, those testing positive for nonvaccine type of the pathogen of interest, or a subset of those testing positive for alternative pathogens. Most studies controlled for age, calendar time, and comorbidities. CONCLUSIONS Our review highlights similarities and differences in the application of the test-negative design that deserve further examination. If vaccination reduces disease severity in breakthrough infections, particular care must be taken in interpreting vaccine effectiveness estimates from test-negative design studies.
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Affiliation(s)
- Huiying Chua
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Benjamin J Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Kissling E, Pozo F, Buda S, Vilcu AM, Rizzo C, Gherasim A, Horváth JK, Brytting M, Domegan L, Meijer A, Paradowska-Stankiewicz I, Machado A, Vučina VV, Lazar M, Johansen K, Dürrwald R, van der Werf S, Bella A, Larrauri A, Ferenczi A, Zakikhany K, O'Donnell J, Dijkstra F, Bogusz J, Guiomar R, Filipović SK, Pitigoi D, Penttinen P, Valenciano M. Effectiveness of influenza vaccine against influenza A in Europe in seasons of different A(H1N1)pdm09 and the same A(H3N2) vaccine components (2016-17 and 2017-18). Vaccine X 2019; 3:100042. [PMID: 31660536 PMCID: PMC6807025 DOI: 10.1016/j.jvacx.2019.100042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Influenza A(H3N2) viruses predominated in Europe in 2016-17. In 2017-18 A(H3N2) and A(H1N1)pdm09 viruses co-circulated. The A(H3N2) vaccine component was the same in both seasons; while the A(H1N1)pdm09 component changed in 2017-18. In both seasons, vaccine seed A(H3N2) viruses developed adaptations/alterations during propagation in eggs, impacting antigenicity. METHODS We used the test-negative design in a multicentre primary care case-control study in 12 European countries to measure 2016-17 and 2017-18 influenza vaccine effectiveness (VE) against laboratory-confirmed influenza A(H1N1)pdm09 and A(H3N2) overall and by age group. RESULTS During the 2017-18 season, the overall VE against influenza A(H1N1)pdm09 was 59% (95% CI: 47-69). Among those aged 0-14, 15-64 and ≥65 years, VE against A(H1N1)pdm09 was 64% (95% CI: 37-79), 50% (95% CI: 28-66) and 66% (95% CI: 42-80), respectively. Overall VE against influenza A(H3N2) was 28% (95% CI: 17-38) in 2016-17 and 13% (95% CI: -15 to 34) in 2017-18. Among 0-14-year-olds VE against A(H3N2) was 28% (95%CI: -10 to 53) and 29% (95% CI: -87 to 73), among 15-64-year-olds 34% (95% CI: 18-46) and 33% (95% CI: -3 to 56) and among those aged ≥65 years 15% (95% CI: -10 to 34) and -9% (95% CI: -74 to 32) in 2016-17 and 2017-18, respectively. CONCLUSIONS Our study suggests the new A(H1N1)pdm09 vaccine component conferred good protection against circulating strains, while VE against A(H3N2) was <35% in 2016-17 and 2017-18. The egg propagation derived antigenic mismatch of the vaccine seed virus with circulating strains may have contributed to this low effectiveness. A(H3N2) seed viruses for vaccines in subsequent seasons may be subject to the same adaptations; in years with lower than expected VE, recommendations of preventive measures other than vaccination should be given in a timely manner.
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Affiliation(s)
- Esther Kissling
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Caterina Rizzo
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
- Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alin Gherasim
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | - Mia Brytting
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Mihaela Lazar
- “Cantacuzino” National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Kari Johansen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Ralf Dürrwald
- Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany
| | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France
- CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Amparo Larrauri
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joanna Bogusz
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Raquel Guiomar
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal
| | | | - Daniela Pitigoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Marta Valenciano
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
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Saito N, Komori K, Suzuki M, Kishikawa T, Yasaka T, Ariyoshi K. Dose-Dependent Negative Effects of Prior Multiple Vaccinations Against Influenza A and Influenza B Among Schoolchildren: A Study of Kamigoto Island in Japan During the 2011-2012, 2012-2013, and 2013-2014 Influenza Seasons. Clin Infect Dis 2019. [PMID: 29528389 DOI: 10.1093/cid/ciy202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background We investigated the negative effects of prior multiple vaccinations on influenza vaccine effectiveness (VE) and analyzed the association of VE with prior vaccine doses. Methods Patients aged 9-18 years presenting with influenza-like illness at a community hospital on a remote Japanese island during the 2011-2012, 2012-2013, and 2013-2014 influenza seasons were tested for influenza using a rapid diagnostic test (RDT). A test-negative, case-control study design was used to estimate the VEs of trivalent inactivated influenza vaccine. Histories of vaccination and medically attended influenza (MA-flu) A and B during 3 previous seasons were collected from registry systems. VE was calculated using multilevel mixed-effects logistic regression models adjusted for the history of RDT-confirmed MA-flu. Results During 3 influenza seasons, 1668 influenza-like illness episodes were analyzed, including 421 and 358 episodes of MA-fluA and MA-fluB, respectively. The adjusted VE (95% confidence interval) yielded significant dose-dependent attenuations by prior vaccinations against both MA-fluA (0 doses during previous 3 seasons: 96% [69%-100%], 1 dose: 48% [-7% to 74%], 2 doses: 52% [11%-74%], 3 doses: 21% [-25% to 51%]; P for trend < .05) and MA-fluB (0 doses: 66% [-5% to 89%], 1 dose: 48% [-14% to 76%], 2 doses: 34% [-33% to 67%], 3 doses: -7% [-83% to 37%]; P for trend < .05). After excluding episodes of MA-flu during prior 3 seasons, similar trends were observed. Conclusions Repeated previous vaccinations over multiple seasons had significant dose-dependent negative impacts on VE against both MA-fluA and MA-fluB. Further studies to confirm this finding are necessary.
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Affiliation(s)
- Nobuo Saito
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Malm M, Vesikari T, Blazevic V. Simultaneous Immunization with Multivalent Norovirus VLPs Induces Better Protective Immune Responses to Norovirus Than Sequential Immunization. Viruses 2019; 11:v11111018. [PMID: 31684058 PMCID: PMC6893631 DOI: 10.3390/v11111018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Human noroviruses (NoVs) are a genetically diverse, constantly evolving group of viruses. Here, we studied the effect of NoV pre-existing immunity on the success of NoV vaccinations with genetically close and distant genotypes. A sequential immunization as an alternative approach to multivalent NoV virus-like particles (VLPs) vaccine was investigated. Mice were immunized with NoV GI.3, GII.4-1999, GII.17, and GII.4 Sydney as monovalent VLPs or as a single tetravalent mixture combined with rotavirus VP6-protein. Sequentially immunized mice were primed with a trivalent vaccine candidate (GI.3 + GII.4-1999 + VP6) and boosted, first with GII.17 and then with GII.4 Sydney VLPs. NoV serum antibodies were analyzed. Similar NoV genotype-specific immune responses were induced with the monovalent and multivalent mixture immunizations, and no immunological interference was observed. Multivalent immunization with simultaneous mix was found to be superior to sequential immunization, as sequential boost induced strong blocking antibody response against the distant genotype (GII.17), but not against GII.4 Sydney, closely related to GII.4-1999, contained in the priming vaccine. Genetically close antigens may interfere with the immune response generation and thereby immune responses may be differently formed depending on the degree of NoV VLP genotype identity.
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Affiliation(s)
- Maria Malm
- Vaccine Research Center, Faculty of Medicine and Health Technology, Tampere University, Biokatu 10, FI-33520 Tampere, Finland.
| | - Timo Vesikari
- Vaccine Research Center, Faculty of Medicine and Health Technology, Tampere University, Biokatu 10, FI-33520 Tampere, Finland.
| | - Vesna Blazevic
- Vaccine Research Center, Faculty of Medicine and Health Technology, Tampere University, Biokatu 10, FI-33520 Tampere, Finland.
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68
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Song JY, Noh JY, Lee JS, Wie SH, Kim YK, Lee J, Jeong HW, Kim SW, Lee SH, Park KH, Choi WS, Cheong HJ, Kim WJ. Effectiveness of repeated influenza vaccination among the elderly population with high annual vaccine uptake rates during the three consecutive A/H3N2 epidemics. Vaccine 2019; 38:318-322. [PMID: 31690467 DOI: 10.1016/j.vaccine.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Annually, about 80% of the Korean elderly aged ≥65 years receive influenza vaccination. Repeated annual vaccination has been suggested as an important factor of poor influenza vaccine effectiveness (VE), though reported conflicting results. METHODS During the consecutive A/H3N2-dominant influenza seasons between 2012 and 2015, we comparatively evaluated the VE (repeated vs. current season only) against laboratory-confirmed influenza, pneumonia and hospitalization in the elderly aged ≥65 years with influenza-like illness (ILI). Clinical and demographic data were collected prospectively, and vaccination status of prior and current seasons was verified using the immunization registry data of Korean Centers for Disease Control and Prevention. RESULTS During the first A/H3N2-dominant season in 2012-2013, influenza vaccine showed statistically significant effectiveness against influenza A infection only and when vaccinated in the current season only (VE 53%, 95% CI 15-77). In the latter two seasons (2013-2015 years), the adjusted VE for influenza A was indistinguishable between repeated vaccination and vaccination in the current season only. CONCLUSION During consecutive influenza A/H3N2 epidemics, poor influenza vaccine effectiveness may be more pronounced among the elderly population with a high annual vaccine uptake rate.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Jin Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, Catholic University Medical College, St. Vincent's Hospital, Suwon, South Korea
| | - Young Keun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Shin Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sun Hee Lee
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University School of Medicine, Pusan, South Korea
| | - Kyung-Hwa Park
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea.
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69
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Skowronski DM, Sabaiduc S, Leir S, Rose C, Zou M, Murti M, Dickinson JA, Olsha R, Gubbay JB, Croxen MA, Charest H, Bastien N, Li Y, Jassem A, Krajden M, De Serres G. Paradoxical clade- and age-specific vaccine effectiveness during the 2018/19 influenza A(H3N2) epidemic in Canada: potential imprint-regulated effect of vaccine (I-REV). Euro Surveill 2019; 24:1900585. [PMID: 31771709 PMCID: PMC6864978 DOI: 10.2807/1560-7917.es.2019.24.46.1900585] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022] Open
Abstract
IntroductionThe Canadian Sentinel Practitioner Surveillance Network reports vaccine effectiveness (VE) for the 2018/19 influenza A(H3N2) epidemic.AimTo explain a paradoxical signal of increased clade 3C.3a risk among 35-54-year-old vaccinees, we hypothesise childhood immunological imprinting and a cohort effect following the 1968 influenza A(H3N2) pandemic.MethodsWe assessed VE by test-negative design for influenza A(H3N2) overall and for co-circulating clades 3C.2a1b and 3C.3a. VE variation by age in 2018/19 was compared with amino acid variation in the haemagglutinin glycoprotein by year since 1968.ResultsInfluenza A(H3N2) VE was 17% (95% CI: -13 to 39) overall: 27% (95% CI: -7 to 50) for 3C.2a1b and -32% (95% CI: -119 to 21) for 3C.3a. Among 20-64-year-olds, VE was -7% (95% CI: -56 to 26): 6% (95% CI: -49 to 41) for 3C.2a1b and -96% (95% CI: -277 to -2) for 3C.3a. Clade 3C.3a VE showed a pronounced negative dip among 35-54-year-olds in whom the odds of medically attended illness were > 4-fold increased for vaccinated vs unvaccinated participants (p < 0.005). This age group was primed in childhood to influenza A(H3N2) viruses that for two decades following the 1968 pandemic bore a serine at haemagglutinin position 159, in common with contemporary 3C.3a viruses but mismatched to 3C.2a vaccine strains instead bearing tyrosine.DiscussionImprinting by the first childhood influenza infection is known to confer long-lasting immunity focused toward priming epitopes. Our findings suggest vaccine mismatch may negatively interact with imprinted immunity. The immunological mechanisms for imprint-regulated effect of vaccine (I-REV) warrant investigation.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Siobhan Leir
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Macy Zou
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michelle Murti
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Matthew A Croxen
- Alberta Precision Laboratories, Edmonton, Alberta
- University of Alberta, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, 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
| | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Laval University, Quebec, Canada
- Centre Hospitalier Universitaire de Québec, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
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70
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Kelvin AA, Zambon M. Influenza imprinting in childhood and the influence on vaccine response later in life. Euro Surveill 2019; 24:1900720. [PMID: 31796156 PMCID: PMC6891942 DOI: 10.2807/1560-7917.es.2019.24.48.1900720] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alyson A Kelvin
- Department of Pediatrics, Division of Infectious Disease, Faculty of Medicine, Dalhousie University, Halifax, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Canada
| | - Maria Zambon
- National Infection Service, Public Health England, London, United Kingdom
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71
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Abstract
Introduction: High variance is associated with influenza vaccine effectiveness (VE). Accumulating evidence suggests that preexisting influenza-specific immunity results in the variance in VE and skews overall immune response to vaccination. Nevertheless, the investigation of preexisting immunity is highly limited due to the lack of proper methodology to explore the complex individual immune history.Areas covered: Retrospective observational studies have shown that the preexisting influenza specific immunity influences on VE. To simplify a discussion, we summarized important findings from the observational studies based on the transition of the individual immune history: the first exposure to influenza virus, the first vaccination, and repetitive exposure throughout life. We also discussed the prospectus of pre-immunized animal models to investigate the interaction between preexisting immunity and vaccine efficacy.Expert opinion: A better understanding in the underlying mechanisms on preexisting immunity is critical to improve VE and to help develop novel vaccine strategies. Using animals pre-immunized with historical influenza strains is a promising approach to verify the underlying immunologic mechanism of interaction between preexisting immunity and vaccine antigen. Also, pre-immunized animal models will be better able to evaluate the efficacy of novel vaccine strategies than naïve animals.
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Affiliation(s)
- Hyesun Jang
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, USA
| | - Ted M Ross
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, USA.,Department of Infectious Diseases, University of Georgia, Athens, GA, USA
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72
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Historical H1N1 Influenza Virus Imprinting Increases Vaccine Protection by Influencing the Activity and Sustained Production of Antibodies Elicited at Vaccination in Ferrets. Vaccines (Basel) 2019; 7:vaccines7040133. [PMID: 31569351 PMCID: PMC6963198 DOI: 10.3390/vaccines7040133] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022] Open
Abstract
Influenza virus imprinting is now understood to significantly influence the immune responses and clinical outcome of influenza virus infections that occur later in life. Due to the yearly cycling of influenza viruses, humans are imprinted with the circulating virus of their birth year and subsequently build a complex influenza virus immune history. Despite this knowledge, little is known about how the imprinting strain influences vaccine responses. To investigate the immune responses of the imprinted host to split-virion vaccination, we imprinted ferrets with a sublethal dose of the historical seasonal H1N1 strain A/USSR/90/1977. After a +60-day recovery period to build immune memory, ferrets were immunized and then challenged on Day 123. Antibody specificity and recall were investigated throughout the time course. At challenge, the imprinted vaccinated ferrets did not experience significant disease, while naïve-vaccinated ferrets had significant weight loss. Haemagglutination inhibition assays showed that imprinted ferrets had a more robust antibody response post vaccination and increased virus neutralization activity. Imprinted-vaccinated animals had increased virus-specific IgG antibodies compared to the other experimental groups, suggesting B-cell maturity and plasticity at vaccination. These results should be considered when designing the next generation of influenza vaccines.
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73
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Hirotsu N, Saisho Y, Hasegawa T, Kitano M, Shishido T. Antibody dynamics in Japanese paediatric patients with influenza A infection treated with neuraminidase inhibitors in a randomised trial. Sci Rep 2019; 9:11891. [PMID: 31417163 PMCID: PMC6695405 DOI: 10.1038/s41598-019-47884-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/16/2019] [Indexed: 12/24/2022] Open
Abstract
Neuraminidase inhibitors (NAIs) complement influenza virus infection management by helping to clear virus, alleviate symptoms, and reduce transmission. In a previous randomised study, we examined the effect of 4 NAIs on virus clearance and influenza symptoms in Japanese paediatric patients. In this second analysis, we examined the effects of NAI treatment on antibody responses and virus clearance, and the relationships between antibody responses and patients' infection histories (previous infection; asymptomatic infection via household members of same virus type/subtype; vaccination), and between infection histories and viral kinetics. Haemagglutination inhibition (HI) antibody responses produced HI titres ≥40 by Day 14 of NAI treatment, in parallel with virus clearance (trend test P = 0.001). Comparing patients with and without influenza infection histories (directly or asymptomatic infection via household members) showed that infection history had a marked positive effect on HI antibody responses in patients vaccinated before the current influenza season (before enrolment). Current virus clearance was significantly faster in patients previously infected with the same virus type/subtype than in those not previously infected, and clearance pattern depended on the NAI. Assessment of anti-influenza effects of antiviral drugs and vaccines should consider virus and antibody dynamics in response to vaccination and natural infection histories.
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74
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Hay JA, Laurie K, White M, Riley S. Characterising antibody kinetics from multiple influenza infection and vaccination events in ferrets. PLoS Comput Biol 2019; 15:e1007294. [PMID: 31425503 PMCID: PMC6715255 DOI: 10.1371/journal.pcbi.1007294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/29/2019] [Accepted: 07/29/2019] [Indexed: 12/20/2022] Open
Abstract
The strength and breadth of an individual's antibody repertoire is an important predictor of their response to influenza infection or vaccination. Although progress has been made in understanding qualitatively how repeated exposures shape the antibody mediated immune response, quantitative understanding remains limited. We developed a set of mathematical models describing short-term antibody kinetics following influenza infection or vaccination and fit them to haemagglutination inhibition (HI) titres from 5 groups of ferrets which were exposed to different combinations of trivalent inactivated influenza vaccine (TIV with or without adjuvant), A/H3N2 priming inoculation and post-vaccination A/H1N1 inoculation. We fit models with various immunological mechanisms that have been empirically observed but have not previously been included in mathematical models of antibody landscapes, including: titre ceiling effects, antigenic seniority and exposure-type specific cross reactivity. Based on the parameter estimates of the best supported models, we describe a number of key immunological features. We found quantifiable differences in the degree of homologous and cross-reactive antibody boosting elicited by different exposure types. Infection and adjuvanted vaccination generally resulted in strong, broadly reactive responses whereas unadjuvanted vaccination resulted in a weak, narrow response. We found that the order of exposure mattered: priming with A/H3N2 improved subsequent vaccine response, and the second dose of adjuvanted vaccination resulted in substantially greater antibody boosting than the first. Either antigenic seniority or a titre ceiling effect were included in the two best fitting models, suggesting a role for a mechanism describing diminishing antibody boosting with repeated exposures. Although there was considerable uncertainty in our estimates of antibody waning parameters, our results suggest that both short and long term waning were present and would be identifiable with a larger set of experiments. These results highlight the potential use of repeat exposure animal models in revealing short-term, strain-specific immune dynamics of influenza.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Animals
- Antibodies, Viral/blood
- Computational Biology
- Cross Reactions
- Disease Models, Animal
- Ferrets/immunology
- Humans
- Immunization, Secondary
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Kinetics
- Models, Immunological
- Orthomyxoviridae Infections/immunology
- Orthomyxoviridae Infections/virology
- Vaccines, Inactivated/administration & dosage
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Affiliation(s)
- James A. Hay
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Karen Laurie
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Seqirus, 63 Poplar Road, Parkville, Victoria, Australia
| | - Michael White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Steven Riley
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
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75
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Auladell M, Jia X, Hensen L, Chua B, Fox A, Nguyen THO, Doherty PC, Kedzierska K. Recalling the Future: Immunological Memory Toward Unpredictable Influenza Viruses. Front Immunol 2019; 10:1400. [PMID: 31312199 PMCID: PMC6614380 DOI: 10.3389/fimmu.2019.01400] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/03/2019] [Indexed: 01/09/2023] Open
Abstract
Persistent and durable immunological memory forms the basis of any successful vaccination protocol. Generation of pre-existing memory B cell and T cell pools is thus the key for maintaining protective immunity to seasonal, pandemic and avian influenza viruses. Long-lived antibody secreting cells (ASCs) are responsible for maintaining antibody levels in peripheral blood. Generated with CD4+ T help after naïve B cell precursors encounter their cognate antigen, the linked processes of differentiation (including Ig class switching) and proliferation also give rise to memory B cells, which then can change rapidly to ASC status after subsequent influenza encounters. Given that influenza viruses evolve rapidly as a consequence of antibody-driven mutational change (antigenic drift), the current influenza vaccines need to be reformulated frequently and annual vaccination is recommended. Without that process of regular renewal, they provide little protection against “drifted” (particularly H3N2) variants and are mainly ineffective when a novel pandemic (2009 A/H1N1 “swine” flu) strain suddenly emerges. Such limitation of antibody-mediated protection might be circumvented, at least in part, by adding a novel vaccine component that promotes cross-reactive CD8+ T cells specific for conserved viral peptides, presented by widely distributed HLA types. Such “memory” cytotoxic T lymphocytes (CTLs) can rapidly be recalled to CTL effector status. Here, we review how B cells and follicular T cells are elicited following influenza vaccination and how they survive into a long-term memory. We describe how CD8+ CTL memory is established following influenza virus infection, and how a robust CTL recall response can lead to more rapid virus elimination by destroying virus-infected cells, and recovery. Exploiting long-term, cross-reactive CTL against the continuously evolving and unpredictable influenza viruses provides a possible mechanism for preventing a disastrous pandemic comparable to the 1918-1919 H1N1 “Spanish flu,” which killed more than 50 million people worldwide.
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Affiliation(s)
- Maria Auladell
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Xiaoxiao Jia
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Luca Hensen
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Chua
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.,Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Annette Fox
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Thi H O Nguyen
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Peter C Doherty
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.,Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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76
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Belongia EA, McLean HQ. Influenza Vaccine Effectiveness: Defining the H3N2 Problem. Clin Infect Dis 2019; 69:1817-1823. [DOI: 10.1093/cid/ciz411] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
Observational studies have consistently shown that influenza vaccine effectiveness (VE) is lower for H3N2 relative to H1N1pdm09 and type B, and this is not entirely explained by antigenic match. The triad of virus, vaccine, and host immunity provides a framework to examine contributing factors. Antigenic evolution facilitates H3N2 immune escape, and increasing glycosylation of the hemagglutinin shields antigenic sites from antibody binding. Egg passage adaptation of vaccine viruses generates mutations that alter glycosylation, impair the neutralizing antibody response, and reduce VE. Complex host immune factors may also influence H3N2 VE, including early childhood imprinting and repeated vaccination, but their role is uncertain. Of the triad of contributing factors, only changes to the vaccine are readily achievable. However, it is unclear whether current licensed non–egg-based vaccines generate superior protection against H3N2. The optimal strategy remains to be defined, but newer vaccine technology platforms offer great potential.
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Affiliation(s)
- Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Wisconsin
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Wisconsin
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77
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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] [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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78
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Zhang D, Zhang Y, Wang Q, Lock J, Pan Y, Cui S, Yang P, Hu Y. The effectiveness of influenza vaccination in preventing hospitalizations in elderly in Beijing, 2016-18. Vaccine 2019; 37:1853-1858. [PMID: 30827734 DOI: 10.1016/j.vaccine.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Influenza vaccinations play an important role in preventing influenza related hospitalizations. The objective of this study was to estimate the effectiveness of vaccination in protecting Beijing residents aged ≥60 years from influenza related hospitalizations during the 2016/17 and 2017/18 influenza seasons. METHODS Patients who met the definition of severe acute respiratory infection (SARI) and were hospitalized in the nine sentinel hospitals in Beijing during the 2016/17 and 2017/18 influenza seasons were identified as the study population. The vaccination status of patients was obtained from a vaccination registry. Real-time reversetranscription polymerasechainreaction (RT-PCR) experiments were conducted to test pharyngeal or lower respiratory tract samples collected from SARI patients for influenza A and B viruses. Vaccine effectiveness (VE) was examined using a test-negative design that compare the odds of vaccination among influenza positives and negatives, adjusting for calendar week of illness onset, age, and underlying medical conditions. RESULTS We identified 50,364 patients in the study, in which there were 145 influenza cases and 528 influenza-negative controls aged ≥60 years in 2016/17 season and 149 cases and 358 controls aged ≥60 years in 2017/18 season. The most commonly identified subtype among participants was influenza A(H3N2) in 2016/17 and 2017/18 season (78.5% and 70.6%). Among the adults aged ≥60 years, the adjusted VE of vaccination against any influenza virus for serious acute respiratory infection (SARI) patients was 32.8% (95% confidence interval [CI]: -22.0 to 63.0%) in 2016/17 season. While the adjusted VE in 2017/18 season were 4.6% (95% CI: -72.4 to 47.2%) against any types of influenza, 29.2% (95% CI: -92.9 to 74%) against influenza A(H1N1)pdm09, -37.7% (95% CI: -293.8; 51.9%) against influenza A(H3N2) viruses, and 3.6% (95% CI: -113.8 to 56.5%) against influenza B. CONCLUSION The influenza vaccine provided moderate protection in 2016/17 season and mild protection in 2017/18 season for influenza related inpatients of adults aged ≥60 years in Beijing.
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Affiliation(s)
- Daitao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China; Institute of Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, 100013 Beijing, China
| | - Yi Zhang
- Institute of Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, 100013 Beijing, China
| | - Quanyi Wang
- Institute of Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, 100013 Beijing, China
| | - Jerome Lock
- Department of Health Ethics and Society, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Yang Pan
- Institute of Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, 100013 Beijing, China
| | - Shujuan Cui
- Institute of Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, 100013 Beijing, China
| | - Peng Yang
- Institute of Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, 100013 Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China.
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Francis ME, King ML, Kelvin AA. Back to the Future for Influenza Preimmunity-Looking Back at Influenza Virus History to Infer the Outcome of Future Infections. Viruses 2019; 11:v11020122. [PMID: 30704019 PMCID: PMC6410066 DOI: 10.3390/v11020122] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
The influenza virus-host interaction is a classic arms race. The recurrent and evolving nature of the influenza virus family allows a single host to be infected several times. Locked in co-evolution, recurrent influenza virus infection elicits continual refinement of the host immune system. Here we give historical context of circulating influenza viruses to understand how the individual immune history is mirrored by the history of influenza virus circulation. Original Antigenic Sin was first proposed as the negative influence of the host’s first influenza virus infection on the next and Imprinting modernizes Antigenic Sin incorporating both positive and negative outcomes. Building on imprinting, we refer to preimmunity as the continual refinement of the host immune system with each influenza virus infection. We discuss imprinting and the interplay of influenza virus homology, vaccination, and host age establishing preimmunity. We outline host signatures and outcomes of tandem infection according to the sequence of virus and classify these relationships as monosubtypic homologous, monosubtypic heterologous, heterosubtypic, or heterotypic sequential infections. Finally, the preimmunity knowledge gaps are highlighted for future investigation. Understanding the effects of antigenic variable recurrent influenza virus infection on immune refinement will advance vaccination strategies, as well as pandemic preparedness.
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Affiliation(s)
- Magen Ellen Francis
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada.
| | - Morgan Leslie King
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada.
| | - Alyson Ann Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada.
- Department of Pediatrics, Division of Infectious Disease, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada.
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax NS B3K 6R8, Canada.
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Ramsay LC, Buchan SA, Stirling RG, Cowling BJ, Feng S, Kwong JC, Warshawsky BF. The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis. BMC Med 2019; 17:9. [PMID: 30626399 PMCID: PMC6327561 DOI: 10.1186/s12916-018-1239-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Conflicting results regarding the impact of repeated vaccination on influenza vaccine effectiveness (VE) may cause confusion regarding the benefits of receiving the current season's vaccine. METHODS We systematically searched MEDLINE, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature from database inception to August 17, 2016, for observational studies published in English that reported VE against laboratory-confirmed influenza for the following four vaccination groups: current season only, prior season only, both seasons, and neither season. We pooled differences in VE (∆VE) between vaccination groups by influenza season and type/subtype using a random-effects model. The study protocol is registered with PROSPERO (registration number: CRD42016037241). RESULTS We identified 3435 unique articles, reviewed the full text of 634, and included 20 for meta-analysis. Compared to prior season vaccination only, vaccination in both seasons was associated with greater protection against influenza H1N1 (∆VE = 25%; 95% CI 14%, 35%) and B (∆VE = 18%; 95% CI 3%, 33%), but not H3N2 (∆VE = 7%; 95% CI - 7%, 21%). Compared to no vaccination for either season, individuals who received the current season's vaccine had greater protection against H1N1 (∆VE = 62%; 95% CI 51%, 70%), H3N2 (∆VE = 45%; 95% CI 35%, 53%), and B (∆VE = 64%; 95% CI 57%, 71%). We observed no differences in VE between vaccination in both seasons and the current season only for H1N1 (∆VE = 3%; 95% CI - 8%, 13%), but less protection against influenza H3N2 (∆VE = - 20%; 95% CI - 36%, - 4%), and B (∆VE = - 11%; 95% CI - 20%, - 2%). CONCLUSIONS Our results support current season vaccination regardless of prior season vaccination because VE for vaccination in the current season only is higher compared to no vaccination in either season for all types/subtypes, and for H1N1 and influenza B, vaccination in both seasons provides better VE than vaccination in the prior season only. Although VE was lower against H3N2 and B for individuals vaccinated in both seasons compared to those vaccinated in the current season only, it should be noted that past vaccination history cannot be altered and this comparison disregards susceptibility to influenza during the prior season among those vaccinated in the current season only. In addition, our results for H3N2 were particularly influenced by the 2014-2015 influenza season and the impact of repeated vaccination for all types/subtypes may vary from season to season. It is important that future VE studies include vaccination history over multiple seasons to evaluate repeated vaccination in more detail.
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Affiliation(s)
- Lauren C. Ramsay
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
| | - Sarah A. Buchan
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
| | - Robert G. Stirling
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
- Public Health Agency of Canada, 130 Colonnade Road, Ottawa, Ontario K1A 0K9 Canada
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jeffrey C. Kwong
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
- Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, Ontario M4N 3M5 Canada
- Department of Family & Community Medicine, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
- University Health Network, 399 Bathurst St, Toronto, Ontario M5T 2S8 Canada
| | - Bryna F. Warshawsky
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, Ontario N6A 3K7 Canada
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Zhang A, Stacey HD, Mullarkey CE, Miller MS. Original Antigenic Sin: How First Exposure Shapes Lifelong Anti–Influenza Virus Immune Responses. THE JOURNAL OF IMMUNOLOGY 2019; 202:335-340. [DOI: 10.4049/jimmunol.1801149] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
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Casado I, Domínguez Á, Toledo D, Chamorro J, Astray J, Egurrola M, Fernández-Sierra MA, Martín V, Morales-Suárez-Varela M, Godoy P, Castilla J. Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: a multicentre case-control study. CMAJ 2018; 190:E3-E12. [PMID: 29311098 DOI: 10.1503/cmaj.170910] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. RESULTS We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). INTERPRETATION Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults.
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Affiliation(s)
- Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Ángela Domínguez
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Diana Toledo
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Judith Chamorro
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Jenaro Astray
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Mikel Egurrola
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - María Amelia Fernández-Sierra
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Vicente Martín
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - María Morales-Suárez-Varela
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Pere Godoy
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA (Casado, Castilla), Pamplona, Spain; Departament de Medicina (Domínguez, Toledo), Universitat de Barcelona, Barcelona, Spain; Complejo Hospitalario de Navarra (Chamorro), Pamplona, Spain; Subdirección General de Epidemiología (Astray), Madrid, Spain; Hospital de Galdakao-Usansolo (Egurrola), Vizcaya, Spain; Complejo Hospitalario Universitario de Granada (Fernández-Sierra), Granada, Spain; Instituto de Biomedicina, Universidad de León (Martín), León, Spain; Departament de Medicina Preventiva (Morales-Suárez-Varela), Universitat de Valencia, Valencia, Spain; Agència de Salut Pública de Catalunya (Godoy), Institut de Recerca Biomèdica de Lleida, Lleida, Spain; CIBER Epidemiología y Salud Pública - CIBERESP (Casado, Domínguez, Toledo, Martín, Morales-Suárez-Varela, Godoy, Castilla), Madrid, Spain.
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination Against Influenza in Pregnancy: A Survey of Canadian Maternity Care Providers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:479-488. [PMID: 30409569 DOI: 10.1016/j.jogc.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Influenza vaccine uptake among Canadian pregnant individuals is suboptimal. Failure to incorporate vaccination into routine prenatal care and a lack of recommendations from healthcare providers are recognized as barriers to vaccination. The aim of this study was to assess Canadian maternity care providers' knowledge, attitudes, and practices regarding influenza vaccination in pregnancy. METHODS A cross-sectional Web-based questionnaire was sent during July and August 2017 to family physicians, obstetricians-gynaecologists, midwives, pharmacists, and nurses who care for pregnant individuals. A multivariable logistic regression model was used to determine variables independently associated with providers' recommendation of the influenza vaccine in pregnancy. RESULTS The analysis included 1061 providers. Most participants (85%) reported being vaccinated against influenza themselves, and 72% reported recommending the influenza vaccine to all of their pregnant patients during the previous influenza season. Participants' attitudes regarding influenza vaccination during pregnancy were generally positive: 64% strongly agreed that pregnant individuals are at an increased risk of complications from influenza, and 69% strongly agreed that it is safe to vaccinate pregnant individuals against influenza. The main determinants of participants' recommendations for influenza vaccination to all pregnant patients were following official recommendations on influenza vaccination, discussing vaccines with most or all pregnant individuals seen in their practice, and being vaccinated themselves during the previous influenza season. CONCLUSION Enhancing influenza vaccine uptake in pregnancy is largely dependent on maternity care providers' recommendations. This study provides valuable insight on providers' knowledge, attitudes, and practices.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, QC.
| | | | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Manale Ouakki
- Institut national de santé publique du Québec, Québec, QC
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC
| | | | - Eliana Castillo
- Cumming School of Medicine, University of Alberta, Edmonton, AB
| | | | - S Michelle Driedger
- Department of Community Health Science, University of Manitoba, Winnipeg, MB
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - William Fisher
- Department of Psychology, Western University, London, ON
| | - Arnaud Gagneur
- Department of Community Health Medicine, Université de Sherbrooke, Sherbrooke, QC
| | - Maryse Guay
- Department of Community Health Medicine, Université de Sherbrooke, Sherbrooke, QC
| | | | | | | | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, ON
| | | | | | | | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
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McLean HQ, Caspard H, Griffin MR, Gaglani M, Peters TR, Poehling KA, Ambrose CS, Belongia EA. Association of Prior Vaccination With Influenza Vaccine Effectiveness in Children Receiving Live Attenuated or Inactivated Vaccine. JAMA Netw Open 2018; 1:e183742. [PMID: 30646262 PMCID: PMC6324442 DOI: 10.1001/jamanetworkopen.2018.3742] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Some studies have reported negative effects of prior-season influenza vaccination. Prior-season influenza vaccination effects on vaccine effectiveness (VE) in children are not well understood. OBJECTIVE To assess the association of prior-season influenza vaccination with subsequent VE in children aged 2 to 17 years. DESIGN, SETTING, AND PARTICIPANTS This multiseason, test-negative case-control study was conducted in outpatient clinics at 4 US sites among children aged 2 to 17 years with a medically attended febrile acute respiratory illness. Participants were recruited during the 2013-2014, 2014-2015, and 2015-2016 seasons when influenza circulated locally. Cases were children with influenza confirmed by reverse-transcription polymerase chain reaction. Test-negative control individuals were children with negative test results for influenza. EXPOSURES Vaccination history, including influenza vaccine type received in the enrollment season (live attenuated influenza vaccine [LAIV], inactivated influenza vaccine [IIV], or no vaccine) and season before enrollment (LAIV, IIV, or no vaccine), determined from medical records and immunization registries. MAIN OUTCOMES AND MEASURES LAIV and IIV effectiveness by influenza type and subtype (influenza A[H1N1]pdm09, influenza A[H3N2], or influenza B), estimated as 100 × (1 - odds ratio) in a logistic regression model with adjustment for potential confounders. Prior season vaccination associations were assessed with an interaction term. RESULTS Of 3369 children (1749 [52%] male; median age, 6.6 years [range, 2-17 years]) included in the analysis, 772 (23%) had a positive test result for influenza and 1674 (50%) were vaccinated in the enrollment season. Among LAIV recipients, VE against influenza A(H3N2) was higher among children vaccinated in both the enrollment and 1 prior season (50.3% [95% CI, 17.0% to 70.2%]) than among those without 1 prior season vaccination (-82.4% [95% CI, -267.5% to 9.5%], interaction P < .001). The effectiveness of LAIV against influenza A(H1N1)pdm09 was not associated with prior season vaccination among those with prior season vaccination (47.5% [95% CI, 11.4% to 68.9%]) and among those without prior season vaccination (7.8% [95% CI, -101.9% to 57.9%]) (interaction P = .37). Prior season vaccination was not associated with effectiveness of IIV against influenza A(H3N2) (38.7% [95% CI, 6.8% to 59.6%] among those with prior-season vaccination and 23.2% [95% CI, -38.3% to 57.4%] among those without prior-season vaccination, interaction P = .16) or with effectiveness of IIV against influenza A[H1N1]pdm09 (72.4% [95% CI, 56.0% to 82.7%] among those with prior season vaccination and 67.5% [95% CI, 32.1% to 84.4%] among those without prior season vaccination, interaction P = .93). Residual protection from prior season vaccination only (no vaccination in the enrollment season) was observed for influenza B (LAIV: 60.0% [95% CI, 36.8% to 74.7%]; IIV: 60.0% [36.9% to 74.6%]). Similar results were observed in analyses that included repeated vaccination in 2 and 3 prior seasons. CONCLUSIONS AND RELEVANCE Influenza VE varied by influenza type and subtype and vaccine type, but prior-season vaccination was not associated with reduced VE. These findings support current recommendations for annual influenza vaccination of children.
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Affiliation(s)
| | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, Temple
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86
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The effectiveness of influenza vaccination against medically-attended illnesses in Hong Kong across three years with different degrees of vaccine match, 2014-17. Vaccine 2018; 36:6117-6123. [PMID: 30190121 DOI: 10.1016/j.vaccine.2018.08.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Influenza vaccination is the most effective intervention to prevent influenza virus infections. Vaccine effectiveness (VE) can vary due to factors such as matching between vaccine strains and prevailing strains, age and other characteristics of the vaccine recipients. OBJECTIVE To evaluate influenza VE against medically-attended illness in different age groups and against specific influenza types/subtypes in Hong Kong. METHODS A test-negative study was conducted from December 2014 through August 2017 in 20 outpatient clinics. Patients at least 6 months of age presenting with at least two symptoms of acute respiratory illness, ARI (fever ≥37.8 °C, cough, sore throat, runny nose, headache, myalgia and phlegm) within 72 h of onset were tested for influenza virus by reverse transcription polymerase chain reaction (PCR). Vaccination history was assessed by self-report or medical records at the clinics. VE against medically-attended illness was estimated using conditional logistic regression for influenza PCR result versus vaccination history, matching by calendar time and adjusting for age, age-squared, sex, and chronic medical illness. Additional analyses examined VE by age group and by influenza type/subtype. RESULTS We enrolled 2566 patients, of whom 1118 (43.6%) tested positive for influenza A or B virus by PCR. Test-positive subjects were generally older, more likely to present with one of the symptoms of ARI, and less likely to receive vaccination against influenza. VE estimates for influenza A(H1N1), A(H3N2), B/Yamagata and B/Victoria were 61.6% (95% confidence interval, CI: 21.8%, 81.1%), 26.4% (95% CI: -1.3%, 46.6%), 67.0% (95% CI: 25.9%, 85.3%), 60.4% (95% CI: 0.3%, 84.3%), respectively. Estimates of VE by age group were generally higher in adults aged 50-64 and lower among children and older adults. CONCLUSIONS VE against medically-attended influenza was moderate in Hong Kong, confirming the impact of influenza vaccination in reducing disease burden. The reduced VE for influenza A(H3N2) is a continuing concern.
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Valenciano M, Kissling E, Larrauri A, Nunes B, Pitigoi D, O'Donnell J, Reuss A, Horváth JK, Paradowska‐Stankiewicz I, Rizzo C, Falchi A, Daviaud I, Brytting M, Meijer A, Kaic B, Gherasim A, Machado A, Ivanciuc A, Domegan L, Schweiger B, Ferenczi A, Korczyńska M, Bella A, Vilcu A, Mosnier A, Zakikhany K, de Lange M, Kurečić Filipovićović S, Johansen K, Moren A. Exploring the effect of previous inactivated influenza vaccination on seasonal influenza vaccine effectiveness against medically attended influenza: Results of the European I-MOVE multicentre test-negative case-control study, 2011/2012-2016/2017. Influenza Other Respir Viruses 2018; 12:567-581. [PMID: 29659149 PMCID: PMC6086844 DOI: 10.1111/irv.12562] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Results of previous influenza vaccination effects on current season influenza vaccine effectiveness (VE) are inconsistent. OBJECTIVES To explore previous influenza vaccination effects on current season VE among population targeted for vaccination. METHODS We used 2011/2012 to 2016/2017 I-MOVE primary care multicentre test-negative data. For each season, we compared current season adjusted VE (aVE) between individuals vaccinated and unvaccinated in previous season. Using unvaccinated in both seasons as a reference, we then compared aVE between vaccinated in both seasons, current only, and previous only. RESULTS We included 941, 2645 and 959 influenza-like illness patients positive for influenza A(H1N1)pdm09, A(H3N2) and B, respectively, and 5532 controls. In 2011/2012, 2014/2015 and 2016/2017, A(H3N2) aVE point estimates among those vaccinated in previous season were -68%, -21% and -19%, respectively; among unvaccinated in previous season, these were 33%, 48% and 46%, respectively (aVE not computable for influenza A(H1N1)pdm09 and B). Compared to current season vaccination only, VE for both seasons' vaccination was (i) similar in two of four seasons for A(H3N2) (absolute difference [ad] 6% and 8%); (ii) lower in three of four seasons for influenza A(H1N1)pdm09 (ad 18%, 26% and 29%), in two seasons for influenza A(H3N2) (ad 27% and 39%) and in two of three seasons for influenza B (ad 26% and 37%); (iii) higher in one season for influenza A(H1N1)pdm09 (ad 20%) and influenza B (ad 24%). CONCLUSIONS We did not identify any pattern of previous influenza vaccination effect. Prospective cohort studies documenting influenza infections, vaccinations and vaccine types are needed to understand previous influenza vaccinations' effects.
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Affiliation(s)
| | | | - Amparo Larrauri
- National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
| | - Baltazar Nunes
- Department of EpidemiologyInstituto Nacional de Saúde, Doctor Ricardo JorgeLisboaPortugal
| | - Daniela Pitigoi
- University of Medicine and Pharmacy Carol DavilaBucharestRomania
- Cantacuzino InstituteNational Institute of Research – Development for Microbiology and ImmunologyBucharestRomania
| | - Joan O'Donnell
- Health Service Executive – Health Protection Surveillance CentreDublinIreland
| | - Annicka Reuss
- Department for Infectious Disease EpidemiologyRobert Koch InstituteBerlinGermany
| | - Judit Krisztina Horváth
- Department of Disease Prevention and SurveillanceNational Centre for EpidemiologyBudapestHungary
| | | | - Caterina Rizzo
- National Center for Epidemiology, Surveillance and Health PromotionIstituto Superiore di SanitàRomeItaly
| | | | | | - Mia Brytting
- The Public Health Agency of SwedenStockholmSweden
| | - Adam Meijer
- Centre for Infectious Disease ControlNational Institute of Public Health and Environment (RIVM)BilthovenThe Netherlands
| | | | - Alin Gherasim
- National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
| | - Ausenda Machado
- Department of EpidemiologyInstituto Nacional de Saúde, Doctor Ricardo JorgeLisboaPortugal
| | - Alina Ivanciuc
- Cantacuzino InstituteNational Institute of Research – Development for Microbiology and ImmunologyBucharestRomania
| | - Lisa Domegan
- Health Service Executive – Health Protection Surveillance CentreDublinIreland
| | - Brunhilde Schweiger
- Department for Infectious Disease EpidemiologyRobert Koch InstituteBerlinGermany
| | - Annamária Ferenczi
- Department of Disease Prevention and SurveillanceNational Centre for EpidemiologyBudapestHungary
| | - Monika Korczyńska
- National Institute of Public Health – National Institute of HygieneWarsawPoland
| | - Antonino Bella
- National Center for Epidemiology, Surveillance and Health PromotionIstituto Superiore di SanitàRomeItaly
| | - Ana‐Maria Vilcu
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136)UPMC Univ Paris 06, INSERMSorbonne UniversitésParisFrance
| | | | | | - Marit de Lange
- Centre for Infectious Disease ControlNational Institute of Public Health and Environment (RIVM)BilthovenThe Netherlands
| | | | - Kari Johansen
- European Centre for Disease Prevention and Control (ECDC)StockholmSweden
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88
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Thompson MG, Pierse N, Sue Huang Q, Prasad N, Duque J, Claire Newbern E, Baker MG, Turner N, McArthur C. Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012–2015. Vaccine 2018; 36:5916-5925. [DOI: 10.1016/j.vaccine.2018.07.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/08/2018] [Accepted: 07/15/2018] [Indexed: 12/26/2022]
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89
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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; 24:873-880. [PMID: 30100400 DOI: 10.1016/j.jiac.2018.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [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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90
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Örtqvist Å, Brytting M, Leval A, Hergens MP. Impact of repeated influenza vaccinations in persons over 65 years of age: A large population-based cohort study of severe influenza over six consecutive seasons, 2011/12-2016/17. Vaccine 2018; 36:5556-5564. [PMID: 30076104 DOI: 10.1016/j.vaccine.2018.07.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/14/2018] [Accepted: 07/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND A forty-year debate on the potential negative effects of repeated seasonal influenza vaccination has been inconclusive, with multiple observational studies of various design providing heterogeneous results too inadequate to inform vaccination policy. METHODS A large population-based cohort study including over one-million observations in individuals over age 65 from six consecutive seasons (2011/12-2016/17) in Stockholm County, Sweden. Current season vaccine effectiveness (VE) against severe, mostly hospital-attended, influenza was assessed using Cox multivariate regression analyses adjusting for demographic variables, comorbidities and previous seasonal influenza vaccination status. RESULTS In none of the six seasons was VE significantly different in persons vaccinated in the current season only, compared to those who had been vaccinated in both the current and the previous season. Neither were there any differences in VE during the seasons 2014/15-2016/17 when comparing persons vaccinated during the current season only vs. those vaccinated during one-three or four-five previous influenza seasons. In contrast, persons only vaccinated during one or more previous years had no protection during the current season. CONCLUSIONS Persons above 65 years are the largest group at risk for severe or complicated influenza and policy should support their yearly seasonal influenza vaccination, which is to-date the best preventive measure available for all risk groups. No negative effects of repeated seasonal vaccination were seen in this large population-based cohort of older persons with severe influenza, which strengthens the recommendation that persons belonging to this age group should be vaccinated yearly.
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Affiliation(s)
- Åke Örtqvist
- Department of Communicable Disease Control and Prevention, Stockholm County Council, and Karolinska Institutet, Department of Medicine Karolinska Solna, Unit of Infectious Diseases, Stockholm, Sweden.
| | - Mia Brytting
- Unit for Laboratory Surveillance of Viral Pathogens and Vaccine Preventable Diseases, Department of Microbiology, The Public Health Agency of Sweden, Solna, Sweden
| | - Amy Leval
- Janssen-Cilag AB, Solna, Sweden(1); Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden(2); Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
| | - Maria-Pia Hergens
- Department of Communicable Disease Control and Prevention, Stockholm County Council, and Karolinska Institutet, Department of Medicine Karolinska Solna, Unit of Infectious Diseases, Stockholm, Sweden.
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91
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Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. Vaccine 2018; 36:3434-3444. [DOI: 10.1016/j.vaccine.2018.04.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 01/06/2023]
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92
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Lewnard JA, Cobey S. Immune History and Influenza Vaccine Effectiveness. Vaccines (Basel) 2018; 6:E28. [PMID: 29883414 PMCID: PMC6027411 DOI: 10.3390/vaccines6020028] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022] Open
Abstract
The imperfect effectiveness of seasonal influenza vaccines is often blamed on antigenic mismatch, but even when the match appears good, effectiveness can be surprisingly low. Seasonal influenza vaccines also stand out for their variable effectiveness by age group from year to year and by recent vaccination status. These patterns suggest a role for immune history in influenza vaccine effectiveness, but inference is complicated by uncertainty about the contributions of bias to the estimates themselves. In this review, we describe unexpected patterns in the effectiveness of seasonal influenza vaccination and explain how these patterns might arise as consequences of study design, the dynamics of immune memory, or both. Resolving this uncertainty could lead to improvements in vaccination strategy, including the use of universal vaccines in experienced populations, and the evaluation of vaccine efficacy against influenza and other antigenically variable pathogens.
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Affiliation(s)
- Joseph A Lewnard
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Chicago, IL 60637, USA.
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93
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Volling C, Coleman BL, Katz K, Simor AE, Muller M, Powis J, McElhaney J, McGeer A. Immunogenicity and reactogenicity of high- vs. standard-dose trivalent inactivated influenza vaccine in healthcare workers: a pilot randomized controlled trial. Clin Microbiol Infect 2018; 25:217-224. [PMID: 29783025 DOI: 10.1016/j.cmi.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare immunogenicity, reactogenicity and acceptability of high- and standard-dose trivalent inactivated influenza vaccine (HDTIV, SDTIV) in 18- to 64-year-olds. METHODS We randomized 18- to 64-year-olds to HDTIV or SDTIV in two consecutive years. We collected serum on days 0 and 21, measured haemagglutination inhibition geometric mean titres (GMT) and compared seroconversion, day 21 titres, seroprotection, reactogenicity and acceptability. RESULTS Immunogenicity was evaluable in 42 of 47 2014 participants, all 33 both-year participants and 87 of 90 2015-only participants. First-dose HDTIV recipients experienced seroconversion more frequently than SDTIV recipients to A(H3N2) in 2014 (13/21, 62% vs. 4/21, 19%, p 0.01) and to all vaccine strains in 2015: (A(H1N1): 24/42, 57% vs. 15/59, 25%; A(H3N2): 42/42, 100% vs. 47/59, 80%; B: 25/42, 60% vs. 13/59, 22%; all p <0.01). Day 21 haemagglutination inhibition GMT were higher in first and two sequential-year HDTIV vs. SDTIV recipients: A(H1N1): GMT 749 and 768 vs. 384 (p <0.0001, p 0.002); A(H3N2): 1238 and 956 vs. 633 (p 0.0003, p 0.1); and B: 1113 and 1086 vs. 556 (p 0.0005, p 0.02). HDTIV was more reactogenic (local pain score 3 vs. 1 of 10 on day 0/1, p 0.0003), but recipients were equally willing to be revaccinated (HDTIV: 76/83 (92%); SDTIV: 76/80 (95%), p 0.54). The ratios of day 21 GMT in SDTIV recipients vaccinated in 0 to 4 prior years to those in SDTIV and HDTIV recipients vaccinated in 15 or more prior years were A(H1N1): 3.73 and 1.38; A(H3N2) 3.07 and 1.16; and B: 2.01 and 1.21. CONCLUSIONS HDTIV is more immunogenic and reactogenic and as acceptable as SDTIV in 18- to 64-year-olds.
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Affiliation(s)
- C Volling
- Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - B L Coleman
- Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
| | - K Katz
- University of Toronto, Toronto, Canada; North York General Hospital, North York, Canada
| | - A E Simor
- University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Muller
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Toronto, Canada
| | - J Powis
- University of Toronto, Toronto, Canada; Michael Garron Hospital, East York, Canada
| | - J McElhaney
- Health Sciences North Research Institute, Sudbury, Canada
| | - A McGeer
- Mount Sinai Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
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94
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Stacey HD, Barjesteh N, Mapletoft JP, Miller MS. "Gnothi Seauton": Leveraging the Host Response to Improve Influenza Virus Vaccine Efficacy. Vaccines (Basel) 2018; 6:vaccines6020023. [PMID: 29649134 PMCID: PMC6027147 DOI: 10.3390/vaccines6020023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023] Open
Abstract
Vaccination against the seasonal influenza virus is the best way to prevent infection. Nevertheless, vaccine efficacy remains far from optimal especially in high-risk populations such as the elderly. Recent technological advancements have facilitated rapid and precise identification of the B and T cell epitopes that are targets for protective responses. While these discoveries have undoubtedly brought the field closer to "universal" influenza virus vaccines, choosing the correct antigen is only one piece of the equation. Achieving efficacy and durability requires a detailed understanding of the diverse host factors and pathways that are required for attaining optimal responses. Sequencing technologies, systems biology, and immunological studies have recently advanced our understanding of the diverse aspects of the host response required for vaccine efficacy. In this paper, we review the critical role of the host response in determining efficacious responses and discuss the gaps in knowledge that will need to be addressed if the field is to be successful in developing new and more effective influenza virus vaccines.
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Affiliation(s)
- Hannah D Stacey
- Michael G. DeGroote Institute for Infectious Diseases Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Neda Barjesteh
- Michael G. DeGroote Institute for Infectious Diseases Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Jonathan P Mapletoft
- Michael G. DeGroote Institute for Infectious Diseases Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.
| | - Matthew S Miller
- Michael G. DeGroote Institute for Infectious Diseases Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.
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95
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Sugaya N, Shinjoh M, Nakata Y, Tsunematsu K, Yamaguchi Y, Komiyama O, Takahashi H, Mitamura K, Narabayashi A, Takahashi T. Three-season effectiveness of inactivated influenza vaccine in preventing influenza illness and hospitalization in children in Japan, 2013–2016. Vaccine 2018; 36:1063-1071. [DOI: 10.1016/j.vaccine.2018.01.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/27/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
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96
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Florek NW, Campos LM, Braun KM, McLean HQ, King JP, Flannery B, Belongia EA, Friedrich TC. An updated influenza A(H3N2) vaccine generates limited antibody responses to previously encountered antigens in children. Vaccine 2017; 36:758-764. [PMID: 29249543 DOI: 10.1016/j.vaccine.2017.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Influenza vaccination may provide a "back-boost" to antibodies against previously encountered strains. If the back-boost effect is common, this could allow more aggressive vaccine updates, as emerging variants would be expected to both elicit de-novo responses and boost pre-existing responses against recently circulating strains. Here we used the emergence of an antigenically novel A(H3N2) strain to determine whether an antigenically updated vaccine boosted antibodies against historical strains. METHODS We performed hemagglutination-inhibition (HI) assays on pre- and post-vaccination sera from 124 children 5-17 years old who received 2015-2016 inactivated influenza vaccine, containing an antigenically updated A(H3N2) strain. We evaluated the mean fold increase in HI titer against both the 2015-2016 vaccine strain and representative strains from two prior antigenic clusters. Factors associated with post-vaccination titers against historical strains were evaluated using linear regression, adjusting for baseline titer. RESULTS Geometric mean titers against each antigen examined increased significantly after vaccination (P < .0001). Mean fold increase was 3.29 against the vaccine strain and 1.22-1.46 against historical strains. Response to vaccine strain was associated with increased post-vaccination titers against historical strains. CONCLUSIONS A vaccine containing an antigenically novel A(H3N2) strain modestly boosted antibody responses against historical influenza strains in children.
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Affiliation(s)
- Nicholas W Florek
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI 53706, USA
| | - Luiza M Campos
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI 53706, USA
| | - Katarina M Braun
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI 53706, USA
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield 54449, WI, USA
| | - Jennifer P King
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield 54449, WI, USA
| | - Brendan Flannery
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta 30333, GA, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield 54449, WI, USA.
| | - Thomas C Friedrich
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI 53706, USA; Wisconsin National Primate Research Center, Madison, WI 53715, USA.
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97
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Smith AM, Huber VC. The Unexpected Impact of Vaccines on Secondary Bacterial Infections Following Influenza. Viral Immunol 2017; 31:159-173. [PMID: 29148920 DOI: 10.1089/vim.2017.0138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Influenza virus infections remain a significant health burden worldwide, despite available vaccines. Factors that contribute to this include a lack of broad coverage by current vaccines and continual emergence of novel virus strains. Further complicating matters, when influenza viruses infect a host, severe infections can develop when bacterial pathogens invade. Secondary bacterial infections (SBIs) contribute to a significant proportion of influenza-related mortality, with Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae as major coinfecting pathogens. Vaccines against bacterial pathogens can reduce coinfection incidence and severity, but few vaccines are available and those that are, may have decreased efficacy in influenza virus-infected hosts. While some studies indicate a benefit of vaccine-induced immunity in providing protection against SBIs, a comprehensive understanding is lacking. In this review, we discuss the current knowledge of viral and bacterial vaccine availability, the generation of protective immunity from these vaccines, and the effectiveness in limiting influenza-associated bacterial infections.
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Affiliation(s)
- Amber M Smith
- 1 Department of Pediatrics, University of Tennessee Health Science Center , Memphis, Tennessee
| | - Victor C Huber
- 2 Division of Basic Biomedical Sciences, University of South Dakota , Vermillion, South Dakota
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98
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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] [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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99
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Puig-Barberà J, Guglieri-López B, Tortajada-Girbés M, López-Labrador FX, Carballido-Fernández M, Mollar-Maseres J, Schwarz-Chavarri G, Baselga-Moreno V, Mira-Iglesias A, Díez-Domingo J. Low influenza vaccine effectiveness and the effect of previous vaccination in preventing admission with A(H1N1)pdm09 or B/Victoria-Lineage in patients 60 years old or older during the 2015/2016 influenza season. Vaccine 2017; 35:7331-7338. [PMID: 29128380 DOI: 10.1016/j.vaccine.2017.10.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/15/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The 2015/2016 influenza season was characterized in Europe by the circulation of A(H1N1)pdm09 clade 6B.1 and B/Victoria-lineage influenza viruses. The components of the vaccines used in the current and past two seasons in the Valencia region were similar but not well matched to the 2015/2016 dominant influenza-circulating strains. We estimate influenza vaccine effectiveness (IVE) and interference of previous vaccination in preventing admission with A(H1N1)pdm09 or B/Victoria-lineage in this particular season. METHODS The Valencia Hospital Network for the Study of Influenza runs an active surveillance hospital-based study to collect clinical and virological data from consecutive admissions possibly related to influenza. Combined nasopharyngeal and pharyngeal swabs are analyzed by reverse transcription polymerase chain reaction, and the hemagglutinin is sequenced in a sample of positive influenza specimens. Vaccination is ascertained consulting a population vaccine information system. We estimate IVE using a test-negative approach. RESULTS During the 2015-2016 season, we recruited 1049 eligible admissions of patients 60 years or older, and 187 tested positive for influenza. The adjusted IVE in preventing admission with A(H1N1)pdm09 was 20.2%; 95% confidence interval (CI) -21.3-47.5% and -33.2%; 95% CI, -140.1-26.1% in preventing admission with B/Victoria-lineage. The majority of A(H1N1)pdm09 sequenced viruses belonged to the emerging 6B.1 subclade, defined by S162N and I216T mutations in the hemagglutinin protein. When we restricted our analysis to those not vaccinated in the previous year, unadjusted IVE was 84.9% (95% CI 9.9-100.0) overall, 77.9% (-32.7-100.0%) in preventing A(H1N1)pdm09 and 48.8% (-219.5-100.0%) in preventing B/Yamagata-lineage admission. CONCLUSIONS Our findings indicate that IVE was low in preventing A(H1N1)pdm09 and strongly correlated with vaccination in the previous season. No effect in preventing admission with B/Victoria-lineage was observed. For the 2015/2016 season, IVE was low due to a mismatch and lack of concordance between the circulating and vaccine viruses.
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Affiliation(s)
- Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; Centro de Salud Pública de Castellón, Castellón, Spain.
| | - Beatriz Guglieri-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | | | - F Xavier López-Labrador
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
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100
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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] [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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