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Abstract
Influenza virus infections are a major public health concern and cause significant morbidity and mortality worldwide. Current influenza virus vaccines are an effective countermeasure against infection but need to be reformulated almost every year owing to antigenic drift. Furthermore, these vaccines do not protect against novel pandemic strains, and the timely production of pandemic vaccines remains problematic because of the limitations of current technology. Several improvements have been made recently to enhance immune protection induced by seasonal and pandemic vaccines, and to speed up production in case of a pandemic. Importantly, vaccine constructs that induce broad or even universal influenza virus protection are currently in preclinical and clinical development.
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102
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Choi WS, Noh JY, Baek JH, Seo YB, Lee J, Song JY, Park DW, Lee JS, Cheong HJ, Kim WJ. Suboptimal effectiveness of the 2011-2012 seasonal influenza vaccine in adult Korean populations. PLoS One 2015; 10:e0098716. [PMID: 25815717 PMCID: PMC4376859 DOI: 10.1371/journal.pone.0098716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/07/2014] [Indexed: 11/30/2022] Open
Abstract
Background The effectiveness of the 2011–2012 seasonal influenza vaccine was evaluated in adult Korean populations with regard to how well it could prevent laboratory-confirmed influenza and influenza-related complications. Materials and Methods A retrospective case-control and retrospective cohort study was conducted among patients who visited four selected hospitals from September 2011 to May 2012. The analysis included 1,130 laboratory-confirmed influenza patients. For each influenza case, one control patient was chosen at a ratio of 1:1. A control was defined as an age group-matched patient who visited the same hospital with influenza-like illness within 48 hours of symptom onset but for whom laboratory tests were negative for influenza. Age group and visit date were matched between the cases and controls. Vaccine effectiveness (VE) was defined as [100 × (1-odds ratio for influenza in vaccinated versus non-vaccinated persons)]. The patients with laboratory-confirmed influenza were followed for at least one month through reviewing the medical records and conducting a telephone interview. Results The VE of the 2011–2012 seasonal influenza vaccine was 3.8% [95% confidence interval (CI), -16.5% to 20.6%] for preventing laboratory-confirmed influenza, -16.1% (95% CI, -48.3 to 9.1) for influenza A and 26.2% (95% CI, -2.6 to 46.2) for influenza B. The age-specific adjusted VE was 0.3% (95% CI, -29.4 to 23.1) among participants aged 19 to 49 years, 11.9% (95% CI, -34.3 to 42.2) among those aged 50 to 64 years and -3.9% (-60.1 to 32.5) among those aged ≥65 years. The adjusted VE for preventing any influenza-related complications was -10.7% (95% CI, -41.1% to 42.2%). Conclusions The 2011–2012 seasonal influenza vaccine was not effective in preventing laboratory-confirmed influenza or influenza-related complications in adult Korean populations.
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Affiliation(s)
- Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Icheon, Republic of Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Icheon, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Transgovernmental Enterprise for Pandemic Influenza in Korea, Seoul, Republic of Korea
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103
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Remschmidt C, Rieck T, Bödeker B, Wichmann O. Application of the screening method to monitor influenza vaccine effectiveness among the elderly in Germany. BMC Infect Dis 2015; 15:137. [PMID: 25887460 PMCID: PMC4371628 DOI: 10.1186/s12879-015-0882-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 03/12/2015] [Indexed: 11/11/2022] Open
Abstract
Background Elderly people are at increased risk for severe influenza illness and constitute therefore a major target-group for seasonal influenza vaccination in most industrialized countries. The aim of this study was to estimate influenza vaccine effectiveness (VE) among individuals aged 60+ years over three seasons and to assess if the screening method is a suitable tool to monitor influenza VE in this particular target-group in Germany. Methods We identified laboratory-confirmed influenza cases aged 60+ years through the national communicable disease reporting system for seasons 2010/11, 2011/12 and 2012/13. Vaccination coverage (VC) data were retrieved from a database of health insurance claims representing ~85% of the total German population. We applied the screening method to calculate influenza subtype-specific VE and compared our results with VE estimates from other observational studies in Europe. Results In total, 7,156 laboratory-confirmed influenza cases were included. VE against all influenza types ranged between 49% (95% confidence interval [CI]: 39–56) in 2011/12 and 80% (95% CI: 76-83%) in 2010/11. In 2010/11 subtype-specific VE against influenza A(H1N1)pdm and B was 76% and 84%, respectively. In the following seasons, VE against influenza A(H1N1)pdm, A(H3N2) and B was 87%, -9% , 74% (2011/12), and 74%, 39%, 73% (2012/13). VE was higher among hospitalized compared to non-hospitalized influenza A cases. Seventeen observational studies from Europe reporting subtype-specific VE among the elderly were identified for the respective seasons (all applying the test-negative design) and showed comparable subtype-specific VE estimates. Conclusions According to our study, influenza vaccination provided moderate protection against laboratory-confirmed influenza A(H1N1)pdm and B in individuals aged 60+ but no or only little protection against A(H3N2). Higher VE among hospitalized cases might indicate higher protection against severe influenza disease. Based on the available data, the screening method allowed us to assess subtype-specific VE in hospitalized and non-hospitalized elderly persons. Since controlling for several important confounders was not possible, the applied method only provided crude VE estimates. However, given the precise VC-data and the large number of cases, the screening method provided results being in line with VE estimates from other observational studies in Europe that applied a different study design. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0882-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Thorsten Rieck
- Immunization Unit, Robert Koch Institute, Berlin, Germany. .,Charité - University Medicine Berlin, Berlin, Germany.
| | - Birte Bödeker
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
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104
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Abstract
The age-associated increased susceptibility to infectious disease would suggest that vaccination should be a route to promote healthy aging and keep our seniors autonomous and independent. While vaccination represents a cost-effective and efficient strategy at community level, the ability of the immune system to mount a protective immune response is still unpredictable at the level of the individual. Thus, at a similar age, some individuals, including the elderly, might still be 'good' responders while some other, even younger, would definitely fail to mount a protective response. In this review, the current burden of vaccine-preventable diseases in the aging and aged population will be detailed with the aim to identify the ideal vaccine candidates over the age of 50 years. This article will conclude with potential strategies to reduce, as best as possible, this burden and the imperative need to overcome barriers in extending current vaccine coverage towards to a lifelong vaccine schedule.
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Affiliation(s)
- Pierre-Olivier Lang
- Translational Medicine Research group, Cranfield Health, Cranfield University, Cranfield, England,
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105
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Jackson ML, Rothman KJ. Effects of imperfect test sensitivity and specificity on observational studies of influenza vaccine effectiveness. Vaccine 2015; 33:1313-6. [PMID: 25659280 DOI: 10.1016/j.vaccine.2015.01.069] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/23/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The recently developed test-negative design is now standard for observational studies of influenza vaccine effectiveness (VE). It is unclear how influenza test misclassification biases test-negative VE estimates relative to VE estimates from traditional cohort or case-control studies. METHODS We simulated populations whose members may develop acute respiratory illness (ARI) due to influenza and to non-influenza pathogens. In these simulations, vaccination reduces the risk of influenza but not of non-influenza ARI. Influenza test sensitivity and specificity, risks of influenza and non-influenza ARI, and VE were varied across the simulations. In each simulation, we estimated influenza VE using a cohort design, a case-control design, and a test-negative design. RESULTS In the absence of influenza test misclassification, all three designs accurately estimated influenza VE. In the presence of misclassification, all three designs underestimated VE. Bias in VE estimates was slightly greater in the test-negative design than in cohort or case-control designs. Assuming the use of highly sensitive and specific reverse-transcriptase polymerase chain reaction tests for influenza, bias in the test-negative studies was trivial across a wide range of realistic values for VE. DISCUSSION Although influenza test misclassification causes more bias in test-negative studies than in traditional cohort or case-control studies, the difference is trivial for realistic combinations of attack rates, test sensitivity/specificity, and VE.
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Affiliation(s)
- Michael L Jackson
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA.
| | - Kenneth J Rothman
- Research Triangle Institute, 200 Park Office Drive, Research Triangle Park, Durham, NC 27709, USA.
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106
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Age-specific differences in influenza virus type and subtype distribution in the 2012/2013 season in 12 European countries. Epidemiol Infect 2015; 143:2950-8. [PMID: 25648399 PMCID: PMC4595855 DOI: 10.1017/s0950268814003422] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The epidemiology of seasonal influenza is influenced by age. During the influenza season, the European Influenza Surveillance Network (EISN) reports weekly virological and syndromic surveillance data [mostly influenza-like illness (ILI)] based on national networks of sentinel primary-care providers. Aggregated numbers by age group are available for ILI, but not linked to the virological data. At the end of the influenza season 2012/2013, all EISN laboratories were invited to submit a subset of their virological data for this season, including information on age. The analysis by age group suggests that the overall distribution of circulating (sub)types may mask substantial differences between age groups. Thus, in cases aged 5–14 years, 75% tested positive for influenza B virus whereas all other age groups had an even distribution of influenza A and B viruses. This means that the intepretation of syndromic surveillance data without age group-specific virological data may be misleading. Surveillance at the European level would benefit from the reporting of age-specific influenza data.
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107
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Rondy M, Launay O, Puig-Barberà J, Gefenaite G, Castilla J, de Gaetano Donati K, Galtier F, Hak E, Guevara M, Costanzo S, Moren A. 2012/13 influenza vaccine effectiveness against hospitalised influenza A(H1N1)pdm09, A(H3N2) and B: estimates from a European network of hospitals. ACTA ACUST UNITED AC 2015; 20. [PMID: 25613779 DOI: 10.2807/1560-7917.es2015.20.2.21011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
While influenza vaccines aim to decrease the incidence of severe influenza among high-risk groups, evidence of influenza vaccine effectiveness (IVE) among the influenza vaccine target population is sparse. We conducted a multicentre test-negative case-control study to estimate IVE against hospitalised laboratory-confirmed influenza in the target population in 18 hospitals in France, Italy, Lithuania and the Navarre and Valencia regions in Spain. All hospitalised patients aged ≥18 years, belonging to the target population presenting with influenza-like illness symptom onset within seven days were swabbed. Patients positive by reverse transcription polymerase chain reaction for influenza virus were cases and those negative were controls. Using logistic regression, we calculated IVE for each influenza virus subtype and adjusted it for month of symptom onset, study site, age and chronic conditions. Of the 1,972 patients included, 116 were positive for influenza A(H1N1)pdm09, 58 for A(H3N2) and 232 for influenza B. Adjusted IVE was 21.3% (95% confidence interval (CI): -25.2 to 50.6; n=1,628), 61.8% (95% CI: 26.8 to 80.0; n=557) and 43.1% (95% CI: 21.2 to 58.9; n=1,526) against influenza A(H1N1) pdm09, A(H3N2) and B respectively. Our results suggest that the 2012/13 IVE was moderate against influenza A(H3N2) and B and low against influenza A(H1N1) pdm09.
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108
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Sullivan SG, Feng S, Cowling BJ. Potential of the test-negative design for measuring influenza vaccine effectiveness: a systematic review. Expert Rev Vaccines 2014; 13:1571-91. [PMID: 25348015 PMCID: PMC4277796 DOI: 10.1586/14760584.2014.966695] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The test-negative design is a variant of the case-control study being increasingly used to study influenza vaccine effectiveness (VE). In these studies, patients with influenza-like illness are tested for influenza. Vaccine coverage is compared between those testing positive versus those testing negative to estimate VE. OBJECTIVES We reviewed features in the design, analysis and reporting of 85 published test-negative studies. DATA SOURCES Studies were identified from PubMed, reference lists and email updates. Study eligibility: All studies using the test-negative design reporting end-of-season estimates were included. STUDY APPRAISAL Design features that may affect the validity and comparability of reported estimates were reviewed, including setting, study period, source population, case definition, exposure and outcome ascertainment and statistical model. RESULTS There was considerable variation in the analytic approach, with 68 unique statistical models identified among the studies. CONCLUSION Harmonization of analytic approaches may improve the potential for pooling VE estimates.
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Affiliation(s)
- Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne VIC 3000, Australia
| | - Shuo Feng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- 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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109
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Ohmit SE, Petrie JG, Malosh RE, Fry AM, Thompson MG, Monto AS. Influenza vaccine effectiveness in households with children during the 2012-2013 season: assessments of prior vaccination and serologic susceptibility. J Infect Dis 2014; 211:1519-28. [PMID: 25416812 DOI: 10.1093/infdis/jiu650] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/02/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are recognized needs to identify determinants of influenza vaccine effectiveness (VE), including the effect of repeated annual vaccination. METHODS We recruited 321 households with 1426 members, including 833 children, and followed them during the 2012-2013 influenza season; specimens were collected from subjects with reported acute respiratory illnesses. We estimated the effectiveness of documented influenza vaccination in preventing laboratory-confirmed influenza, using adjusted Cox proportional hazards models. Antibody titers in a subset of subjects were determined by a hemagglutination inhibition assay to determine the subjects' preseason susceptibility to influenza. RESULTS Influenza was identified in 76 (24%) households and 111 (8%) individuals. VE point estimates indicated significant protection in adults (48%; 95% confidence interval [CI], 1%-72%), similar protection in children aged 9-17 years (49%; 95% CI, -16% to 78%), but no evidence of effectiveness in children aged <9 years (-4%; 95% CI, -110% to 49%). Lower VE was observed in those vaccinated in both the current and prior seasons, compared with those vaccinated in the current season only; susceptibility titers against type A but not type B were consistent with this observation. Residual protection from vaccination in the prior season was indicated by both VE and serologic results. CONCLUSIONS Prior vaccination appears to modify VE by both residual protection and reduced vaccine response.
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Affiliation(s)
- Suzanne E Ohmit
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Ryan E Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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110
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Lafond KE, Tam JS, Bresee JS, Widdowson MA. International meeting on influenza vaccine effectiveness, 3-4 December 2012, Geneva, Switzerland. Vaccine 2014; 32:6591-5. [PMID: 25446822 PMCID: PMC5733129 DOI: 10.1016/j.vaccine.2014.09.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
On December 3–4 2012, the World Health Organization convened a meeting of influenza vaccine effectiveness (VE) experts from over 25 countries in Geneva, Switzerland, to review recent developments in the global influenza vaccine landscape and evaluate approaches to determining the effectiveness of influenza vaccine products among target populations. Vaccine manufacturers from Thailand, Vietnam, India, and Brazil shared recent advances illustrating the expansion of influenza vaccine production worldwide. Randomized controlled trials are underway in several low and middle-income countries including India, Thailand, Bangladesh, and South Africa, to fill knowledge gaps in target populations such as children and pregnant women. National and international networks in the United States, Canada, Europe, Latin America and Australia are conducting multi-site observational studies with shared methodologies to generate national influenza VE estimates and pool data for regional estimates. Standardized VE estimation methods are key to generating point estimates that are comparable internationally and across different settings.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - John S. Tam
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Joseph S. Bresee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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111
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Oseltamivir prophylaxis in controlling influenza outbreak in nursing homes: a comparison between three different approaches. Infection 2014; 43:73-81. [PMID: 25403263 DOI: 10.1007/s15010-014-0703-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess influenza outbreaks in nursing homes (NHs) using different pharmacological preventive measures. METHODS We compared characteristics of influenza A outbreaks that occurred during 2011/2012 influenza season in three NHs of similar size (208, 167, and 164 residents in NH1, NH2, and NH3, respectively) implementing comparable treatment approaches and non-pharmacological outbreak control measures but different prophylactic pharmacological interventions including oseltamivir 75 mg o.d. for 10 days for all residents (NH1), for directly exposed residents (NH2), and no prophylaxis (NH3). RESULTS The proportions of residents who developed acute respiratory infection (ARI) in the course of influenza outbreak were 55/208 (26.4 %) in NH1, 64/167 (38.3 %) in NH2, and 31/164 (18.9 %) in NH3; hospital admission was required in 2/55 (3.6 %), 5/64 (7.8 %), and 5/31 (16.1 %) residents of NH1, NH2, and NH3, respectively, while 1/55 (1.8 %), 1/64 (1.6 %), and 3/31 (9.7 %) residents of the corresponding NHs died during influenza outbreak. The duration of the outbreak was shorter in the NH1 where oseltamivir prophylaxis was instituted for all residents (8 days), than in NHs where selective prophylaxis with oseltamivir and no prophylaxis were used (14 and 12 days, respectively). The calculated vaccine effectiveness in residents was 48, 71, and 44 % in NH1, NH2, and NH3, respectively. Staff members had similar ARI attack rate but in comparison to residents were less often vaccinated against influenza and demonstrated higher influenza vaccine effectiveness. CONCLUSIONS Comparison of influenza outbreaks in three NHs revealed that the duration of the outbreak was the shortest in the NH where prophylaxis with oseltamivir was given to all residents.
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112
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Puig-Barberà J, García-de-Lomas J, Díez-Domingo J, Arnedo-Pena A, Ruiz-García M, Limón-Ramírez R, Pérez-Vilar S, Micó-Esparza JL, Tortajada-Girbés M, Carratalá-Munuera C, Larrea-González R, Beltrán-Garrido JM, Otero-Reigada MDC, Mollar-Maseres J, Correcher-Medina P, Schwarz-Chavarri G, Gil-Guillén V. Influenza vaccine effectiveness in preventing influenza A(H3N2)-related hospitalizations in adults targeted for vaccination by type of vaccine: a hospital-based test-negative study, 2011-2012 A(H3N2) predominant influenza season, Valencia, Spain. PLoS One 2014; 9:e112294. [PMID: 25392931 PMCID: PMC4230985 DOI: 10.1371/journal.pone.0112294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most evidence of the effectiveness of influenza vaccines comes from studies conducted in primary care, but less is known about their effectiveness in preventing serious complications. Here, we examined the influenza vaccine effectiveness (IVE) against hospitalization with PCR-confirmed influenza in the predominant A(H3N2) 2011-2012 influenza season. METHODS A hospital-based, test-negative study was conducted in nine hospitals in Valencia, Spain. All emergency admissions with a predefined subset of symptoms were eligible. We enrolled consenting adults age 18 and over, targeted for influenza vaccination because of comorbidity, with symptoms of influenza-like-illness within seven days of admission. We estimated IVE as (1-adjusted vaccination odds ratio)*100 after accounting for major confounders, calendar time and recruitment hospital. RESULTS The subjects included 544 positive for influenza A(H3N2) and 1,370 negative for influenza admissions. Age was an IVE modifying factor. Regardless of vaccine administration, IVE was 72% (38 to 88%) in subjects aged under 65 and 21% (-5% to 40%) in subjects aged 65 and over. By type of vaccine, the IVE of classical intramuscular split-influenza vaccine, used in subjects 18 to 64, was 68% (12% to 88%). The IVE for intradermal and virosomal influenza vaccines, used in subjects aged 65 and over, was 39% (11% to 58%) and 16% (-39% to 49%), respectively. CONCLUSIONS The split-influenza vaccine was effective in preventing influenza-associated hospitalizations in adults aged under 65. The intradermal vaccine was moderately effective in those aged 65 and over.
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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
| | | | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | | | | | | | | | | | | | - Concha Carratalá-Munuera
- Hospital San Juan, Alicante, Spain
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan, Alicante, Spain
| | | | | | | | | | - Patricia Correcher-Medina
- Hospital Lluis Alcanyis, Xativa, Spain, 12 Centro de Salud San Blas, Alicante, Spain, 13 Hospital de Elda, Elda, Spain
| | | | - Vicente Gil-Guillén
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan, Alicante, Spain
- Hospital de Elda, Elda, Spain
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113
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Torner N, Martínez A, Basile L, Marcos MA, Antón A, Mar Mosquera M, Isanta R, Cabezas C, Jané M, Domínguez A, Program of Catalonia TPIDIRACSS. Influenza vaccine effectiveness assessment through sentinel virological data in three post-pandemic seasons. Hum Vaccin Immunother 2014; 11:225-30. [PMID: 25483540 PMCID: PMC4514250 DOI: 10.4161/hv.36155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/08/2014] [Indexed: 11/19/2022] Open
Abstract
Influenza vaccination aims at reducing the incidence of serious disease, complications and death among those with the most risk of severe influenza disease. Influenza vaccine effectiveness (VE) through sentinel surveillance data from the PIDIRAC program (Daily Acute Respiratory Infection Surveillance of Catalonia) during 2010-2011, 2011-2012, and 2012-2013 influenza seasons, with three different predominant circulating influenza virus (IV) types [A(H1N1)pdm09, A(H3N2) and B, respectively] was assessed. The total number of sentinel samples with known vaccination background collected during the study period was 3173, 14.7% of which had received the corresponding seasonal influenza vaccine. 1117 samples (35.2%) were positive for IV. A retrospective negative case control design was used to assess vaccine effectiveness (VE) for the entire period and for each epidemic influenza season. An overall VE of 58.1% (95% CI:46.8-67) was obtained. Differences in VE according to epidemic season were observed, being highest for the 2012-2013 season with predominance of IV type B (69.7% ;95% CI:51.5-81) and for the 2010-2011 season, with predominance of the A(H1N1)pdm09 influenza virus strain (67.2% ;95%CI:49.5-78.8) and lowest for the 2011-2012 season with A(H3N2) subtype predominance (34.2% ;95%CI:4.5-54.6). Influenza vaccination prevents a substantial number of influenza-associated illnesses. Although vaccines with increased effectiveness are needed and the search for a universal vaccine that is not subject to genetic modifications might increase VE, nowadays only the efforts to increase vaccination rates of high-risk population and healthcare personnel let reduce the burden of influenza and its complications.
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Affiliation(s)
- Núria Torner
- Public Health Agency of Catalonia; Department of Health; Generalitat of Catalonia; Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP); Carlos III Health Institute; Madrid, Spain
- Department of Public Health; University of Barcelona; Barcelona, Spain
| | - Ana Martínez
- Public Health Agency of Catalonia; Department of Health; Generalitat of Catalonia; Barcelona, Spain
| | - Luca Basile
- Public Health Agency of Catalonia; Department of Health; Generalitat of Catalonia; Barcelona, Spain
| | - M Angeles Marcos
- Virology Department; Hospital Clinic of Barcelona; Barcelona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit; Microbiology Department; Hospital Universitari Vall d’Hebron; Barcelona, Spain
| | - M Mar Mosquera
- Virology Department; Hospital Clinic of Barcelona; Barcelona, Spain
| | - Ricard Isanta
- Virology Department; Hospital Clinic of Barcelona; Barcelona, Spain
| | - Carmen Cabezas
- Public Health Agency of Catalonia; Department of Health; Generalitat of Catalonia; Barcelona, Spain
| | - Mireia Jané
- Public Health Agency of Catalonia; Department of Health; Generalitat of Catalonia; Barcelona, Spain
| | - Angela Domínguez
- CIBER Epidemiologia y Salud Pública (CIBERESP); Carlos III Health Institute; Madrid, Spain
- Department of Public Health; University of Barcelona; Barcelona, Spain
| | - the PIDIRAC Sentinel Surveillance Program of Catalonia
- Public Health Agency of Catalonia; Department of Health; Generalitat of Catalonia; Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP); Carlos III Health Institute; Madrid, Spain
- Department of Public Health; University of Barcelona; Barcelona, Spain
- Virology Department; Hospital Clinic of Barcelona; Barcelona, Spain
- Respiratory Viruses Unit; Microbiology Department; Hospital Universitari Vall d’Hebron; Barcelona, Spain
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Influenza vaccine effectiveness estimates for Western Australia during a period of vaccine and virus strain stability, 2010 to 2012. Vaccine 2014; 32:6312-8. [PMID: 25223268 DOI: 10.1016/j.vaccine.2014.08.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/04/2014] [Accepted: 08/27/2014] [Indexed: 11/22/2022]
Abstract
During 2010-2012 the strain composition of the influenza vaccine in the Southern Hemisphere did not change, but the circulating virus type/subtype did. We pooled data for these years from the Western Australian sentinel medical practice surveillance system for influenza to estimate vaccine effectiveness (VE) by influenza virus type and subtype. A case test-negative design was used with VE estimated as (1-odds ratio)×100%. There were 2182 patients included in the analysis across the 3 years studied. The predominant subtype was A/H1pdm09 in 2010 and 2011, and A/H3 in 2012. The overall adjusted VE estimate against all influenza for 2010-2012 was 51% (95% CI: 36, 63). Estimates were highest against A/H1pdm09 at 74% (95% CI: 47, 87), followed by 56% (95% CI: 33, 71) for influenza B and lowest against A/H3 at 39% (95% CI: 13, 57). When analyses were restricted to compare influenza-positive patients with patients who tested positive for a non-influenza virus, overall adjusted VE was 59% (95% CI: 39, 72). These results suggest moderate protection against influenza by vaccination in Western Australia over the period 2010-2012, and are consistent with findings from other settings.
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Cowling BJ, Chan KH, Feng S, Chan ELY, Lo JYC, Peiris JSM, Chiu SS. The effectiveness of influenza vaccination in preventing hospitalizations in children in Hong Kong, 2009-2013. Vaccine 2014; 32:5278-84. [PMID: 25092636 PMCID: PMC4165553 DOI: 10.1016/j.vaccine.2014.07.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/11/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza vaccination is widely recommended every year to protect individuals against influenza virus infection and illness. There are few published estimates of influenza vaccine effectiveness against hospitalization in children or from subtropical regions. METHODS We conducted a test-negative year-round study between October 2009 and September 2013, recruiting children 6 months to 17 years of age admitted to two hospitals in Hong Kong with a febrile acute respiratory infection. Cases were tested for influenza A and B and conditional logistic regression was used to estimate vaccine effectiveness comparing influenza vaccination history of the trivalent influenza vaccine (TIV) among patients testing positive versus negative for influenza, adjusting for age and sex and matching by calendar week of recruitment. RESULTS Overall vaccine effectiveness against hospitalization with laboratory-confirmed influenza A and B was estimated to be 61.7% (95% CI: 43.0%, 74.2%). The estimated vaccine effectiveness against A(H3N2) was 36.6% (95% CI: -25.5%, 67.9%) compared to 71.5% (95% CI: 39.4%, 86.6%) for A(H1N1)pdm09 and 68.8% (95% CI: 41.6%, 83.3%) for B. CONCLUSIONS Vaccine effectiveness against hospitalization in children varied from year to year, but was moderate to high overall even in an area with influenza activity throughout the year.
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Affiliation(s)
- Benjamin J Cowling
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Hung Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eunice L Y Chan
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Janice Y C Lo
- Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - J S Malik Peiris
- Division of Public Health Laboratory Sciences, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China; Centre for Influenza Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Susan S Chiu
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Puig-Barberà J, Natividad-Sancho A, Calabuig-Pérez J, Lluch-Rodrigo J, Pastor-Villalba E, Martínez-Úbeda S, Díez-Domingo J. Intradermal and virosomal influenza vaccines for preventing influenza hospitalization in the elderly during the 2011–2012 influenza season: A comparative effectiveness study using the Valencia health care information system. Vaccine 2014; 32:5447-54. [DOI: 10.1016/j.vaccine.2014.07.095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 06/25/2014] [Accepted: 07/30/2014] [Indexed: 12/12/2022]
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Ciancio BC, Rezza G. Costs and benefits of influenza vaccination: more evidence, same challenges. BMC Public Health 2014; 14:818. [PMID: 25103561 PMCID: PMC4139610 DOI: 10.1186/1471-2458-14-818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022] Open
Abstract
Seasonal influenza vaccination coverage in most EU/EEA remains suboptimal. Providers’ and users’ confidence in influenza vaccines is undermined by reports of moderate to low vaccine effectiveness and by the lack of solid evidence on disease burden. A study from Preaud and co. indicates that even with current levels of vaccine effectiveness, increasing vaccination coverage would significantly reduce disease burden and health cost. The results of the study should be interpreted cautiously because some of the assumptions are not generalizable or are imprecise, especially those on vaccine coverage, disease burden and health cost. Increasing vaccination coverage in EU/EEA countries is very challenging. Multifaceted approaches and country specific strategies are needed to address vaccine hesitancy in health care workers and in the population, and to manage organisational and financial obstacles. One key element for increasing vaccination coverage is the development of better influenza vaccines, e.g. vaccines that are more effective, provide longer lasting immunity and do not require annual administration. Vaccine producers should consider this as the highest research priority in the field of influenza vaccine development.
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Preaud E, Durand L, Macabeo B, Farkas N, Sloesen B, Palache A, Shupo F, Samson SI. Annual public health and economic benefits of seasonal influenza vaccination: a European estimate. BMC Public Health 2014; 14:813. [PMID: 25103091 PMCID: PMC4141103 DOI: 10.1186/1471-2458-14-813] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination is currently the most effective means of preventing influenza infection. Yet evidence of vaccine performance, and the impact and value of seasonal influenza vaccination across risk groups and between seasons, continue to generate much discussion. Moreover, vaccination coverage is below recommended levels. METHODS A model was generated to assess the annual public health benefits and economic importance of influenza vaccination in 5 WHO recommended vaccination target groups (children 6 - 23 months of age; persons with underlying chronic health conditions; pregnant women; health care workers; and, the elderly, 65 years of age) in 27 countries of the European Union. Model estimations were based on standard calculation methods, conservative assumptions, age-based and country-specific data. RESULTS Out of approximately 180 million Europeans for whom influenza vaccination is recommended, only about 80 million persons are vaccinated. Seasonal influenza vaccination currently prevents an annual average of between 1.6 million and 2.1 million cases of influenza, 45,300 to 65,600 hospitalizations, and 25,200 to 37,200 deaths. To reach the 75% vaccination coverage target set by the EU Council Recommendation in 2009, an additional 57.4 million person would need to be vaccinated in the elderly and other risk groups. By achieving the 75% target rate set in EU-27 countries, average annual influenza- related events averted would increase from current levels to an additional +1.6 to +1.7 million cases, +23,800 to +31,400 hospitalization, +9,800 to +14,300 deaths, +678,500 to +767,800 physician visits, and +883,800 to +1,015,100 lost days of work yearly. Influenza-related costs averted because of vaccination would increase by an additional + €190 to + €226 million yearly, in vaccination target groups. CONCLUSIONS Full implementation of current influenza vaccination recommendations of 75% vaccination coverage rate (VCR) in Europe by the 2014-2015 influenza season could immediately reduce an important public health and economic burden.
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Affiliation(s)
| | - Laure Durand
- />Sanofi Pasteur, 2, Avenue Pont Pasteur, Lyon, 69007 France
| | | | - Norbert Farkas
- />Novartis Vaccines & Diagnostics AG, Lichtstrasse 35, 4056 Basel, Switzerland
| | | | - Abraham Palache
- />Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands
| | - Francis Shupo
- />Creativ-Ceutical Ltd, The Bank Chambers, Borough High Street, London, SE1 9QQ UK
| | | | - on behalf of Vaccines Europe influenza working group
- />Sanofi Pasteur MSD, 162 av Jean Jaures, Lyon, 69367 France
- />Sanofi Pasteur, 2, Avenue Pont Pasteur, Lyon, 69007 France
- />Novartis Vaccines & Diagnostics AG, Lichtstrasse 35, 4056 Basel, Switzerland
- />GlaxoSmithKline, Rue de l’Institut 89, Rixensart, Belgium
- />Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands
- />Creativ-Ceutical Ltd, The Bank Chambers, Borough High Street, London, SE1 9QQ UK
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119
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Yang P, Thompson MG, Ma C, Shi W, Wu S, Zhang D, Wang Q. Influenza vaccine effectiveness against medically-attended influenza illness during the 2012-2013 season in Beijing, China. Vaccine 2014; 32:5285-9. [PMID: 25092635 DOI: 10.1016/j.vaccine.2014.07.083] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/08/2014] [Accepted: 07/22/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Influenza vaccine coverage remains low in China, and there is limited information on the preventive value of local vaccination programs. METHODS As part of influenza virological surveillance in Beijing, China during the 2012-2013 influenza season, we assessed the vaccine effectiveness (VE) of one or more doses of trivalent inactivated influenza vaccine (IIV3) in preventing medically-attended influenza-like-illness (ILI) associated with laboratory-confirmed influenza virus infection using a test-negative case-control design. Influenza vaccination was determined based on self-report by adult patients or the parents of child patients. RESULTS Of 1998 patients with ILI, 695 (35%) tested positive for influenza viruses, including 292 (42%) A(H3N2), 398 (57%) A(H1N1)pdm09, and 5 (1%) not (sub)typed influenza viruses. The rate of influenza vaccination among all patients was 4% (71/1998). Among influenza positive patients, 2% (57/1303) were vaccinated compared to 4% (14/695) among influenza negative patients, resulting in VE for one or more doses of vaccine (adjusted for age, sex, week, and days since illness onset) against all circulating influenza viruses of 52% (95% CI=12-74%). A significant adjusted VE for one or more doses of vaccine for all ages against A(H1N1)pdm09 of 59% (95% CI, 8-82%) was observed; however, the VE against A(H3N2) was 43% (95% CI, -30% to 75%). The point estimate of VE was 59% (95% CI, 19-79%) for those aged <60 years, but a negative VE point estimate without statistical significance was observed among those aged ≥60 years. CONCLUSIONS IIV3 conferred moderate protection against medically-attended influenza in Beijing, China during the 2012-2013 season, especially against the A(H1N1)pdm09 strain and among those aged <60 years old.
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Affiliation(s)
- Peng Yang
- Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chunna Ma
- Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing, China
| | - Weixian Shi
- Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing, China
| | - Shuangsheng Wu
- Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing, China
| | - Daitao Zhang
- Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing, China.
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Frey SE, Reyes MRADL, Reynales H, Bermal NN, Nicolay U, Narasimhan V, Forleo-Neto E, Arora AK. Comparison of the safety and immunogenicity of an MF59®-adjuvanted with a non-adjuvanted seasonal influenza vaccine in elderly subjects. Vaccine 2014; 32:5027-34. [PMID: 25045825 DOI: 10.1016/j.vaccine.2014.07.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/02/2014] [Accepted: 07/08/2014] [Indexed: 12/09/2022]
Abstract
AIM Adjuvanted influenza vaccines can overcome the poor antibody response of conventional non-adjuvanted vaccines in the elderly. We evaluated the immunogenicity, safety and clinical effectiveness of an MF59(®)-adjuvanted trivalent influenza vaccine (aTIV) compared with a non-adjuvanted vaccine (TIV) in subjects ≥65 years old, with or without co-morbidities. METHODS In 2010-2011, subjects (N=7082) were randomized to receive one dose of aTIV or TIV. Co-primary objectives were to assess lot-to-lot consistency of aTIV, non-inferiority, superiority and immunogenicity 22 days after vaccination. Clinical effectiveness, reactogenicity and serious adverse events were monitored up to Day 366. RESULTS The immunological equivalence of three lots of aTIV was demonstrated. aTIV was not only non-inferior to TIV but also elicited significantly higher antibody responses at Day 22 than TIV against all homologous and heterologous strains, even in subjects with co-morbidities. Superiority was not established. Reactogenicity was higher in the aTIV group, but reactions were mild to moderate and transient. CONCLUSIONS aTIV elicited a significantly higher antibody response than TIV, especially against A/H3N2 strains, although superiority by pre-defined criteria was not formally met. The study demonstrates potential immunological benefits of MF59-adjuvanted influenza vaccines for the elderly. This trial was registered with www.clinicaltrials.gov (NCT01162122).
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Affiliation(s)
- Sharon E Frey
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | | | - Humberto Reynales
- Centro de Atención e Investigación Médica (CAIMED), Bogotá, Colombia
| | | | - Uwe Nicolay
- Novartis Vaccines and Diagnostics Inc., Cambridge, MA, USA
| | - Vas Narasimhan
- Novartis Vaccines and Diagnostics Inc., Cambridge, MA, USA
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Andrews N, McMenamin J, Durnall H, Ellis J, Lackenby A, Robertson C, von Wissmann B, Cottrell S, Smyth B, Moore C, Gunson R, Zambon M, Fleming D, Pebody R. Effectiveness of trivalent seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2012/13 end of season results. Euro Surveill 2014. [DOI: 10.2807/1560-7917.es2014.19.27.20851] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N Andrews
- Public Health England Health Protection Directorate, Colindale, London, United Kingdom
| | - J McMenamin
- Health Protection Scotland, Glasgow, United Kingdom
| | - H Durnall
- Royal College of General Practitioners Research and Surveillance Centre, Birmingham, United Kingdom
| | - J Ellis
- Public Health England Operations Directorate, Microbiology Services, Colindale, London, United Kingdom
| | - A Lackenby
- Public Health England Operations Directorate, Microbiology Services, Colindale, London, United Kingdom
| | - C Robertson
- Health Protection Scotland, Glasgow, United Kingdom
- International Prevention Research Institute, Lyon, France
- University of Strathclyde, Glasgow, United Kingdom
| | | | - S Cottrell
- Public Health Wales, Cardiff, United Kingdom
| | - B Smyth
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - C Moore
- Public Health Wales, Cardiff, United Kingdom
| | - R Gunson
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | - M Zambon
- Public Health England Operations Directorate, Microbiology Services, Colindale, London, United Kingdom
| | - D Fleming
- Royal College of General Practitioners Research and Surveillance Centre, Birmingham, United Kingdom
| | - R Pebody
- Public Health England Health Protection Directorate, Colindale, London, United Kingdom
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Minodier L, Arena C, Heuze G, Ruello M, Amoros JP, Souty C, Varesi L, Falchi A. Epidemiology and viral etiology of the influenza-like illness in corsica during the 2012-2013 Winter: an analysis of several sentinel surveillance systems. PLoS One 2014; 9:e100388. [PMID: 24959929 PMCID: PMC4069071 DOI: 10.1371/journal.pone.0100388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/26/2014] [Indexed: 11/19/2022] Open
Abstract
Influenza-like illness (ILI) surveillance is important to identify circulating and emerging/reemerging strains and unusual epidemiological trends. The present study aimed to give an accurate picture of the 2012-2013 ILI outbreak in Corsica by combining data from several surveillance systems: general practice, emergency general practice, hospital emergency units, intensive care units, and nursing homes. Twenty-eight respiratory viruses were retrospectively investigated from patients in general practice with ILI. Sequence analysis of the genetic changes in the hemagglutinin gene of influenza viruses (A(H1N1)pdm2009, A(H3N2) and B) was performed. The trends in ILI/influenza consultation rates and the relative illness ratios (RIRs) of having an ILI consultation were estimated by age group for the different surveillance systems analyzed. Of the 182 ILI patients enrolled by general practitioners, 57.7% tested positive for influenza viruses. Phylogenetic analyses suggested a genetic drift for influenza B and A(H3N2) viruses. The ILI/influenza surveillance systems showed similar trends and were well correlated. In accordance with virological data, the RIRs of having an ILI consultation were highest among the young (<15 years old) and decreased with age. No clusters of acute respiratory illness were declared by the sentinel nursing homes. This study is noteworthy in that it is the first extensive description of the 2012-2013 ILI outbreak in Corsica as monitored through several surveillance systems. To improve ILI surveillance in Corsica, a consortium that links together the complementary regional surveillance ILI systems described here is being implemented.
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Affiliation(s)
- Laëtitia Minodier
- EA7310, Laboratoire de Virologie, Université de Corse, Institut national de la Santé et de la Recherche Médicale, Corte, France
| | - Christophe Arena
- EA7310, Laboratoire de Virologie, Université de Corse, Institut national de la Santé et de la Recherche Médicale, Corte, France
- Observatoire régional de la Santé de Corse, Ajaccio, France
| | - Guillaume Heuze
- Cellule de l'Institut national de Veille Sanitaire en région, Ajaccio, France
| | - Marc Ruello
- Cellule de l'Institut national de Veille Sanitaire en région, Ajaccio, France
| | - Jean Pierre Amoros
- EA7310, Laboratoire de Virologie, Université de Corse, Institut national de la Santé et de la Recherche Médicale, Corte, France
| | - Cécile Souty
- Sorbonne Universités Pierre et Marie Curie, Paris 06, UMRS 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Institut national de la Santé et de la Recherche Médicale, UMRS 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Laurent Varesi
- EA7310, Laboratoire de Virologie, Université de Corse, Institut national de la Santé et de la Recherche Médicale, Corte, France
| | - Alessandra Falchi
- EA7310, Laboratoire de Virologie, Université de Corse, Institut national de la Santé et de la Recherche Médicale, Corte, France
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Belongia EA, Sundaram ME, McClure DL, Meece JK, Ferdinands J, VanWormer JJ. Waning vaccine protection against influenza A (H3N2) illness in children and older adults during a single season. Vaccine 2014; 33:246-51. [PMID: 24962752 DOI: 10.1016/j.vaccine.2014.06.052] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/27/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies have suggested that vaccine-induced protection against influenza may decline within one season. We reanalyzed data from a study of influenza vaccine effectiveness to determine if time since vaccination was an independent predictor of influenza A (H3N2). METHODS Patients with acute respiratory illness were actively recruited during the 2007-2008 season. Respiratory swabs were tested for influenza, and vaccination dates were determined by a validated immunization registry. The association between influenza RT-PCR result and vaccination interval (days) was examined using multivariable logistic regression, adjusting for calendar time, age and other confounders. RESULTS There were 629 vaccinated participants, including 177 influenza A (H3N2) cases and 452 test negative controls. The mean (SD) interval from vaccination to illness onset was 101.7 (25.9) days for influenza cases and 93.0 (29.9) days for controls. There was a significant association between vaccination interval and influenza result in the main effects model. The adjusted odds ratio (aOR) for influenza was 1.12 (CI 1.01, 1.26) for every 14 day increase in the vaccination interval. Age modified the association between vaccination interval and influenza (p=0.005 for interaction). Influenza was associated with increasing vaccination interval in young children and older adults, but not in adolescents or non-elderly adults. Similar results were found when calendar week of vaccine receipt was assessed as the primary exposure variable. CONCLUSIONS Identification of influenza A (H3N2) was associated with increasing time since vaccination among young children and older adults during a single influenza season.
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Affiliation(s)
- Edward A Belongia
- Marshfield Clinic Research Foundation, 1000 North Oak Ave Marshfield, WI 54449, USA.
| | - Maria E Sundaram
- Marshfield Clinic Research Foundation, 1000 North Oak Ave Marshfield, WI 54449, USA
| | - David L McClure
- Marshfield Clinic Research Foundation, 1000 North Oak Ave Marshfield, WI 54449, USA
| | - Jennifer K Meece
- Marshfield Clinic Research Foundation, 1000 North Oak Ave Marshfield, WI 54449, USA
| | - Jill Ferdinands
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Battelle Memorial Institute, Atlanta, GA, USA
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Foundation, 1000 North Oak Ave Marshfield, WI 54449, USA
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Nunes B, Machado A, Guiomar R, Pechirra P, Conde P, Cristovão P, Falcão I. Estimates of 2012/13 influenza vaccine effectiveness using the case test-negative control design with different influenza negative control groups. Vaccine 2014; 32:4443-4449. [PMID: 24962756 DOI: 10.1016/j.vaccine.2014.06.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/22/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In recent years several reports of influenza vaccine effectiveness (VE) have been made early for public health decision. The majority of these studies use the case test-negative control design (TND), which has been showed to provide, under certain conditions, unbiased estimates of influenza VE. Nevertheless, discussions have been taken on the best influenza negative control group to use. The present study aims to contribute to the knowledge on this field by comparing influenza VE estimates using three test-negative controls: all influenza negative, non-influenza respiratory virus and pan-negative. METHODS Incident ILI patients were prospectively selected and swabbed by a sample of general practitioners. Cases were ILI patients tested positive for influenza and controls ILI patients tested negative for influenza. The influenza negative control group was divided into non-influenza virus control group and pan-negative control group. Data were collected on vaccination status and confounding factors. Influenza VE was estimated as one minus the odds ratio of been vaccinated in cases versus controls adjusted for confounding effect by logistic regression. RESULTS Confounder adjusted influenza VE against medically attended laboratory-confirmed influenza was 68.4% (95% CI: 20.7-87.4%) using all influenza negatives controls, 82.1% (95% CI: 47.6-93.9%) using non-influenza controls and 49.4% (95% CI: -44.7% to 82.3%) using pan-negative controls. CONCLUSIONS Influenza VE estimates differed according to the influenza negative control group used. These results are in accordance with the expected under the hypothesis of differential viral interference between influenza vaccinated and unvaccinated individuals. Given the wide importance of TND study further studies should be conducted in order to clarify the observed differences.
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Affiliation(s)
- Baltazar Nunes
- Unidade de Investigação Epidemiológica, Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal.
| | - Ausenda Machado
- Unidade de Investigação Epidemiológica, Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Raquel Guiomar
- Laboratório Nacional de Referência para o Vírus da Gripe, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Pedro Pechirra
- Laboratório Nacional de Referência para o Vírus da Gripe, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Patrícia Conde
- Laboratório Nacional de Referência para o Vírus da Gripe, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Paula Cristovão
- Laboratório Nacional de Referência para o Vírus da Gripe, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Isabel Falcão
- Unidade de Apoio às Emergências em Saúde Pública, Direção Geral da Saúde, Lisboa, Portugal
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Even-Or O, Samira S, Ellis R, Kedar E, Barenholz Y. Adjuvanted influenza vaccines. Expert Rev Vaccines 2014; 12:1095-108. [PMID: 24053401 DOI: 10.1586/14760584.2013.825445] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Influenza is one of the most common causes of human morbidity and mortality that is preventable by vaccination. Immunization with available vaccines provides incomplete protection against illness caused by influenza virus, especially in high-risk groups such as the elderly and young children. Thus, more efficacious vaccines are needed for the entire population, and all the more so for high-risk groups. One way to improve immune responses and protection is to formulate the vaccine with antigen carriers and/or adjuvants, which can play an important role in improving immune responses and delivery to antigen-presenting cells, especially for a vaccine like influenza that is based on protein antigens usually administered without a carrier or adjuvant. In this review, the authors present an overview of available vaccines, focusing on research and development of new adjuvants used in influenza vaccines, as well as adjuvanted influenza vaccines aimed to improve immune responses, protection and breadth of coverage for influenza.
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Affiliation(s)
- Orli Even-Or
- Laboratory of Membrane and Liposome Research, Department of Biochemistry, The Hebrew University-Hadassah Medical School, P.O. Box 12272, Jerusalem 91120, Israel
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Tsang TK, Cauchemez S, Perera RAPM, Freeman G, Fang VJ, Ip DKM, Leung GM, Malik Peiris JS, Cowling BJ. Association between antibody titers and protection against influenza virus infection within households. J Infect Dis 2014; 210:684-92. [PMID: 24676208 DOI: 10.1093/infdis/jiu186] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have established that antibody titer measured by the hemagglutination-inhibiting (HAI) assay is correlated with protection against influenza virus infection, with an HAI titer of 1:40 generally associated with 50% protection. METHODS We recruited index cases with confirmed influenza virus infection from outpatient clinics, and followed up their household contacts for 7-10 days to identify secondary infections. Serum samples collected from a subset of household contacts were tested by HAI and microneutralization (MN) assays against prevalent influenza viruses. We analyzed the data using an individual hazard-based transmission model that adjusted for age and vaccination history. RESULTS Compared to a reference group with antibody titers <1:10, we found that HAI titers of 1:40 against influenza A(H1N1) and A(H3N2) were associated with 31% (95% confidence interval [CI], 13%-46%) and 31% (CI, 1%-53%) protection against polymerase chain reaction (PCR)-confirmed A(H1N1) and A(H3N2) virus infection, respectively, while an MN titer of 1:40 against A(H3N2) was associated with 49% (95% CI, 7%-81%) protection against PCR-confirmed A(H3N2) virus infection. CONCLUSIONS An HAI titer of 1:40 was associated with substantially less than 50% protection against PCR-confirmed influenza virus infection within households, perhaps because of exposures of greater duration or intensity in that confined setting.
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Affiliation(s)
- Tim K Tsang
- Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Ranawaka A P M Perera
- Division of Public Health Laboratory Sciences, School of Public Health Centre of Influenza Research
| | - Guy Freeman
- Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J Fang
- Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis K M Ip
- Division of Community Medicine and Public Health Practice, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gabriel M Leung
- Division of Community Medicine and Public Health Practice, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | | - Benjamin J Cowling
- Division of Epidemiology and Biostatistics, 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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127
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Jimenez-Jorge S, Pozo F, de Mateo S, Delgado-Sanz C, Casas I, Garcia-Cenoz M, Castilla J, Sancho R, Etxebarriarteun-Aranzabal L, Quinones C, Martinez E, Vega T, Garcia A, Gimenez J, Vanrell JM, Castrillejo D, Larrauri A. Influenza vaccine effectiveness in Spain 2013/14: subtype-specific early estimates using the cycEVA study. ACTA ACUST UNITED AC 2014; 19. [PMID: 24626206 DOI: 10.2807/1560-7917.es2014.19.9.20727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adjusted early estimates of the 2013/14 influenza vaccine effectiveness (VE) in Spain for all age groups was 35% (95% CI: -9 to 62), 33% (95% CI: -33 to 67) and 28% (95% CI: -33 to 61) against any influenza virus type, A(H1N1)pdm09 and A(H3N2) viruses, respectively. For the population targeted for vaccination, the adjusted VE was 44% (95% CI: -11 to 72), 36% (95% CI: -64 to 75) and 42% (95% CI: -29 to 74), respectively. These preliminary results in Spain suggest a suboptimal protective effect of the vaccine against circulating influenza viruses.
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Affiliation(s)
- S Jimenez-Jorge
- National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
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128
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Martinot M, Heller R, Martin A, Sagot E, Souply L, Mothes A, Mohseni-Zadeh M, de Briel D. Contribution of systematic RT-PCR screening for influenza during the epidemic season. Med Mal Infect 2014; 44:123-7. [DOI: 10.1016/j.medmal.2014.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/11/2013] [Accepted: 01/28/2014] [Indexed: 01/14/2023]
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129
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Kissling E, Valenciano M, Buchholz U, Larrauri A, Cohen JM, Nunes B, Rogalska J, Pitigoi D, Paradowska-Stankiewicz I, Reuss A, Jiménez-Jorge S, Daviaud I, Guiomar R, O'Donnell J, Necula G, Głuchowska M, Moren A. Influenza vaccine effectiveness estimates in Europe in a season with three influenza type/subtypes circulating: the I-MOVE multicentre case-control study, influenza season 2012/13. ACTA ACUST UNITED AC 2014; 19. [PMID: 24556348 DOI: 10.2807/1560-7917.es2014.19.6.20701] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the fifth season of Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE), we undertook a multicentre case-control study (MCCS) in seven European Union (EU) Member States to measure 2012/13 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory confirmed as influenza. The season was characterised by substantial co-circulation of influenza B, A(H1N1)pdm09 and A(H3N2) viruses. Practitioners systematically selected ILI patients to swab ≤7 days of symptom onset. We compared influenza-positive by type/subtype to influenza-negative patients among those who met the EU ILI case definition. We conducted a complete case analysis using logistic regression with study as fixed effect and calculated adjusted vaccine effectiveness (AVE), controlling for potential confounders (age, sex, symptom onset week and presence of chronic conditions). We calculated AVE by type/subtype. Study sites sent 7,954 ILI/acute respiratory infection records for analysis. After applying exclusion criteria, we included 4,627 ILI patients in the analysis of VE against influenza B (1,937 cases), 3,516 for A(H1N1)pdm09 (1,068 cases) and 3,340 for influenza A(H3N2) (730 cases). AVE was 49.3% (95% confidence interval (CI): 32.4 to 62.0) against influenza B, 50.4% (95% CI: 28.4 to 65.6) against A(H1N1)pdm09 and 42.2% (95% CI: 14.9 to 60.7) against A(H3N2). Our results suggest an overall low to moderate AVE against influenza B, A(H1N1)pdm09 and A(H3N2), between 42 and 50%. In this season with many co-circulating viruses, the high sample size enabled stratified AVE by type/subtype. The low estimates indicate seasonal influenza vaccines should be improved to achieve acceptable protection levels.
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130
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Vaccine effectiveness against medically attended laboratory-confirmed influenza in Japan, 2011-2012 Season. PLoS One 2014; 9:e88813. [PMID: 24551167 PMCID: PMC3923823 DOI: 10.1371/journal.pone.0088813] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to estimate influenza vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza during the 2011-2012 season in Japan using a test-negative case-control study design. The effect of co-circulating non-influenza respiratory viruses (NIRVs) on VE estimates was also explored. Nasopharyngeal swab samples were collected from outpatients with influenza-like illnesses (ILIs) in a community hospital in Nagasaki, Japan. Thirteen respiratory viruses (RVs), including influenza A and B, were identified from the samples using a multiplex polymerase chain reaction. The difference in VE point estimates was assessed using three different controls: ILI patients that tested negative for influenza, those that tested negative for all RVs, and those that tested positive for NIRVs. The adjusted VE against medically attended, laboratory-confirmed influenza using all influenza-negative controls was 5.3% (95% confidence interval [CI], -60.5 to 44.1). The adjusted VEs using RV-negative and NIRV-positive controls were -1.5% (95% CI, -74.7 to 41) and 50% (95% CI, -43.2 to 82.5), respectively. Influenza VE was limited in Japan during the 2011-2012 season. Although the evidence is not conclusive, co-circulating NIRVs may affect influenza VE estimates in test-negative case-control studies.
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131
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Lang PO. Why Influenza Viruses Continue to Pose a Significant Threat to Aging and Aged Populations Worldwide. CURRENT GERIATRICS REPORTS 2013. [DOI: 10.1007/s13670-013-0070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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132
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Sullivan SG, Komadina N, Grant K, Jelley L, Papadakis G, Kelly H. Influenza vaccine effectiveness during the 2012 influenza season in Victoria, Australia: influences of waning immunity and vaccine match. J Med Virol 2013; 86:1017-25. [PMID: 24395730 DOI: 10.1002/jmv.23847] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2013] [Indexed: 11/08/2022]
Abstract
Vaccine effectiveness may wane with increasing time since vaccination. This analysis used the Victorian sentinel general practitioner (GP) network to estimate vaccine effectiveness for trivalent inactivated vaccines in the 2012 season. A test-negative design was used where patients presenting to GPs with influenza-like illness who tested positive for influenza were cases and noncases were those who tested negative. Vaccination status was recorded by GPs. Vaccine effectiveness was calculated as (1-odds ratio) × 100%. Estimates were compared early versus late in the season and by time since vaccination. Virus isolates were assessed antigenically by hemagglutination inhibition assay in a selection of positive samples and viruses from healthy adults who experienced a vaccine breakthrough were analyzed genetically. The adjusted vaccine effectiveness estimate for any type of influenza was 45% (95% CI: 8,66) and for influenza A(H3) was 35% (95% CI: -11,62). A non-significant effect of waning effectiveness by time since vaccination was observed for A(H3). For those vaccinated <93 days of presentation vaccine effectiveness was 37% (95% CI: -29,69), while for those vaccinated ≥93 days before presentation it was 18% (95% CI: -83,63). Comparison of early versus late in the season estimates was very sensitive to the cut off week chosen for analysis. Antigenic data suggested that low vaccine effectiveness was not associated with poor vaccine match among the A(H3) viruses. However, genetic analysis suggested nucleotide substitutions in antigenic sites. In 2012, the trivalent influenza vaccine provided moderate protection against influenza and showed limited evidence for waning effectiveness. Antigenic and genetic data can provide additional insight into understanding these estimates.
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Affiliation(s)
- Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Victoria, Australia
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133
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Sullivan SG, Kelly H. Late season interim estimates of influenza vaccine effectiveness reliably predict end of season estimates in Victoria, Australia, 2007 to 2012. ACTA ACUST UNITED AC 2013; 18:20605. [PMID: 24135124 DOI: 10.2807/1560-7917.es2013.18.41.20605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twice each year the World Health Organization makes a recommendation for the composition of the influenza vaccine, based on circulating strains of influenza A(H3N2), A(H1N1) and B. Strain selection has always been based on immunogenicity studies with limited human data. Immunogenicity can be considered as a proxy for vaccine effectiveness (VE). However, only interim VE estimates for the target hemisphere can be considered in time for the strain selection meeting.Using surveillance data from Victoria, Australia, we retrospectively estimated and compared interim and final VE estimates for 2007 to 2012. In general, interim estimates were within five percentage points of final estimates. However, estimates made too early or in years of low influenza activity may be unreliable.
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Affiliation(s)
- S G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
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134
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Jiménez-Jorge S, de Mateo S, Delgado-Sanz C, Pozo F, Casas I, Garcia-Cenoz M, Castilla J, Pérez E, Gallardo V, Rodriguez C, Vega T, Quiñones C, Martínez E, Vanrell JM, Giménez J, Castrillejo D, Serrano MDC, Ramos JM, Larrauri A. Effectiveness of influenza vaccine against laboratory-confirmed influenza, in the late 2011-2012 season in Spain, among population targeted for vaccination. BMC Infect Dis 2013; 13:441. [PMID: 24053661 PMCID: PMC3848794 DOI: 10.1186/1471-2334-13-441] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/13/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Spain, the influenza vaccine effectiveness (VE) was estimated in the last three seasons using the observational study cycEVA conducted in the frame of the existing Spanish Influenza Sentinel Surveillance System. The objective of the study was to estimate influenza vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza-like illness (ILI) among the target groups for vaccination in Spain in the 2011-2012 season. We also studied influenza VE in the early (weeks 52/2011-7/2012) and late (weeks 8-14/2012) phases of the epidemic and according to time since vaccination. METHODS Medically attended patients with ILI were systematically swabbed to collect information on exposure, laboratory outcome and confounding factors. Patients belonging to target groups for vaccination and who were swabbed <8 days after symptom onset were included. Cases tested positive for influenza and controls tested negative for any influenza virus. To examine the effect of a late season, analyses were performed according to the phase of the season and according to the time between vaccination and symptoms onset. RESULTS The overall adjusted influenza VE against A(H3N2) was 45% (95% CI, 0-69). The estimated influenza VE was 52% (95% CI, -3 to 78), 40% (95% CI, -40 to 74) and 22% (95% CI, -135 to 74) at 3.5 months, 3.5-4 months, and >4 months, respectively, since vaccination. A decrease in VE with time since vaccination was only observed in individuals aged ≥ 65 years. Regarding the phase of the season, decreasing point estimates were only observed in the early phase, whereas very low or null estimates were obtained in the late phase for the shortest time interval. CONCLUSIONS The 2011-2012 influenza vaccine showed a low-to-moderate protective effect against medically attended, laboratory-confirmed influenza in the target groups for vaccination, in a late season and with a limited match between the vaccine and circulating strains. The suggested decrease in influenza VE with time since vaccination was mostly observed in the elderly population. The decreasing protective effect of the vaccine in the late part of the season could be related to waning vaccine protection because no viral changes were identified throughout the season.
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Affiliation(s)
- Silvia Jiménez-Jorge
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
| | - Salvador de Mateo
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
| | - Concha Delgado-Sanz
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Majadahonda, Madrid 28220, Spain
| | - Inmaculada Casas
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Majadahonda, Madrid 28220, Spain
| | - Manuel Garcia-Cenoz
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
- Instituto de Salud Pública de Navarra, Navarra, Spain
| | - Jesús Castilla
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
- Instituto de Salud Pública de Navarra, Navarra, Spain
| | - Esteban Pérez
- Servicio de Epidemiología y Salud Laboral. Secretaría General de Salud Pública y Participación. Consejería de Salud de Andalucía, Consejería, Spain
| | - Virtudes Gallardo
- Servicio de Epidemiología y Salud Laboral. Secretaría General de Salud Pública y Participación. Consejería de Salud de Andalucía, Consejería, Spain
| | - Carolina Rodriguez
- Dirección General de Salud Pública, Consejería de Sanidad de Castilla y León, Spain
| | - Tomás Vega
- Dirección General de Salud Pública, Consejería de Sanidad de Castilla y León, Spain
| | - Carmen Quiñones
- Servicio de Epidemiología, Subdirección de Salud Pública de La Rioja, La Rioja, Spain
| | - Eva Martínez
- Servicio de Epidemiología, Subdirección de Salud Pública de La Rioja, La Rioja, Spain
| | - Juana María Vanrell
- Servicio de Epidemiología, Dirección General de Salut Pública, Baleares, Spain
| | - Jaume Giménez
- Servicio de Epidemiología, Dirección General de Salut Pública, Baleares, Spain
| | - Daniel Castrillejo
- Servicio de Epidemiología. Dirección General de Sanidad y Consumo, Consejería de Bienestar Social y Sanidad, Ciudad Autónoma de Melilla, Spain
| | | | - Julián Mauro Ramos
- Dirección General de Salud Pública, Servicio Extremeño de Salud, Junta de Extremadura, Spain
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
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135
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Fantoni A, Arena C, Corrias L, Salez N, de Lamballerie XN, Amoros JP, Blanchon T, Varesi L, Falchi A. Genetic drift of influenza A(H3N2) viruses during two consecutive seasons in 2011-2013 in Corsica, France. J Med Virol 2013; 86:585-91. [PMID: 24105757 DOI: 10.1002/jmv.23745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/11/2022]
Abstract
The 2011-2012 and 2012-2013 post-pandemic influenza outbreaks were characterized by variability in the A(H3N2) influenza viruses, resulting in low to moderate vaccine effectiveness (VE). The aim of this study was to investigate the molecular evolution and vaccine strain match of the A(H3N2) influenza viruses, having been circulated throughout the population of the French Corsica Island in 2011-2012 and again in 2012-2013. Clinical samples from 31 patients with confirmed A(H3N2) influenza viruses were collected by general practitioners (GPs) over these two consecutive seasons. An analysis of genetic distance and antigenic drift was conducted. Based on a hemagglutinin (HA) aminoacid sequence analysis, the Corsican A(H3N2) viruses fell into the A/Victoria/208/2009 genetic clade, group 3. All influenza viruses were characterized by at least four fixed amino acid mutations which were: N145S (epitope A); Q156H and V186G (epitope B) Y219S (epitope D), with respect to the A/Perth/16/2009 (reference vaccine strain for the 2011-2012) and the A/Victoria/361/2011 (reference vaccine strain for the 2012-2013). Using the p(epitope) model, the percentages of the perfect match VE estimated against circulated strains declined within and between seasons, with estimations of <50%. Overall, these results seem to indicate an antigenic drift of the A(H3N2) influenza viruses which were circulated in Corsica. These findings highlight the importance of the continuous and careful surveillance of genetic changes in the HA domain during seasonal influenza epidemics, in order to provide information on newly emerging genetic variants.
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Affiliation(s)
- Anais Fantoni
- INSERM, U707, Paris, France; Laboratory of Virology, EA 7310, University of Corsica, Corte, France
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136
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De Serres G, Skowronski DM, Wu XW, Ambrose CS. The test-negative design: validity, accuracy and precision of vaccine efficacy estimates compared to the gold standard of randomised placebo-controlled clinical trials. Euro Surveill 2013; 18. [DOI: 10.2807/1560-7917.es2013.18.37.20585] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- G De Serres
- Institut national de santé publique du Québec and Department of Social and Preventive Medicine, Laval University, Quebec, Canada
| | - D M Skowronski
- British Columbia Center for Disease Control, Vancouver Canada
| | - X W Wu
- MedImmune, Gaithersburg, MD, USA
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137
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Kwong JC, Campitelli MA, Gubbay JB, Peci A, Winter AL, Olsha R, Turner R, Rosella LC, Crowcroft NS. Vaccine effectiveness against laboratory-confirmed influenza hospitalizations among elderly adults during the 2010-2011 season. Clin Infect Dis 2013; 57:820-7. [PMID: 23788243 PMCID: PMC3749748 DOI: 10.1093/cid/cit404] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/06/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although annual influenza immunization is recommended for adults aged ≥65 years due to the substantial burden of illness, the evidence base for this recommendation is weak. Prior observational studies that examined influenza vaccine effectiveness against nonspecific serious outcomes suffered from selection bias and the lack of laboratory confirmation for influenza infection. The objective of this study was to determine the effectiveness of the 2010-2011 seasonal influenza vaccine against laboratory-confirmed influenza hospitalizations among community-dwelling elderly adults, a serious and highly specific outcome. METHODS We conducted a test-negative study of community-dwelling adults aged >65 years in Ontario, Canada. Respiratory specimens collected between 1 December 2010 and 30 April 2011 from patients admitted to acute care hospitals were tested for influenza using nucleic acid amplification techniques. Influenza vaccination was ascertained from physician billing claims through linkage to health administrative datasets. RESULTS Receipt of the 2010-2011 seasonal influenza vaccine was associated with a 42% (95% confidence interval, 29%-53%) reduction in laboratory-confirmed influenza hospitalizations. Vaccine effectiveness estimates were consistent across age groups, by sex, and regardless of outcome severity, timing of testing, and when considering individuals vaccinated <7 or <14 days prior to admission as unvaccinated. CONCLUSIONS Results of this study will better inform decision making regarding influenza vaccination of elderly adults. Similar analyses are needed annually due to antigenic drift and frequent changes in influenza vaccine composition. The linkage of routinely collected laboratory testing and health administrative data represents an efficient method for estimating influenza vaccine effectiveness that complements prospective studies.
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Affiliation(s)
- Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada.
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138
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Trilla A. [Safety and effectiveness of the influenza vaccine: new data, new challenges]. Med Clin (Barc) 2013; 141:67-9. [PMID: 23768850 DOI: 10.1016/j.medcli.2013.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/18/2013] [Indexed: 11/29/2022]
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139
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Sullivan SG, Tay EL, Kelly H. Variable definitions of the influenza season and their impact on vaccine effectiveness estimates. Vaccine 2013; 31:4280-3. [PMID: 23850417 DOI: 10.1016/j.vaccine.2013.06.103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/20/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Abstract
Vaccine effectiveness (VE) studies are often made for a "season" which may refer to different analysis periods in different systems. We examined whether the use of four different definitions of season would materially affect estimates of influenza VE using data from the Victorian general practice sentinel surveillance network for 2007-2012. In general, the choice of analysis period had little effect on VE estimates (≤ five percentage points) when there was a statistically significant protective effect of vaccination (2007, 2010 and 2012). In contrast, for years when the analysis period varied widely depending on the method used and when VE estimates were imprecise, the change in VE estimate was as much as 43 percentage points (2008). Studies of influenza VE should clearly define the analysis period used and, where possible, provide sensitivity analyses to align this definition with other VE studies.
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Affiliation(s)
- Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia.
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140
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Abstract
Influenza directly or indirectly contributes to the four leading causes of global mortality, at rates that are highest in older adults. As the proportion of older adults in the Korean population is greater than in most other countries, influenza prevention is a greater public health priority in Korea than elsewhere. Conventional inactivated influenza vaccine (IIV) is less immunogenic and efficacious (-50%) in older than in young adults, but adjuvanting the vaccine with oil-in-water emulsion MF59® increases immunogenicity, resulting in comparatively higher levels of hemagglutination inhibition antibodies and greater protection against all influenza, as well as cases requiring hospitalization. A recent observational study demonstrated that the adjuvanted vaccine protected older adults against influenza in a year when nonadjuvanted IIV was ineffective. In another multiyear study, the adjuvanted vaccine was estimated to be 25% more effective in preventing pneumonia and influenza hospitalizations compared to nonadjuvanted vaccine. Although MF59-adjuvanted vaccine is transiently more reactogenic than nonadjuvanted vaccine, there is no evidence that it increases risks for serious adverse events, including those with an autoimmune etiology. Experience thus far indicates a favorable balance of benefit to risk for MF59. This may reflect the adjuvant's mechanism of action in which the squalene oil emulsion increases antibody responses to co-administered antigen without acting more generally as an immunopotentiator.
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Affiliation(s)
- Theodore F Tsai
- Novartis Vaccines and Diagnostics Inc., 350 Massachusetts Ave, Cambridge, USA
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141
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Rondy M, Puig-Barbera J, Launay O, Duval X, Castilla J, Guevara M, Costanzo S, de Gaetano Donati K, Moren A. 2011-12 seasonal influenza vaccines effectiveness against confirmed A(H3N2) influenza hospitalisation: pooled analysis from a European network of hospitals. A pilot study. PLoS One 2013; 8:e59681. [PMID: 23565159 PMCID: PMC3614550 DOI: 10.1371/journal.pone.0059681] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Influenza vaccination strategies aim at protecting high-risk population from severe outcomes. Estimating the effectiveness of seasonal vaccines against influenza related hospitalisation is important to guide these strategies. Large sample size is needed to have precise estimate of influenza vaccine effectiveness (IVE) against severe outcomes. We assessed the feasibility of measuring seasonal IVE against hospitalisation with laboratory confirmed influenza through a network of 21 hospitals in the European Union. METHODS We conducted a multicentre study in France (seven hospitals), Italy (one hospital), and Navarra (four hospitals) and Valencia (nine hospitals) regions in Spain. All ≥18 years hospitalised patients presenting an influenza-like illness within seven days were swabbed. Cases were patients RT-PCR positive for influenza A (H3N2); controls were patients negative for any influenza virus. Using logistic regression with study site as a fixed effect we calculated IVE adjusted for potential confounders. We restricted the analyses to those swabbed within four days. RESULTS We included, 375 A(H3N2) cases and 770 controls. The overall adjusted IVE was 24.9% (95%CI-1.8;44.6). Among the target group for vaccination (N = 1058) the adjusted IVE was 28.8% (95%CI:2.8;47.9); it was respectively 36.8% (95%CI:-48.8; 73.1), 42.6% (95%CI:-16.5;71.7), 17.8%(95%CI:-40.8; 52.1) and 37.5% (95%CI:-22.8;68.2) in the age groups 18-64, 65-74, 75-84 and more than 84 years. DISCUSSION Estimation of IVE based on the pooling of data obtained through a European network of hospitals was feasible. Our results suggest a low IVE against hospitalised confirmed influenza in 2011-12. The low IVE may be explained by a poor immune response in the high-risk population, imperfect match between vaccine and circulating strain or waning immunity due to a late season. Increased sample size within this network would allow more precise estimates and stratification of the IVE by time since vaccination and vaccine types or brands.
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