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Halme J, Syrjänen RK, Baum U, Palmu AA. Effectiveness of trivalent influenza vaccines against hospitalizations due to laboratory-confirmed influenza a in the elderly: Comparison of test-negative design with register-based designs. Vaccine 2022; 40:4242-4252. [PMID: 35691869 DOI: 10.1016/j.vaccine.2022.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Measuring influenza vaccine effectiveness (IVE) seasonally is important and has been conducted utilizing several observational study designs. The active test-negative design has been most widely used and the validity of passive register-based studies has been debated. We aimed to explore the potential differences, advantages, and weaknesses of different study designs in estimating influenza vaccine effectiveness. METHODS We compared three study designs in estimating IVE against hospitalization in the elderly aged 65 years or more over three influenza seasons 2015/16, 2016/17 and 2017/18. Designs compared were active test-negative design (TND), register-based cohort design and register-based case-control design with different selection criteria for cases and controls. RESULTS Adjusted IVE estimates for the three consecutive seasons 2015-18 in active test-negative design were 82% (95% confidence interval 26, 96), 21% (-179, 77), 15% (-113, 66). For case-control design, estimates from different analyses ranged in 2015/16 from 47% (-16, 76) to 52% (-48, 84), in 2016/17 from 10% (-42, 43) to 29% (-20, 58), and in 2017/18 from -27% (-91, 15) to 1% (-40, 30). In the cohort design, the adjusted IVE estimates were 48% (-9, 75), 29% (1, 49), 13% (-21, 37) for the three seasons. CONCLUSIONS The register-based cohort design produced results more concordant with the active test-negative design than the case-control design. Furthermore, the register-based cohort design yielded most precise estimates with narrower confidence intervals. In Finland with the availability of near real-time nationwide register data, the register-based cohort design is the method of choice to continue the annual surveillance of influenza vaccine effectiveness.
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Affiliation(s)
- Jussi Halme
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Biokatu 6, 33520 Tampere, Finland
| | - Ritva K Syrjänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Biokatu 6, 33520 Tampere, Finland.
| | - Ulrike Baum
- Department of Health Security, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Biokatu 6, 33520 Tampere, Finland
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2
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Martínez-Baz I, Casado I, Miqueleiz A, Navascués A, Pozo F, Trobajo-Sanmartín C, Albéniz E, Elía F, Burgui C, Fernández-Huerta M, Ezpeleta C, Castilla J. Effectiveness of influenza vaccination in preventing influenza in primary care, Navarre, Spain, 2021/22. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35775428 PMCID: PMC9248265 DOI: 10.2807/1560-7917.es.2022.27.26.2200488] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Compared with individuals unvaccinated in the current and three previous influenza seasons, in 2021/22, influenza vaccine effectiveness at primary care level was 37% (95% CI: 16 to 52) for current season vaccination, regardless of previous doses, and 35% (95% CI: −3 to 45) for only previous seasons vaccination. Against influenza A(H3N2), estimates were 39% (95% CI: 16 to 55) and 24% (95% CI: −8 to 47) suggesting moderate effectiveness of current season vaccination and possible remaining effect of prior vaccinations.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Miqueleiz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Navascués
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Francisco Pozo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Esther Albéniz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Fernando Elía
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Miguel Fernández-Huerta
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Carmen Ezpeleta
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
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Martínez-Baz I, Navascués A, Casado I, Aguinaga A, Ezpeleta C, Castilla J. Simple models to include influenza vaccination history when evaluating the effect of influenza vaccination. ACTA ACUST UNITED AC 2021; 26. [PMID: 34387185 PMCID: PMC8365179 DOI: 10.2807/1560-7917.es.2021.26.32.2001099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Most reports of influenza vaccine effectiveness consider current-season vaccination only. Aim We evaluated a method to estimate the effect of influenza vaccinations (EIV) considering vaccination history. Methods We used a test-negative design with well-documented vaccination history to evaluate the average EIV over eight influenza seasons (2011/12–2018/19; n = 10,356). Modifying effect was considered as difference in effects of vaccination in current and previous seasons and current-season vaccination only. We also explored differences between current-season estimates excluding from the reference category people vaccinated in any of the five previous seasons and estimates without this exclusion or only for one or three previous seasons. Results The EIV was 50%, 45% and 38% in people vaccinated in the current season who had previously received none, one to two and three to five doses, respectively, and it was 30% and 43% for one to two and three to five prior doses only. Vaccination in at least three previous seasons reduced the effect of current-season vaccination by 12 percentage points overall, 31 among outpatients, 22 in 9–65 year-olds, and 23 against influenza B. Including people vaccinated in previous seasons only in the unvaccinated category underestimated EIV by 9 percentage points on average (31% vs 40%). Estimates considering vaccination of three or five previous seasons were similar. Conclusions Vaccine effectiveness studies should consider influenza vaccination in previous seasons, as it can retain effect and is often an effect modifier. Vaccination status in three categories (current season, previous seasons only, unvaccinated) reflects the whole EIV.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Ana Navascués
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Aitziber Aguinaga
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Carmen Ezpeleta
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Jesús Castilla
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Instituto de Salud Pública de Navarra, Pamplona, Spain
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4
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Workplace influenza vaccination to reduce employee absenteeism: An economic analysis from the employers' perspective. Vaccine 2021; 39:2005-2015. [PMID: 33632564 DOI: 10.1016/j.vaccine.2021.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Each year, up to 10% of unvaccinated adults contracts seasonal influenza, with half of this proportion developing symptoms. As a result, employers experience significant economic losses in terms of employee absenteeism. Influenza vaccines can be instrumental in reducing this burden. Workplace vaccination is expected to reduce employee absenteeism more than linearly as a result of positive externalities. It remains unclear whether workplace influenza vaccination yields a positive return on investment. METHODS We simulated the spread of influenza in the seasons 2011-12 up to 2017-18 in Belgium by means of a compartmental transmission model. We accounted for age-specific social contact patterns and included reduced contact behavior when symptomatically infected. We simulated the impact of employer-funded influenza vaccination at the workplace and performed a cost-benefit analysis to assess the employers' return on workplace vaccination. Furthermore, we look into the cost-benefit of rewarding vaccinated employees by offering an additional day off. RESULTS Workplace vaccination reduced the burden of influenza both on the workplace and in the population at large. Compared to the current vaccine coverage - 21% in the population at large - an employee vaccine coverage of 90% could avert an additional 355 000 cases, of which about 150 000 in the employed population and 205 000 in the unemployed population. While seasonal influenza vaccination has been cost-saving on average at about €10 per vaccinated employee, the cost-benefit analysis was prone to between-season variability. CONCLUSIONS Vaccinated employees can serve as a barrier to limit the spread of influenza in the population, reducing the attack rate by 78% at an employee coverage of 90%. While workplace vaccination is relatively inexpensive (due to economies of scale) and convenient, the return on investment is volatile. Government subsidies can be pivotal to encourage employers to provide vaccination at the workplace with positive externalities to society as a whole.
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Mazagatos C, Godoy P, Muñoz Almagro C, Pozo F, Larrauri A. Effectiveness of influenza vaccination during pregnancy to prevent severe infection in children under 6 months of age, Spain, 2017-2019. Vaccine 2020; 38:8405-8410. [PMID: 32741669 DOI: 10.1016/j.vaccine.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/14/2020] [Accepted: 07/09/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Influenza vaccination is recommended to pregnant women in Spain to reduce the risk of influenza-related complications. Influenza related hospitalizations pose a significant disease burden in children every year. Although children below 6 months are too young to be vaccinated, they can receive protection against influenza through vaccination of their mothers during pregnancy. We estimated the effectiveness of maternal influenza vaccination to prevent influenza hospitalizations in infants under 6 months of age. METHODS This is a retrospective pilot study, using data from the Severe Hospitalized Confirmed Influenza Cases (SHCIC) surveillance system in seasons 2017/18 and 2018/19 in Spain. Maternal vaccination status during pregnancy was collected for cases in children 6 months and younger hospitalized with confirmed influenza infection. Influenza vaccine effectiveness was estimated using the screening method, by comparing the proportion of children with vaccinated mothers during pregnancy (proportion of cases vaccinated, PCV), with the vaccination coverage among pregnant women in Spain (proportion of population vaccinated, PPV). RESULTS For all the study period, the PCV was 17% and the PPV was 35%. Influenza vaccination in mothers during pregnancy prevented influenza confirmed hospitalizations in infants aged 6 months and younger with a 61% (95%CI: 27-79%) effectiveness. CONCLUSIONS In line with evidence from other countries, influenza vaccination during pregnancy protects infants up to 6 months of age from influenza hospitalizations in Spain. These results support current recommendations of influenza vaccination in pregnant women, and more studies are needed in Spain to confirm the double protection of maternal vaccination in mothers and infants.
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Affiliation(s)
- Clara Mazagatos
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Pere Godoy
- Servicio de Vigilancia y Salud, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Carmen Muñoz Almagro
- Dirección General de Salud Pública, Aragón, Spain; Servicio de Vigilancia Epidemiológica, Dirección General de Salud Pública, Consejería de Sanidad, Asturias, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Francisco Pozo
- Servicio de Epidemiología, Dirección General de Salud Pública y Participación, Baleares, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - A Larrauri
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain.
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6
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Martínez-Baz I, Navascués A, Casado I, Aguinaga A, Ezpeleta C, Castilla J. Remaining Effect of Influenza Vaccines Received in Prior Seasons. J Infect Dis 2020; 220:1136-1140. [PMID: 31107953 DOI: 10.1093/infdis/jiz266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/18/2019] [Indexed: 11/14/2022] Open
Abstract
This study evaluates the remaining effect of influenza vaccines received in the 5 prior seasons. During 7 influenza seasons, 8933 patients were enrolled and 47% were confirmed for influenza. Compared with unvaccinated individuals in the current and 5 prior seasons, vaccination was protective when the last dose had been received in the current season (40% [95% confidence interval {CI}, 32%-47%]), and 1 (42% [95% CI, 27%-54%]), 2-3 (35% [95% CI, 16%-49%]), or 4-5 seasons (31% [95% CI, 4%-51%]) prior. This effect lasted for fewer seasons in the elderly and in patients with chronic conditions. On average, several recent prior doses were as protective as current-season vaccination.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid
| | - Ana Navascués
- Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid
| | | | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid
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7
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Colucci ME, Affanni P, Cantarelli A, Caruso L, Bracchi MT, Capobianco E, Zoni R, Paini G, Odone A, Mohieldin Mahgoub Ibrahim MM, Veronesi L. Influenza vaccine effectiveness in children: a retrospective study on eight post-pandemic seasons with trivalent inactivated vaccine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:63-70. [PMID: 32275269 PMCID: PMC7975907 DOI: 10.23750/abm.v91i3-s.9424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023]
Abstract
Background and aim of the work: The global burden of disease attributable to seasonal influenza virus in children is difficult to quantify. Children with chronic medical conditions and healthy children may experience severe or fatal complications. Aim of the study was to estimate the influenza vaccine effectiveness (VE) in a cohort of outpatient children. Methods: From 2010 to 2018, a Pediatrician of Parma from the InfluNet network of Emilia-Romagna Region, performed nasal/throat swabs on every child with Influenza-like illness at least 14 days from the vaccination with trivalent vaccine. VE estimates against influenza season, virus type and subtype and age group were evaluated using a test-negative design. Results: 2,480 swabs were performed. The 57.6% of the analyzed swabs were positive for influenza viruses. Type A (57%) and type B viruses (43%) co-circulated. The 37.1% of type A viruses belonged to subtype A(H3N2), 19.4% to subtype A(H1N1)pdm09. The subtype A(H3N2) was prevalent among children up to 23 months (42.4%) while the type B in the 2-4 (40.7%) and 5-16 year old age groups (49.4%). Overall, 19.9% of the children were vaccinated. The highest prevalence of vaccinated subjects was found in children aged 5-16 (30.5%). The VE against subtype A(H1N1)pdm09 was 63% (95%CI 42.6-76.0), against type B 27.5% (95%CI 7.9-42.9) and against subtype A(H3N2) -14.3% (95%CI - 46.0-10.7). Conclusions: Our findings represent a useful contribution to the ongoing debate about the appropriateness of including influenza vaccination for healthy children, 6 months and older, in the updating National Vaccine Prevention Plan (PNPV).
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Affiliation(s)
| | - Paola Affanni
- Department of Medicine and Surgery, University of Parma.
| | | | - Luca Caruso
- Department of Medicine and Surgery, University of Parma.
| | | | | | - Roberta Zoni
- Department of Medicine and Surgery, University of Parma.
| | - Giulia Paini
- Department of Medicine and Surgery, University of Parma.
| | - Anna Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan.
| | | | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma.
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8
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Castilla J, Portillo ME, Casado I, Pozo F, Navascués A, Adelantado M, Gómez Ibáñez C, Ezpeleta C, Martínez-Baz I. Effectiveness of the current and prior influenza vaccinations in Northern Spain, 2018–2019. Vaccine 2020; 38:1925-1932. [DOI: 10.1016/j.vaccine.2020.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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Sofia Arriola C, El Omeiri N, Azziz-Baumgartner E, Thompson MG, Sotomayor-Proschle V, Fasce RA, Von Horoch M, Enrique Carrizo Olalla J, Aparecida Ferreira de Almeida W, Palacios J, Palekar R, Couto P, Descalzo M, María Ropero-Álvarez A. Influenza vaccine effectiveness against hospitalizations in children and older adults-Data from South America, 2013-2017. A test negative design. Vaccine X 2019; 3:100047. [PMID: 31867577 PMCID: PMC6904815 DOI: 10.1016/j.jvacx.2019.100047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In 2013, the Pan American Health Organization established a multi-site, multi-country network to evaluate influenza vaccine effectiveness (VE). We pooled data from five consecutive seasons in five countries to conduct an analysis of southern hemisphere VE against laboratory-confirmed influenza hospitalizations in young children and older adults. METHODS We used a test-negative design to estimate VE against laboratory-confirmed influenza in hospitalized young children (aged 6─24 months) and older adults (aged ≥60 years) in Argentina, Brazil, Chile, Colombia, and Paraguay. Following country-specific influenza surveillance protocol, hospitalized persons with severe acute respiratory infections (SARI) at 48 sentinel hospitals (March 2013-December 2017) were tested for influenza virus infection by rRT-PCR. VE was estimated for young children and older adults using logistic random effects models accounting for cluster (country), adjusting for sex, age (months for children, and age-in-year categories for adults), calendar year, country, preexisting conditions, month of illness onset and prior vaccination as an effect modifier for the analysis in adults. RESULTS We included 8426 SARI cases (2389 children and 6037 adults) in the VE analyses. Among young children, VE against SARI hospitalization associated with any influenza virus was 43% (95%CI: 33%, 51%) for children who received two doses, but was 20% (95%CI: -16%, 45%) and not statistically significant for those who received one dose in a given season. Among older adults, overall VE against SARI hospitalization associated with any influenza virus was 41% (95%CI: 28%, 52%), 45% (95%CI: 34%, 53%) against A(H3N2), 40% (95%CI: 18%, 56%) against A(H1N1)pdm09, and 20% (95%CI: -40%, 54%) against influenza B viruses. CONCLUSIONS Our results suggest that over the five-year study period, influenza vaccination programs in five South American countries prevented more than one-third of laboratory confirmed influenza-associated hospitalizations in young children receiving the recommended two doses and vaccinated older adults.
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Affiliation(s)
- Carmen Sofia Arriola
- Influenza Division, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nathalie El Omeiri
- Department of Family Gender and Life Course/Immunization, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, DC, USA
| | | | - Mark G. Thompson
- Influenza Division, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | - Martha Von Horoch
- Health Surveillance Unit, Ministry of Public Health and Social Welfare, Paraguay
| | | | | | | | - Rakhee Palekar
- Department of Public Health Emergencies, PAHO/WHO, Washington, DC, USA
| | - Paula Couto
- Department of Public Health Emergencies, PAHO/WHO, Washington, DC, USA
| | | | - Alba María Ropero-Álvarez
- Department of Family Gender and Life Course/Immunization, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, DC, USA
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10
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Colucci ME, Veronesi L, Bracchi MT, Zoni R, Caruso L, Capobianco E, Rossi D, Bizzarro A, Cantarelli A, Affanni P. On field vaccine effectiveness in three periods of 2018/2019 influenza season in Emilia-Romagna Region. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:21-27. [PMID: 31517886 PMCID: PMC7233652 DOI: 10.23750/abm.v90i9-s.8699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023]
Abstract
Background and aim of the work: Epidemic influenza is associated with significant morbidity and mortality, particularly in people at risk. The vaccine reduces complications, hospitalization and mortality excess, as well as health care and social costs. Aim of the study was to estimate the influenza vaccine effectiveness (VE) in Emilia-Romagna Region during the 2018/2019 season. Methods: Within the context of virological surveillance conducted at the Regional Reference Laboratory of Parma, nasal/throat swabs were performed by sentinel practitioners and clinicians, on patients with ILI (Influenza-like illness). VE estimates, overall and against subtype A(H1N1)pdm09 and A(H3N2), were evaluated in three periods of the season, using a test-negative case-control design. Results: From November 2018 to April 2019, 2,230 specimens were analyzed: 1,674 (75.1%) performed by clinicians and 556 (24.9%) by sentinel practitioners of the regional network. The season was characterized by the predominant circulation of influenza type A viruses: 57.4% belonged to subtype A(H3N2), 41.2% to subtype A(H1N1)pdm09. 23.5% of patients was vaccinated against influenza with quadrivalent or adjuvate vaccine. The overall VE was -5% (95% CI -33% - 18%) with a decreasing trend during the season. The overall VE against subtype A(H1N1)pdm09 was 39% (95% CI 11% - 58%) and remained stable during the season. The overall VE against subtype A(H3N2) was -43% (95% CI -89% - -9%), and showed an important decreasing trend. Conclusions: The possibility to make accurate and continuous VE estimates during the season will help to better define the composition of the vaccine for the following season. (www.actabiomedica.it)
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11
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Effectiveness of oral cholera vaccine in preventing cholera among fishermen in Lake Chilwa, Malawi: A case-control study. Vaccine 2019; 37:3668-3676. [PMID: 31133470 DOI: 10.1016/j.vaccine.2019.05.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/04/2019] [Accepted: 05/13/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In response to a cholera outbreak among mobile, difficult-to-reach fishermen on Lake Chilwa, Malawi in 2016, a novel vaccine distribution strategy exploited the proven vaccine thermostability. Fishermen, while taking the first vaccine dose under supervision, received the second dose in a sealed bag, and were told to drink it two weeks later. This study assessed short-term vaccine protection of this strategy. METHODS Patients with diarrhoea admitted to health facilities around lake were interviewed and a stool sample collected for PCR testing. Vaccine effectiveness was assessed in a case-control test-negative design by comparing cases (PCR-positive for V. cholerae O1) and controls (patients with diarrhoea but PCR-negative) and with the screening method that compared the proportions of vaccinated among cholera cases versus the general fishermen population. RESULTS Of 145 study participants, 120 were fishermen living on the lake. Vaccine effectiveness at three-months was 90.0% [95%CI:38.8;98.4] among fishermen and 83.3% [95%CI: 20.8; 96.5] among all participants in the case-control test-negative design, and 97.5% [95%CI: 90.9;99.3] with the screening method. CONCLUSION This strategy was effective in providing short-term protection in fishermen against cholera. Further research is needed to determine the adding value of the second dose and to identify the optimal vaccination strategies for different contexts.
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12
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Price OH, Carville KS, Sullivan SG. Right sizing for vaccine effectiveness studies: how many is enough for reliable estimation? Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The precision of vaccine effectiveness (VE) estimates is dependent on sample size and sampling methods. In Victoria, participating general practitioners (GPs) are not limited by the number of influenza-like illness (ILI) patients they collect respiratory samples (swabs) from in sentinel surveillance. However, in the context of scarce resources it is of interest to determine the minimum sample size needed for reliable estimates. Methods Following the test-negative design, patients with ILI were recruited by GPs and tested for influenza. Descriptive analyses were conducted to assess possible selection bias introduced by GPs. VE was calculated by logistic regression as [1 – odds ratio] x 100% and adjusted for week of presentation and age. Random 20% and 50% samples were selected without replacement to estimate the effect of swab rates on VE estimates. Results GPs swabbed a smaller proportion of patients aged ≥65 years (45.9%, n=238) than those <5 (75.6%, n=288), 5–17 (67.9%, n=547) and 18–64 (75.6%, n=2662) years. Decreasing the swab rate did not alter VE point estimates significantly. However, it reduced the precision of estimates and in some instances resulted in too small a sample size to estimate VE. Conclusion Imposing a 20% or 50% swabbing rate produces less robust VE estimates. The number of swabs required per year to produce precise estimates should be dictated by seasonal severity, rather than an arbitrary rate. It would be beneficial for GPs to swab patients systematically by age group to ensure there are sufficient data to investigate VE against a particular subtype in a given age group.
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Affiliation(s)
- Olivia H Price
- 1-WHO Collaborating Centre for Reference and Research on Influenza, at the Peter Doherty Institute for Infection and Immunity, Victoria 3000 Australia 2- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kylie S Carville
- Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Victoria 3000 Australia
| | - Sheena G Sullivan
- 1-WHO Collaborating Centre for Reference and Research on Influenza, at the Peter Doherty Institute for Infection and Immunity, Victoria 3000 Australia 2-School of Population and Global Health, University of Melbourne, Melbourne, Australia
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13
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Castilla J, Navascués A, Casado I, Pérez-García A, Aguinaga A, Ezpeleta G, Pozo F, Ezpeleta C, Martínez-Baz I. Interim effectiveness of trivalent influenza vaccine in a season dominated by lineage mismatched influenza B, northern Spain, 2017/18. ACTA ACUST UNITED AC 2019; 23. [PMID: 29471624 PMCID: PMC5824126 DOI: 10.2807/1560-7917.es.2018.23.7.18-00057] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The 2017/18 interim estimate of trivalent influenza vaccine effectiveness (VE) was 39% (95% confidence interval: 20-54) in Navarre. Compared with individuals unvaccinated in the current and five previous seasons, VE against influenza B was 41% for current and any prior doses, 67% for current vaccination only, and 22% for any prior doses, and 43%, 51% and 54%, respectively against influenza A(H3N2). This suggests moderate VE despite predominance of lineage mismatched influenza B.
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Affiliation(s)
- Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Ana Navascués
- Servicio de Microbiología, Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Itziar Casado
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Alejandra Pérez-García
- Servicio de Microbiología, Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Aitziber Aguinaga
- Servicio de Microbiología, Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Guillermo Ezpeleta
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Francisco Pozo
- Centro Nacional de Microbiología (WHO National Influenza Centre - Madrid), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Carmen Ezpeleta
- Servicio de Microbiología, Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Iván Martínez-Baz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
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- The members of these networks are listed at the end of the article
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- The members of these networks are listed at the end of the article
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14
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El Omeiri N, Azziz-Baumgartner E, Thompson MG, Clará W, Cerpa M, Palekar R, Mirza S, Ropero-Álvarez AM. Seasonal influenza vaccine effectiveness against laboratory-confirmed influenza hospitalizations - Latin America, 2013. Vaccine 2018; 36:3555-3566. [PMID: 28648543 PMCID: PMC5988548 DOI: 10.1016/j.vaccine.2017.06.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite widespread utilization of influenza vaccines, effectiveness (VE) has not been routinely measured in Latin America. METHODS We used a case test-negative control design to estimate trivalent inactivated influenza VE against laboratory-confirmed influenza among hospitalized children aged 6months-5years and adults aged ≥60years which are age-groups targeted for vaccination. We sought persons with severe acute respiratory infections (SARI), hospitalized at 71 sentinel hospitals in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Honduras, Panama, and Paraguay during January-December 2013. Cases had an influenza virus infection confirmed by real-time reverse transcription PCR (rRT-PCR); controls had a negative rRT-PCR result for influenza viruses. We used a two-stage random effects model to estimate pooled VE per target age-group, adjusting for the month of illness onset, age and preexisting medical conditions. RESULTS We identified 2620 SARI patients across sites: 246 influenza cases and 720 influenza-negative controls aged ≤5years and 448 cases and 1206 controls aged ≥60years. The most commonly identified subtype among participants (48%) was the influenza A(H1N1)pdm09 virus followed by influenza A(H3N2) (34%) and influenza B (18%) viruses. Among children, the adjusted VE of full vaccination (one dose for previously vaccinated or two if vaccine naïve) against any influenza virus SARI was 47% (95% confidence interval [CI]: 14-71%); VE was 58% (95% CI: 16-79%) against influenza A(H1N1)pdm09, and 65% (95% CI: -9; 89%) against influenza A(H3N2) viruses associated SARI. Crude VE of full vaccination against influenza B viruses associated SARI among children was 3% (95% CI: -150; 63). Among adults aged ≥60years, adjusted VE against any influenza SARI was 48% (95% CI: 34-60%); VE was 54% (95% CI: 37-69%) against influenza A(H1N1)pdm09, 43% (95% CI: 18-61%) against influenza A(H3N2) and 34% (95% CI: -4; 58%) against B viruses associated SARI. CONCLUSION Influenza vaccine provided moderate protection against severe influenza illness among fully vaccinated young children and older adults, supporting current vaccination strategies.
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MESH Headings
- Aged
- Case-Control Studies
- Child, Preschool
- Female
- Hospitalization/statistics & numerical data
- Humans
- Immunogenicity, Vaccine
- Infant
- Influenza A Virus, H1N1 Subtype/drug effects
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/drug effects
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza B virus/drug effects
- Influenza B virus/immunology
- Influenza Vaccines/administration & dosage
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Latin America/epidemiology
- Male
- Middle Aged
- Seasons
- Sentinel Surveillance
- Vaccination
- Vaccine Potency
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Affiliation(s)
- Nathalie El Omeiri
- Department of Family Gender and Life Course/Immunization, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington D.C., USA; Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
| | | | - Mark G Thompson
- US Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, Georgia, USA
| | | | - Mauricio Cerpa
- Department of Communicable Diseases and Health Analysis, PAHO/WHO, Washington D.C., USA
| | - Rakhee Palekar
- Department of Communicable Diseases and Health Analysis, PAHO/WHO, Washington D.C., USA
| | - Sara Mirza
- US Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, Georgia, USA
| | - Alba María Ropero-Álvarez
- Department of Family Gender and Life Course/Immunization, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington D.C., USA
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15
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Hekimoğlu CH, Emek M, Avcı E, Topal S, Demiröz M, Ergör G. Seasonal Influenza Vaccine Effectiveness in Preventing Laboratory Confirmed Influenza in 2014-2015 Season in Turkey: A Test-Negative Case Control Study. Balkan Med J 2018; 35:77-83. [PMID: 28903887 PMCID: PMC5820451 DOI: 10.4274/balkanmedj.2017.0487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Influenza has an important public health impact worldwide with its considerable annual morbidity among persons with or without risk factors and its serious complications among persons in high-risk groups. The seasonal influenza vaccine is essential for preventing the burden of influenza in a population. Since the vaccine is reformulated each season according to the virus serotypes in circulation, its effectiveness can vary from season to season. Vaccine effectiveness is defined as the relative risk reduction in vaccinated individuals in observational studies. AIMS To calculate influenza vaccine effectiveness in preventing laboratory-confirmed influenza in the Turkish population for the first time using the national sentinel surveillance data in the 2014-2015 influenza season. STUDY DESIGN Test-negative case-control study. METHODS We compared vaccination odds of influenza positive cases to influenza negative controls in the national influenza surveillance in Turkey to estimate influenza vaccine effectiveness. RESULTS The influenza vaccine effectiveness against influenza A (H1N1) (68.4%, 95% CI: -2.9 to 90.3) and B (44.6%, 95% CI: -27.9 to 66.6) were moderate, and the influenza vaccine effectiveness against influenza A (H3N2) (75.0%, 95% CI: -86.1 to 96.7) was relatively high; all had low precision given the low vaccination coverage. Overall, the influenza vaccination coverage rate was 4.2% (95% CI: 3.5 to 5.0), which is not sufficient to control the burden of influenza. CONCLUSION In Turkey, national surveillance for influenza should be strengthened and utilised annually for the assessment of influenza vaccine effectiveness with more precision. Annual influenza vaccine effectiveness in Turkey should continue to be monitored as part of the national sentinel influenza surveillance.
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Affiliation(s)
- Can Hüseyin Hekimoğlu
- Department of Microbiology Reference Laboratories, Public Health Institute of Turkey, Ankara, Turkey
| | - Mestan Emek
- Antalya Public Health Directorate, Antalya, Turkey
| | - Emine Avcı
- Department of Infectious Diseases, Public Health Institute of Turkey, Ankara, Turkey
| | - Selmur Topal
- Department of Infectious Diseases, Public Health Institute of Turkey, Ankara, Turkey
| | | | - Gül Ergör
- Department of Public Health, Dokuz Eylül University School of Medicine, İzmir, Turkey
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16
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Rondy M, El Omeiri N, Thompson MG, Levêque A, Moren A, Sullivan SG. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. J Infect 2017; 75:381-394. [PMID: 28935236 PMCID: PMC5912669 DOI: 10.1016/j.jinf.2017.09.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults. METHODS We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18-64 and 65 years and above) using random-effects models. RESULTS We identified 3411 publications and 30 met our inclusion criteria. Between 2010-11 and 2014-15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18-64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59),37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI:-3;30) when A(H3N2) variant viruses predominated. CONCLUSIONS Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant.
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Affiliation(s)
- Marc Rondy
- Epiconcept, Paris, France; Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux F-33000, France.
| | - Nathalie El Omeiri
- Université Libre de Bruxelles, School of Public Health, Brussels, Belgium
| | - Mark G Thompson
- US Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, USA
| | - Alain Levêque
- Université Libre de Bruxelles, School of Public Health, Brussels, Belgium
| | | | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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17
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Estimation of seasonal influenza vaccine effectiveness using data collected in primary care in France: comparison of the test-negative design and the screening method. Clin Microbiol Infect 2017; 24:431.e5-431.e12. [PMID: 28899840 DOI: 10.1016/j.cmi.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/09/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We discussed which method between the test-negative design (TND) and the screening method (SM) could provide more robust real-time and end-of-season vaccine effectiveness (VE) estimates using data collected from routine influenza surveillance in primary care. METHODS We used data collected during two influenza seasons, 2014-15 and 2015-16. Using the SM, we estimated end-of-season VE in preventing medically attended influenza-like illness and laboratory-confirmed influenza among the population at risk. Using the TND, we estimated end-of-season VE in preventing influenza among both the general and the at-risk population. We estimated real-time VE using both methods. RESULTS For the SM, the overall adjusted end-of-season VE was 24% (95% confidence interval (CI), 16 to 32) and 12% (95% CI, -16 to 33) during season 2014-15, and 53% (95% CI, 44 to 60) and 47% (95% CI, 23 to 64) during season 2015-16, in preventing influenza-like illness and laboratory-confirmed influenza, respectively. For the TND, the overall adjusted end-of-season VE was -17% (95% CI, -79 to 24) and -38% (95% CI, -199 to 13) in 2014-15, and 10% (95% CI, -31 to 39) and 18% (95% CI, -33 to 50) in 2015-16, among the general and at-risk population, respectively. Real-time VE estimates obtained through the TND showed more variability across each season and lower precision than those estimated with the SM. CONCLUSIONS Although the worldwide use of the TND allows for comparison of overall VE estimates among countries, the SM performs better in providing robust real-time VE estimates among the population at risk.
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18
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Rondy M, Launay O, Castilla J, Costanzo S, Puig-Barberà J, Gefenaite G, Larrauri A, Rizzo C, Pitigoi D, Syrjänen RK, Machado A, Kurečić Filipović S, Krisztina Horváth J, Paradowska-Stankiewicz I, Marbus S, Moren A. Repeated seasonal influenza vaccination among elderly in Europe: Effects on laboratory confirmed hospitalised influenza. Vaccine 2017; 35:4298-4306. [PMID: 28709555 DOI: 10.1016/j.vaccine.2017.06.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 11/19/2022]
Abstract
In Europe, annual influenza vaccination is recommended to elderly. From 2011 to 2014 and in 2015-16, we conducted a multicentre test negative case control study in hospitals of 11 European countries to measure influenza vaccine effectiveness (IVE) against laboratory confirmed hospitalised influenza among people aged ≥65years. We pooled four seasons data to measure IVE by past exposures to influenza vaccination. We swabbed patients admitted for clinical conditions related to influenza with onset of severe acute respiratory infection ≤7days before admission. Cases were patients RT-PCR positive for influenza virus and controls those negative for any influenza virus. We documented seasonal vaccination status for the current season and the two previous seasons. We recruited 5295 patients over the four seasons, including 465A(H1N1)pdm09, 642A(H3N2), 278 B case-patients and 3910 controls. Among patients unvaccinated in both previous two seasons, current seasonal IVE (pooled across seasons) was 30% (95%CI: -35 to 64), 8% (95%CI: -94 to 56) and 33% (95%CI: -43 to 68) against influenza A(H1N1)pdm09, A(H3N2) and B respectively. Among patients vaccinated in both previous seasons, current seasonal IVE (pooled across seasons) was -1% (95%CI: -80 to 43), 37% (95%CI: 7-57) and 43% (95%CI: 1-68) against influenza A(H1N1)pdm09, A(H3N2) and B respectively. Our results suggest that, regardless of patients' recent vaccination history, current seasonal vaccine conferred some protection to vaccinated patients against hospitalisation with influenza A(H3N2) and B. Vaccination of patients already vaccinated in both the past two seasons did not seem to be effective against A(H1N1)pdm09. To better understand the effect of repeated vaccination, engaging in large cohort studies documenting exposures to vaccine and natural infection is needed.
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Affiliation(s)
| | - Odile Launay
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; CIC De Vaccinologie, Cochin-Pasteur, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jesus Castilla
- Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli (Isernia), Italy
| | - 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
| | - Giedre Gefenaite
- Department of Infectious Diseases of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Spain
| | - Caterina Rizzo
- Epidemiology Unit Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | | | - Ritva K Syrjänen
- Impact Assessment Unit, National Institute for Health and Welfare (THL), Tampere, Finland
| | - Ausenda Machado
- Epidemiology Research Unit, Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | | | - Judit Krisztina Horváth
- National Centre for Epidemiology, Department of Communicable Disease Prevention and Surveillance, Budapest, Hungary
| | | | - Sierk Marbus
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Martínez-Baz I, Casado I, Navascués A, Díaz-González J, Aguinaga A, Barrado L, Delfrade J, Ezpeleta C, Castilla J. Effect of Repeated Vaccination With the Same Vaccine Component Against 2009 Pandemic Influenza A(H1N1) Virus. J Infect Dis 2017; 215:847-855. [PMID: 28453845 DOI: 10.1093/infdis/jix055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
Abstract
Background The 2009 pandemic influenza A(H1N1) (A[H1N1]pdm09) vaccine component has remained unchanged from 2009. We estimate the effectiveness of current and prior inactivated influenza A(H1N1)pdm09 vaccination from influenza seasons 2010-2011 to 2015-2016. Methods Patients attended with influenza-like illness were tested for influenza. Four periods with continued A(H1N1)pdm09 circulation were included in a test-negative design. Results We enrolled 1278 cases and 2343 controls. As compared to individuals never vaccinated against influenza A(H1N1)pdm09, the highest effectiveness (66%; 95% confidence interval, 49%-78%) was observed in those vaccinated in the current season who had received 1-2 prior doses. The effectiveness was not statistically lower in individuals vaccinated in the current season only (52%) or in those without current vaccination and >2 prior doses (47%). However, the protection was lower in individuals vaccinated in the current season after >2 prior doses (38%; P = .009) or those currently unvaccinated with 1-2 prior doses (10%; P < .001). Current-season vaccination improved the effect in individuals with 1-2 prior doses and did not modify significantly the risk of influenza in individuals with >2 prior doses. Conclusion Current vaccination or several prior doses were needed for high protection. Despite the decreasing effect of repeated vaccination, current-season vaccination was not inferior to no current-season vaccination.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Navascués
- Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Jorge Díaz-González
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | | | - Josu Delfrade
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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20
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Gherasim A, Martínez-Baz I, Castilla J, Pozo F, Larrauri A. Effect of previous and current vaccination against influenza A(H1N1)pdm09, A(H3N2), and B during the post-pandemic period 2010-2016 in Spain. PLoS One 2017; 12:e0179160. [PMID: 28614376 PMCID: PMC5470701 DOI: 10.1371/journal.pone.0179160] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/24/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent studies suggest that the protective effect of the current influenza vaccine could be influenced by vaccination in previous seasons. We estimated the combined effect of the previous and current influenza vaccines from the 2010-2011 season to the 2015-2016 season in Spain. METHODS We performed a test-negative case-control study in patients ≥9 years old. We estimated the influenza vaccine effectiveness (IVE) against influenza A(H1N1)pdm09, A(H3N2), and B virus. RESULTS We included 1206 influenza A(H1N1)pdm09 cases, 1358 A(H3N2) cases and 1079 B cases. IVE against A(H1N1)pdm09 virus in the pooled-season analysis was 53% (95% Confidence Interval (CI): 21% to 72%) for those vaccinated only in the current season and 50% (95%CI: 23% to 68%) for those vaccinated in the both current and previous seasons. Against the influenza A(H3N2) virus, IVE was 17% (95%CI: -43% to 52%) for those vaccinated only in the current season and 3% (95%CI: -33% to 28%) for those vaccinated in both seasons. Regarding influenza B, we obtained similar IVEs for those vaccinated only in the current and those vaccinated in both seasons: 57% (95%CI: 12% to 79%) and 56% (95%CI: 36% to 70%), respectively. CONCLUSION Our results suggested no interference between the previous and current influenza vaccines against A(H1N1)pdm09 and B viruses, but a possible negative interference against A(H3N2) virus.
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Affiliation(s)
- Alin Gherasim
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública y Laboral de Navarra, IdiSNA—Navarra Institute of Health Research, Pamplona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública y Laboral de Navarra, IdiSNA—Navarra Institute of Health Research, Pamplona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Francisco Pozo
- National Centre of Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Carlos III Health Institute, Madrid, Spain
| | - Amparo Larrauri
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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21
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Castilla J, Navascués A, Casado I, Díaz-González J, Pérez-García A, Fernandino L, Martínez-Baz I, Aguinaga A, Pozo F, Ezpeleta C, Primary Health Care Sentinel Network And The Network For Influenza Surveillance In Hospitals Of Navarre. Combined effectiveness of prior and current season influenza vaccination in northern Spain: 2016/17 mid-season analysis. ACTA ACUST UNITED AC 2017; 22. [PMID: 28230523 PMCID: PMC5322189 DOI: 10.2807/1560-7917.es.2017.22.7.30465] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 12/15/2022]
Abstract
The 2016/17 mid-season vaccine effectiveness estimate against influenza A(H3N2) was 15% (95% confidence interval: −11 to 35) in Navarre. Comparing to individuals unvaccinated in the current and four prior seasons, effectiveness was 24% for current and 3–4 prior doses, 61% for current and 1–2 prior doses, 42% for only current vaccination, and 58% for 3–4 prior doses. This suggests moderate effectiveness for different combinations of vaccination in the current and prior seasons.
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Affiliation(s)
- Jesús Castilla
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ana Navascués
- Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jorge Díaz-González
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Alejandra Pérez-García
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Leticia Fernandino
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Aitziber Aguinaga
- Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
| | - Francisco Pozo
- Centro Nacional de Microbiología (WHO National Influenza Centre - Madrid), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Carmen Ezpeleta
- Complejo Hospitalario de Navarra, IdiSNA - Navarre Institute for Health Research, Pamplona, Spain
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22
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van Doorn E, Darvishian M, Dijkstra F, Donker GA, Overduin P, Meijer A, Hak E. Influenza vaccine effectiveness estimates in the Dutch population from 2003 to 2014: The test-negative design case-control study with different control groups. Vaccine 2017; 35:2831-2839. [PMID: 28412077 PMCID: PMC7126814 DOI: 10.1016/j.vaccine.2017.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
Information about influenza vaccine effectiveness (IVE) is important for vaccine strain selection and immunization policy decisions. The test-negative design (TND) case-control study is commonly used to obtain IVE estimates. However, the definition of the control patients may influence IVE estimates. We have conducted a TND study using the Dutch Sentinel Practices of NIVEL Primary Care Database which includes data from patients who consulted the General Practitioner (GP) for an episode of acute influenza-like illness (ILI) or acute respiratory infection (ARI) with known influenza vaccination status. Cases were patients tested positive for influenza virus. Controls were grouped into those who tested (1) negative for influenza virus (all influenza negative), (2) negative for influenza virus, but positive for respiratory syncytial virus, rhinovirus or enterovirus (non-influenza virus positive), and (3) negative for these four viruses (pan-negative). We estimated the IVE over all epidemic seasons from 2003/2004 through 2013/2014, pooled IVE for influenza vaccine partial/full matched and mismatched seasons and the individual seasons using generalized linear mixed-effect and multiple logistic regression models. The overall IVE adjusted for age, GP ILI/ARI diagnosis, chronic disease and respiratory allergy was 35% (95% CI: 15-48), 64% (95% CI: 49-75) and 21% (95% CI: -1 to 39) for all influenza negative, non-influenza virus positive and pan-negative controls, respectively. In both the main and subgroup analyses IVE estimates were the highest using non-influenza virus positive controls, likely due to limiting inclusion of controls without laboratory-confirmation of a virus causing the respiratory disease.
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Affiliation(s)
- Eva van Doorn
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Maryam Darvishian
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederika Dijkstra
- Infectious Disease Epidemiology and Surveillance, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gé A Donker
- Sentinel Practices, NIVEL Primary Care Database, Utrecht, The Netherlands
| | - Pieter Overduin
- Infectious Disease Research, Diagnostics and Screening, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Adam Meijer
- Infectious Disease Research, Diagnostics and Screening, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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23
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Kissling E, Nunes B, Robertson C, Valenciano M, Reuss A, Larrauri A, Cohen JM, Oroszi B, Rizzo C, Machado A, Pitigoi D, Domegan L, Paradowska-Stankiewicz I, Buchholz U, Gherasim A, Daviaud I, Horváth JK, Bella A, Lupulescu E, O Donnell J, Korczyńska M, Moren A. I-MOVE multicentre case-control study 2010/11 to 2014/15: Is there within-season waning of influenza type/subtype vaccine effectiveness with increasing time since vaccination? ACTA ACUST UNITED AC 2017; 21:30201. [PMID: 27124420 DOI: 10.2807/1560-7917.es.2016.21.16.30201] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Abstract
Since the 2008/9 influenza season, the I-MOVE multicentre case-control study measures influenza vaccine effectiveness (VE) against medically-attended influenza-like-illness (ILI) laboratory confirmed as influenza. In 2011/12, European studies reported a decline in VE against influenza A(H3N2) within the season. Using combined I-MOVE data from 2010/11 to 2014/15 we studied the effects of time since vaccination on influenza type/subtype-specific VE. We modelled influenza type/subtype-specific VE by time since vaccination using a restricted cubic spline, controlling for potential confounders (age, sex, time of onset, chronic conditions). Over 10,000 ILI cases were included in each analysis of influenza A(H3N2), A(H1N1)pdm09 and B; with 4,759, 3,152 and 3,617 influenza positive cases respectively. VE against influenza A(H3N2) reached 50.6% (95% CI: 30.0-65.1) 38 days after vaccination, declined to 0% (95% CI: -18.1-15.2) from 111 days onwards. At day 54 VE against influenza A(H1N1)pdm09 reached 55.3% (95% CI: 37.9-67.9) and remained between this value and 50.3% (95% CI: 34.8-62.1) until season end. VE against influenza B declined from 70.7% (95% CI: 51.3-82.4) 44 days after vaccination to 21.4% (95% CI: -57.4-60.8) at season end. To assess if vaccination campaign strategies need revising more evidence on VE by time since vaccination is urgently needed.
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24
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Castilla J, Navascués A, Fernández-Alonso M, Reina G, Albéniz E, Pozo F, Álvarez N, Martínez-Baz I, Guevara M, García-Cenoz M, Irisarri F, Casado I, Ezpeleta C. Effects of previous episodes of influenza and vaccination in preventing laboratory-confirmed influenza in Navarre, Spain, 2013/14 season. ACTA ACUST UNITED AC 2017; 20:30243. [PMID: 27277013 DOI: 10.2807/1560-7917.es.2016.21.22.30243] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/25/2016] [Indexed: 11/20/2022]
Abstract
We estimated whether previous episodes of influenza and trivalent influenza vaccination prevented laboratory-confirmed influenza in Navarre, Spain, in season 2013/14. Patients with medically-attended influenza-like illness (MA-ILI) in hospitals (n = 645) and primary healthcare (n = 525) were included. We compared 589 influenza cases and 581 negative controls. MA-ILI related to a specific virus subtype in the previous five seasons was defined as a laboratory-confirmed influenza infection with the same virus subtype or MA-ILI during weeks when more than 25% of swabs were positive for this subtype. Persons with previous MA-ILI had 30% (95% confidence interval (CI): -7 to 54) lower risk of MA-ILI, and those with previous MA-ILI related to A(H1N1)pdm09 or A(H3N2) virus, had a, respectively, 63% (95% CI: 16-84) and 65% (95% CI: 13-86) lower risk of new laboratory-confirmed influenza by the same subtype. Overall adjusted vaccine effectiveness in preventing laboratory-confirmed influenza was 31% (95% CI: 5-50): 45% (95% CI: 12-65) for A(H1N1)pdm09 and 20% (95% CI: -16 to 44) for A(H3N2). While a previous influenza episode induced high protection only against the same virus subtype, influenza vaccination provided low to moderate protection against all circulating subtypes. Influenza vaccine remains the main preventive option for high-risk populations.
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Affiliation(s)
- Jesús Castilla
- Instituto de Salud Pública de Navarra, IdiSNA - Navarra Institute for Health Research, Pamplona, Spain
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25
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Leval A, Hergens MP, Persson K, Örtqvist Å. Real-time real-world analysis of seasonal influenza vaccine effectiveness: method development and assessment of a population-based cohort in Stockholm County, Sweden, seasons 2011/12 to 2014/15. ACTA ACUST UNITED AC 2016; 21:30381. [PMID: 27813473 PMCID: PMC5114721 DOI: 10.2807/1560-7917.es.2016.21.43.30381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
Real-world estimates of seasonal influenza vaccine effectiveness (VE) are important for early detection of vaccine failure. We developed a method for evaluating real-time in-season vaccine effectiveness (IVE) and overall seasonal VE. In a retrospective, register-based, cohort study including all two million individuals in Stockholm County, Sweden, during the influenza seasons from 2011/12 to 2014/15, vaccination status was obtained from Stockholm’s vaccine register. Main outcomes were hospitalisation or primary care visits for influenza (International Classification of Disease (ICD)-10 codes J09-J11). VE was assessed using Cox multivariate stratified and non-stratified analyses adjusting for age, sex, socioeconomic status, comorbidities and previous influenza vaccinations. Stratified analyses showed moderate VE in prevention of influenza hospitalisations among chronically ill adults ≥ 65 years in two of four seasons, and lower but still significant VE in one season; 53% (95% confidence interval (CI): 33–67) in 2012/13, 55% (95% CI: 25–73) in 2013/14 and 18% (95% CI: 3–31) in 2014/15. In conclusion, seasonal influenza vaccination was associated with substantial reductions in influenza-specific hospitalisation, particularly in adults ≥ 65 years with underlying chronic conditions. With the use of population-based patient register data on influenza-specific outcomes it will be possible to obtain real-time estimates of seasonal influenza VE.
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Affiliation(s)
- Amy Leval
- Department of Communicable Disease Control and Prevention for Stockholm County, Stockholm, Sweden
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26
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Martínez-Baz I, Navascués A, Pozo F, Chamorro J, Albeniz E, Casado I, Reina G, Cenoz MG, Ezpeleta C, Castilla J. Influenza vaccine effectiveness in preventing inpatient and outpatient cases in a season dominated by vaccine-matched influenza B virus. Hum Vaccin Immunother 2016; 11:1626-33. [PMID: 25996366 DOI: 10.1080/21645515.2015.1038002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Studies that have evaluated the influenza vaccine effectiveness (VE) to prevent laboratory-confirmed influenza B cases are uncommon, and few have analyzed the effect in preventing hospitalized cases. We have evaluated the influenza VE in preventing outpatient and hospitalized cases with laboratory-confirmed influenza in the 2012-2013 season, which was dominated by a vaccine-matched influenza B virus. In the population covered by the Navarra Health Service, all hospitalized patients with influenza-like illness (ILI) and all ILI patients attended by a sentinel network of general practitioners were swabbed for influenza testing, and all were included in a test-negative case-control analysis. VE was calculated as (1-odds ratio) × 100. Among 744 patients tested, 382 (51%) were positive for influenza virus: 70% for influenza B, 24% for A(H1N1)pdm09, and 5% for A(H3N2). The overall estimate of VE in preventing laboratory-confirmed influenza was 63% (95% confidence interval (CI): 34 to 79), 55% (1 to 80) in outpatients and 74% (33 to 90) in hospitalized patients. The VE was 70% (41 to 85) against influenza B and 43% (-45 to 78) against influenza A. The VE against virus B was 87% (52 to 96) in hospitalized patients and 56% in outpatients (-5 to 81). Adjusted comparison of vaccination status between inpatient and outpatient cases with influenza B did not show statistically significant differences (odds ratio: 1.13; p = 0.878). These results suggest a high protective effect of the vaccine in the 2012-2013 season, with no differences found for the effect between outpatient and hospitalized cases.
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27
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Redlberger-Fritz M, Kundi M, Popow-Kraupp T. Detailed Report on 2014/15 Influenza Virus Characteristics, and Estimates on Influenza Virus Vaccine Effectiveness from Austria's Sentinel Physician Surveillance Network. PLoS One 2016; 11:e0149916. [PMID: 26975056 PMCID: PMC4790898 DOI: 10.1371/journal.pone.0149916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is influenced by the antigenic similarity between vaccine- and circulating strains. MATERIAL AND METHODS This paper presents data obtained by the Austrian sentinel surveillance system on the evolution of influenza viruses during the season 2014/15 and its impact on influenza vaccine effectiveness in primary care in Austria as estimated by a test-negative case control design. VE estimates were performed for each influenza virus type/subtype, stratified by underlying diseases and adjusted for age, sex and calendar week of infection. RESULTS Detailed genetic and antigenic analyses showed that circulating A(H3N2) viruses were genetically distinct from the 2014/15 A(H3N2) vaccine component indicating a profound vaccine mismatch. The Influenza A(H1N1)pdm09 viruses were antigenically conserved and matched the respective vaccine component. Influenza B viruses were lineage-matched B/Yamagata viruses with a clade-level variation. Consistent with substantial vaccine mismatch for the A(H3N2) viruses a crude overall VE of only 47% was estimated, whereas the VE estimates for A(H1N1)pdm09 were 84% and for influenza B viruses 70%. Increased VE estimates were obtained after stratification by underlying diseases and adjustment for the covariates sex and age, whereby the adjustment for the calendar week of infection was the covariate exerting the highest influence on adjusted VE estimates. CONCLUSION In summary, VE data obtained in this study underscore the importance to perform VE estimates in the context of detailed characterization of the contributing viruses and also demonstrate that the calendar week of influenza virus infection is the most important confounder of VE estimates.
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Affiliation(s)
| | - Michael Kundi
- Institute of Environmental Health, Center for Public Health, Medical University Vienna, Vienna, Austria
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28
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Damien GB, Djènontin A, Chaffa E, Yamadjako S, Drame PM, Ndille EE, Henry MC, Corbel V, Remoué F, Rogier C. Effectiveness of insecticidal nets on uncomplicated clinical malaria: a case-control study for operational evaluation. Malar J 2016; 15:102. [PMID: 26891758 PMCID: PMC4759848 DOI: 10.1186/s12936-016-1156-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background In a context of large-scale implementation of malaria vector control tools, such as the distribution of long-lasting insecticide nets (LLIN), it is necessary to regularly assess whether strategies are progressing as expected and then evaluate their effectiveness. The present study used the case–control approach to evaluate the effectiveness of LLIN 42 months after national wide distribution. This study design offers an alternative to cohort study and randomized control trial as it permits to avoid many ethical issues inherent to them. Methods From April to August 2011, a case–control study was conducted in two health districts in Benin; Ouidah–Kpomasse–Tori (OKT) in the south and Djougou–Copargo–Ouake (DCO) in the north. Children aged 0–60 months randomly selected from community were included. Cases were children with a high axillary temperature (≥37.5 °C) or a reported history of fever during the last 48 h with a positive rapid diagnostic test (RDT). Controls were children with neither fever nor signs suggesting malaria with a negative RDT. The necessary sample size was at least 396 cases and 1188 controls from each site. The main exposure variable was “sleeping every night under an LLIN for the 2 weeks before the survey” (SL). The protective effectiveness (PE) of LLIN was calculated as PE = 1 − odds ratio. Results The declared SL range was low, with 17.0 and 27.5 % in cases and controls in the OKT area, and 44.9 and 56.5 % in cases and controls, in the DCO area, respectively. The declared SL conferred 40.5 % (95 % CI 22.2–54.5 %) and 55.5 % (95 % CI 28.2–72.4 %) protection against uncomplicated malaria in the OKT and the DCO areas, respectively. Significant differences in PE were observed according to the mother’s education level. Conclusion In the context of a mass distribution of LLIN, their use still conferred protection in up to 55 % against the occurrence of clinical malaria cases in children. Social factors, the poor use and the poor condition of an LLIN can be in disfavour with its effectiveness. In areas, where LLIN coverage is assumed to be universal or targeted at high-risk populations, case–control studies should be regularly conducted to monitor the effectiveness of LLIN. The findings will help National Malaria Control Programme and their partners to improve the quality of malaria control according to the particularity of each area or region as far as possible.
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Affiliation(s)
- Georgia Barikissou Damien
- IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin.
| | - Armel Djènontin
- IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin. .,Laboratoire Evolution, Biodiversité des Arthropodes et Assainissement, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Abomey-Calavi, Bénin.
| | - Evelyne Chaffa
- Programme National de Lutte contre le Paludisme (PNLP), Direction Nationale de la Santé Publique, Ministère de la Santé, Cotonou, Benin.
| | - Sandra Yamadjako
- IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin.
| | - Papa Makhtar Drame
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), 34394, Montpellier, France. .,IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin. .,Laboratory of Parasitic Diseases, NIAID, NIH, 4 Center Dr, Bethesda, MD, 20892-0425, USA.
| | - Emmanuel Elanga Ndille
- IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin.
| | - Marie-Claire Henry
- IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin.
| | - Vincent Corbel
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), 34394, Montpellier, France. .,IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin.
| | - Franck Remoué
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), 34394, Montpellier, France. .,IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin.
| | - Christophe Rogier
- Institut Pasteur de Madagascar, Antananarivo, Madagascar. .,Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France. .,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Aix-Marseille Université, Marseille, France.
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Castilla J, Navascués A, Fernández-Alonso M, Reina G, Pozo F, Casado I, Guevara M, Martínez-Baz I, Barricarte A, Ezpeleta C. Effectiveness of subunit influenza vaccination in the 2014-2015 season and residual effect of split vaccination in previous seasons. Vaccine 2016; 34:1350-7. [PMID: 26854911 DOI: 10.1016/j.vaccine.2016.01.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/08/2016] [Accepted: 01/26/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Navarra, Spain, subunit vaccine was first used in the 2014-2015 season, whereas trivalent split-virion influenza vaccines had been used in previous seasons. We estimate the effectiveness of the subunit vaccine in the current season and split vaccine in the two previous seasons against laboratory-confirmed influenza in the 2014-2015 season. METHODS Patients with influenza-like illness hospitalized or attended by sentinel general practitioners were swabbed for influenza testing. The previous and current vaccine status of laboratory-confirmed cases was compared to test-negative controls. RESULTS Among 1213 patients tested, 619 (51%) were confirmed for influenza virus: 52% influenza A(H3N2), 46% influenza B, and 2% A(H1N1)pdm09. The overall effectiveness for subunit vaccination in the current season was 19% (95% confidence interval [CI]: -13 to 42), 2% (95%CI: -47 to 35) against influenza A(H3N2) and 32% (95%CI: -4 to 56) against influenza B. The effectiveness against any influenza was 67% (95%CI: 17-87) for 2012-2013 and 2013-2014 vaccination only, 42% (95%CI: -31 to 74) for 2014-2015 vaccination only, and 38% (95%CI: 8-58) for vaccination in the 2012-2013, 2013-2014 and 2014-2015 seasons. The same estimates against influenza A(H3N2) were 47% (95%CI: -60 to 82), -54% (95%CI: -274 to 37) and 28% (95%CI: -17 to 56), and against influenza B were 82% (95%CI: 19-96), 93% (95%CI: 45-99) and 43% (95%CI: 5-66), respectively. CONCLUSION These results suggest a considerable residual protection of split vaccination in previous seasons, low overall effectiveness of current season subunit vaccination, and possible interference between current subunit and previous split vaccines.
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Affiliation(s)
- Jesús Castilla
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Ana Navascués
- Complejo Hospitalario de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Mirian Fernández-Alonso
- Clínica Universidad de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel Reina
- Clínica Universidad de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Francisco Pozo
- Centro Nacional de Microbiología (WHO National Influenza Centre-Madrid), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Aurelio Barricarte
- Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carmen Ezpeleta
- Complejo Hospitalario de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
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30
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Rondy M, Castilla J, Launay O, Costanzo S, Ezpeleta C, Galtier F, de Gaetano Donati K, Moren A. Moderate influenza vaccine effectiveness against hospitalisation with A(H3N2) and A(H1N1) influenza in 2013-14: Results from the InNHOVE network. Hum Vaccin Immunother 2016; 12:1217-24. [PMID: 27065000 DOI: 10.1080/21645515.2015.1126013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We conducted a multicentre test negative case control study to estimate the 2013-14 influenza vaccine effectiveness (IVE) against hospitalised laboratory confirmed influenza in 12 hospitals in France, Italy and Spain. We included all ≥18 years hospitalised patients targeted by local influenza vaccination campaign reporting an influenza-like illness within 7 days before admission. We defined as cases patients RT-PCR positive for influenza and as controls those negative for all influenza virus. We used a logistic regression to calculate IVE adjusted for country, month of onset, chronic diseases and age. We included 104 A(H1N1)pdm09, 157 A(H3N2) cases and 585 controls. The adjusted IVE was 42.8% (95%CI: 6.3;65;0) against A(H1N1)pdm09. It was respectively 61.4% (95%CI: -1.9;85.4), 39.4% (95%CI: -32.2;72.2) and 19.7% (95%CI:-148.1;74.0) among patients aged 18-64, 65-79 and ≥80 years. The adjusted IVE against A(H3N2) was 38.1% (95%CI: 8.3;58.2) overall. It was respectively 7.8% (95%CI: -145.3;65.4), 25.6% (95%CI: -36.0;59.2) and 55.2% (95%CI: 15.4;76.3) among patients aged 18-64, 65-79 and ≥80 years. These results suggest a moderate and age varying effectiveness of the 2013-14 influenza vaccine to prevent hospitalised laboratory-confirmed influenza. While vaccination remains the most effective prevention measure, developing more immunogenic influenza vaccines is needed to prevent severe outcomes among target groups.
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Affiliation(s)
- M Rondy
- a Epicon0063ept , Paris , France
| | - J Castilla
- b Instituto de Salud Pública de Navarra, IdiSNA, CIBER Epidemiología y Salud Pública , Spain
| | - O Launay
- c Inserm, CIC 1417 and F-CRIN, Innovative clinical research network in vaccinologie (I-REIVAC), Université Paris Descartes; Sorbonne Paris Cité ; Paris , France
| | - S Costanzo
- d Department of Epidemiology and Prevention , IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli (Isernia) , Italy
| | - C Ezpeleta
- e Service of Clinical Microbiology, Complejo Hospitalario de Navarra, IdiSNA , Pamplona , Spain
| | - F Galtier
- f CHRU de Montpellier, Inserm, CIC 1411 and REIVAC , Montpellier , France
| | | | - A Moren
- a Epicon0063ept , Paris , France
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McAnerney JM, Walaza S, Cohen AL, Tempia S, Buys A, Venter M, Blumberg L, Duque J, Cohen C. Effectiveness and knowledge, attitudes and practices of seasonal influenza vaccine in primary healthcare settings in South Africa, 2010-2013. Influenza Other Respir Viruses 2016; 9:143-50. [PMID: 25677874 PMCID: PMC4415698 DOI: 10.1111/irv.12305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives Influenza vaccine effectiveness (VE) and coverage data for sub-Saharan Africa are scarce. Using a test-negative case–control design, we estimated influenza VE annually among individuals with influenza-like illness presenting to an outpatient sentinel surveillance programme in South Africa from 2010 to 2013. A knowledge, attitudes and practices (KAP) influenza vaccine survey of programme clinicians was conducted in 2013. Sample In total, 9420 patients were enrolled in surveillance of whom 5344 (56.7%) were included in the VE analysis: 2678 (50.1%) were classified as controls (influenza test-negative) and 2666 (49.9%) as cases (influenza test-positive). Results Mean annual influenza vaccine coverage among controls was 4.5% for the four years. Annual VE estimates adjusted for age, underlying medical conditions and seasonality for 2010-2013 were 54.2% (95% confidence interval (CI): 2.4–78.6%), 57.1% (95% CI: 15.5–78.2%), 38.4% (95% CI: −71.7–78.1%) and 87.2% (95% CI: 67.2–95.0%), respectively. The KAP survey showed that >90% of clinicians were familiar with the indications for and the benefits of influenza vaccination. Conclusions Our study showed that the vaccine was significantly protective in 2010, 2011 and 2013, but not in 2012 when the circulating A(H3N2) strain showed genetic drift. Vaccine coverage was low despite good clinician knowledge of vaccination indications. Further studies are needed to investigate the reason for the low uptake of influenza vaccine.
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Affiliation(s)
- Johanna M McAnerney
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Services (NHLS), Johannesburg, South Africa
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KUREČIĆ FILIPOVIĆ S, GJENERO-MARGAN I, KISSLING E, KAIĆ B, CVITKOVIĆ A. Influenza vaccine effectiveness estimates in Croatia in 2010-2011: a season with predominant circulation of A(H1N1)pdm09 influenza virus. Epidemiol Infect 2015; 143:2596-603. [PMID: 25567212 PMCID: PMC9151050 DOI: 10.1017/s0950268814003677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/14/2014] [Accepted: 12/02/2014] [Indexed: 11/07/2022] Open
Abstract
This is a retrospective study using the test-negative case-control method to estimate seasonal 2010-2011 influenza vaccine effectiveness (VE) in Croatia. Of patients consulting a physician for influenza-like illness (ILI) and for whom a swab was taken, we compared RT-PCR influenza-positive and RT-PCR influenza-negative patients. We used a structured questionnaire and physicians' records to obtain information on vaccination status and potential confounders. We conducted a complete case analysis using logistic regression to measure adjusted VE overall, against A(H1N1)pdm09 and in age groups. Out of 785 interviewed patients, 495 eligible patients were included in the study, after applying exclusion criteria [217 cases, of which 92·6% were A(H1N1)pdm09 positive, 278 controls]. Crude VE was 31·9% [95% confidence interval (CI) -40·9 to 67·1] and adjusted VE was 20·7% (95% CI -71·4 to 63·3), with higher VE in youngest and oldest age groups. Results from this first VE study in Croatia suggest a low to moderate VE for the 2010-2011 season. Studies year on year are needed with a greater sample size to provide more precise estimates, and also by age group and risk groups for vaccination.
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Affiliation(s)
- S. KUREČIĆ FILIPOVIĆ
- Epidemiology Department, Croatian National Institute of Public Health, Zagreb, Croatia
| | | | | | - B. KAIĆ
- Epidemiology Department, Croatian National Institute of Public Health, Zagreb, Croatia
| | - A. CVITKOVIĆ
- Public Health Institute, Brodsko-Posavska County, Slavonski Brod, Croatia
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El Omeiri N, Azziz-Baumgartner E, Clará W, Guzmán-Saborío G, Elas M, Mejía H, Molina IB, De Molto Y, Mirza S, Widdowson MA, Ropero-Álvarez AM. Pilot to evaluate the feasibility of measuring seasonal influenza vaccine effectiveness using surveillance platforms in Central-America, 2012. BMC Public Health 2015; 15:673. [PMID: 26184659 PMCID: PMC4504410 DOI: 10.1186/s12889-015-2001-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
Background Since 2004, the uptake of seasonal influenza vaccines in Latin America and the Caribbean has markedly increased. However, vaccine effectiveness (VE) is not routinely measured in the region. We assessed the feasibility of using routine surveillance data collected by sentinel hospitals to estimate influenza VE during 2012 against laboratory-confirmed influenza hospitalizations in Costa-Rica, El Salvador, Honduras and Panama. We explored the completeness of variables needed for VE estimation. Methods We conducted the pilot case–control study at 23 severe acute respiratory infections (SARI) surveillance hospitals. Participant inclusion criteria included children 6 months–11 years and adults ≥60 years targeted for vaccination and hospitalized for SARI during January–December 2012. We abstracted information needed to estimate target group specific VE (i.e., date of illness onset and specimen collection, preexisting medical conditions, 2012 and 2011 vaccination status and date, and pneumococcal vaccination status for children and adults) from SARI case-reports and for children ≤9 years, inquired about the number of annual vaccine doses given. A case was defined as an influenza virus positive by RT-PCR in a person with SARI, while controls were RT-PCR negative. We recruited 3 controls per case from the same age group and month of onset of symptoms. Results We identified 1,186 SARI case-patients (342 influenza cases; 849 influenza-negative controls), of which 994 (84 %) had all the information on key variables sought. In 893 (75 %) SARI case-patients, the vaccination status field was missing in the SARI case-report forms and had to be completed using national vaccination registers (36 %), vaccination cards (30 %), or other sources (34 %). After applying exclusion criteria for VE analyses, 541 (46 %) SARI case-patients with variables necessary for the group-specific VE analyses were selected (87 cases, 236 controls among children; 64 cases, 154 controls among older adults) and were insufficient to provide precise regional estimates (39 % for children and 25 % for adults of minimum sample size needed). Conclusions Sentinel surveillance networks in middle income countries, such as some Latin American and Caribbean countries, could provide a simple and timely platform to estimate regional influenza VE annually provided SARI forms collect all necessary information. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2001-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie El Omeiri
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET)/The Taskforce for Global Health, Inc., ᅟ, ᅟ. .,Pan American Health Organization, Ancón, Avenida Gorgas, Edificio 261, Panama City, Panama.
| | | | - Wilfrido Clará
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
| | - Guiselle Guzmán-Saborío
- Costa-Rican Social Security Fund (Caja Costarricense de Seguro Social), San José, Costa-Rica.
| | - Miguel Elas
- Ministry of Health, San Salvador, El Salvador.
| | | | | | | | - Sara Mirza
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
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Jimenez-Jorge S, de Mateo S, Delgado-Sanz C, Pozo F, Casas I, Garcia-Cenoz M, Castilla J, Rodriguez C, Vega T, Quinones C, Martinez E, Vanrell JM, Gimenez J, Castrillejo D, Altzibar JM, Carril F, Ramos JM, Serrano MC, Martinez A, Torner N, Perez E, Gallardo V, Larrauri A. Estimating influenza vaccine effectiveness in Spain using sentinel surveillance data. ACTA ACUST UNITED AC 2015. [PMID: 26212144 DOI: 10.2807/1560-7917.es2015.20.28.21187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We aimed to estimate influenza vaccine effectiveness (VE) against laboratory-confirmed influenza during three influenza seasons (2010/11 to 2012/2013) in Spain using surveillance data and to compare the results with data obtained by the cycEVA study, the Spanish component of the Influenza Monitoring Vaccine Effectiveness (I-MOVE) network. We used the test-negative case–control design, with data from the Spanish Influenza Sentinel Surveillance System (SISS) or from the cycEVA study. Cases were laboratory-confirmed influenza patients with the predominant influenza virus of each season, and controls were those testing negative for any influenza virus. We calculated the overall and age-specific adjusted VE. Although the number of patients recorded in the SISS was three times higher than that in the cycEVA study, the quality of information for important variables, i.e. vaccination status and laboratory results, was high in both studies. Overall, the SISS and cycEVA influenza VE estimates were largely similar during the study period. For elderly patients (> 59 years), the SISS estimates were slightly lower than those of cycEVA, and estimates for children (0–14 years) were higher using SISS in two of the three seasons studied. Enhancing the SISS by collecting the date of influenza vaccination and reducing the percentage of patients with incomplete information would optimise the system to provide reliable annual influenza VE estimates to guide influenza vaccination policies.
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Affiliation(s)
- S Jimenez-Jorge
- National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
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Savage RD, Winter AL, Rosella LC, Olsha R, Gubbay JB, Skowronski DM, Crowcroft NS. Strengths and limitations of assessing influenza vaccine effectiveness using routinely collected, passive surveillance data in Ontario, Canada, 2007 to 2012: balancing efficiency versus quality. ACTA ACUST UNITED AC 2015; 20. [PMID: 25953275 DOI: 10.2807/1560-7917.es2015.20.16.21100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prompt evaluation of annual influenza vaccine effectiveness (IVE) is important. IVE is estimated in Ontario using a test-negative design (TND) within a national sentinel surveillance network (SPSN). To explore alternative approaches, we applied the screening method (SM) during five seasons spanning 2007 to 2012 to passive surveillance data to determine whether routinely collected data could provide unbiased IVE estimates. Age-adjusted SM-IVE estimates, excluding 2008/09 pandemic cases and cases with missing immunisation status, were compared with TND-IVE estimates in SPSN participants, adjusted for age, comorbidity, week of illness onset and interval to specimen collection. In four seasons, including the 2009 pandemic, the SM underestimated IVE (22–39% seasonal; 72% pandemic) by 20 to 35% relative to the TND-IVE (58–63% seasonal; 93% pandemic), except for the 2010/11 season when both estimates were low (33% and 30%, respectively). Half of the cases in the routine surveillance data lacked immunisation information; imputing all to be unimmunised better aligned SM-IVE with TND-IVE, instead overestimating in four seasons by 4 to 29%. While the SM approach applied to routine data may offer the advantage of timeliness, ease and efficiency, methodological issues related to completeness of vaccine information and/or case ascertainment may constitute trade-offs in reliability.
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Affiliation(s)
- R D Savage
- Public Health Ontario, Toronto, Ontario, Canada
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36
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Helmeke C, Gräfe L, Irmscher HM, Gottschalk C, Karagiannis I, Oppermann H. Effectiveness of the 2012/13 trivalent live and inactivated influenza vaccines in children and adolescents in Saxony-Anhalt, Germany: a test-negative case-control study. PLoS One 2015; 10:e0122910. [PMID: 25885063 PMCID: PMC4401761 DOI: 10.1371/journal.pone.0122910] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/18/2015] [Indexed: 11/24/2022] Open
Abstract
A live attenuated influenza vaccine has been available in Germany since the influenza season 2012/13, which is approved for children aged 2-17 years. Using data from our laboratory-based surveillance system, we described the circulation of influenza and non-influenza respiratory viruses during the influenza season 2012/13 in Saxony-Anhalt. We estimated the effectiveness of live and inactivated trivalent influenza vaccines in preventing laboratory-confirmed cases among children and adolescents. From week 40/2012 to 19/2013, sentinel paediatricians systematically swabbed acute respiratory illness patients for testing of influenza and 5 non-influenza viruses by PCR. We compared influenza cases and influenza-negative controls. Among children aged 2-17 years, we calculated overall and vaccine type-specific effectiveness against laboratory-confirmed influenza, stratified by age group (2-6; 7-17 years). We used multivariable logistic regression to adjust estimates for age group, sex and month of illness. Out of 1,307 specimens, 647 (35%) were positive for influenza viruses and 189 (15%) for at least one of the tested non-influenza viruses. For vaccine effectiveness estimation, we included 834 patients (mean age 7.3 years, 53% males) in our analysis. Of 347 (42%) influenza-positive specimens, 61 (18%) were positive for A(H1N1)pdm09, 112 (32%) for A(H3N2) and 174 (50%) for influenza B virus. The adjusted overall vaccine effectiveness including both age groups was 38% (95% CI: 0.8-61%). The adjusted effectiveness for inactivated vaccines was 37% (95% CI: -35-70%) and for live vaccines 84% (95% CI: 45-95%). Effectiveness for the live vaccine was higher in 2-6 year-old children (90%, 95% CI: 20-99%) than in children aged 7-17 years (74%, 95% CI: -32-95%). Our study of the strong influenza season in 2012/13 suggests a high preventive effect of live attenuated influenza vaccine especially among young children, which could not be reached by inactivated vaccines. We recommend the use of live attenuated influenza vaccines in children unless there are contraindications.
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MESH Headings
- Adolescent
- Case-Control Studies
- Child
- Child, Preschool
- Female
- Germany
- Humans
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza B virus/genetics
- Influenza B virus/immunology
- Influenza Vaccines/immunology
- Influenza Vaccines/standards
- Influenza, Human/prevention & control
- Logistic Models
- Male
- Odds Ratio
- RNA, Viral/analysis
- Treatment Outcome
- Vaccines, Attenuated/immunology
- Vaccines, Attenuated/standards
- Vaccines, Inactivated/immunology
- Vaccines, Inactivated/standards
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Affiliation(s)
- Carina Helmeke
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- State Agency for Consumer Protection Saxony-Anhalt, Department of Hygiene, Magdeburg, Germany
- * E-mail:
| | - Lutz Gräfe
- State Agency for Consumer Protection Saxony-Anhalt, Department of Hygiene, Magdeburg, Germany
| | - Hanns-Martin Irmscher
- State Agency for Consumer Protection Saxony-Anhalt, Department of Hygiene, Magdeburg, Germany
| | - Constanze Gottschalk
- State Agency for Consumer Protection Saxony-Anhalt, Department of Hygiene, Magdeburg, Germany
| | - Ioannis Karagiannis
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Hanna Oppermann
- State Agency for Consumer Protection Saxony-Anhalt, Department of Hygiene, Magdeburg, Germany
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Arriola CS, Anderson EJ, Baumbach J, Bennett N, Bohm S, Hill M, Lindegren ML, Lung K, Meek J, Mermel E, Miller L, Monroe ML, Morin C, Oni O, Reingold A, Schaffner W, Thomas A, Zansky SM, Finelli L, Chaves SS. Does Influenza Vaccination Modify Influenza Severity? Data on Older Adults Hospitalized With Influenza During the 2012-2013 Season in the United States. J Infect Dis 2015; 212:1200-8. [PMID: 25821227 DOI: 10.1093/infdis/jiv200] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/19/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza severity in adults aged ≥50 years who were hospitalized with laboratory-confirmed influenza. METHODS We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012-2013 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models, and propensity score matching (PSM). RESULTS Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50-64 years (but not other age groups) who were vaccinated against influenza had a shorter length of ICU stay than those who were unvaccinated (hazard ratio for discharge, 1.84; 95% confidence interval, 1.12-3.01). CONCLUSIONS Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed.
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Affiliation(s)
- Carmen S Arriola
- Epidemic Intelligence Service Program Influenza Division, Centers for Disease Control and Prevention
| | - Evan J Anderson
- Department of Medicine, Emory University School of Medicine Atlanta Veterans Affairs Medical Center, Georgia
| | | | - Nancy Bennett
- Department of Medicine, University of Rochester School of Medicine and Dentistry
| | - Susan Bohm
- Michigan Department of Community Health, Lansing
| | - Mary Hill
- Salt Lake County Health Department, Utah
| | | | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | | | - Lisa Miller
- Colorado Department of Public Health and Environment, Denver
| | - Maya L Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore
| | | | | | | | | | | | - Shelley M Zansky
- Emerging Infections Program, New York State Department of Health, Albany, New York
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention
| | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention
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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: 15] [Impact Index Per Article: 1.7] [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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39
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Wagner KS, Freedman JL, Andrews NJ, Jones JA. Effectiveness of the typhoid Vi vaccine in overseas travelers from England. J Travel Med 2015; 22:87-93. [PMID: 25444695 DOI: 10.1111/jtm.12178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/26/2014] [Accepted: 10/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 500 cases of enteric fever, caused by Salmonella enterica serovar Typhi and Paratyphi, are reported in the UK each year. The majority are associated with travel to the Indian subcontinent. The typhoid Vi vaccine protects against S. Typhi and is available to travelers from their general practice or private clinics. The effectiveness of this vaccine has been assessed previously in endemic regions of the world but not in travelers. METHODS Data from the enhanced surveillance scheme concerning persons in England aged ≥2 years who traveled from the UK and contracted culture-confirmed enteric fever were used to calculate the effectiveness of the vaccine in travelers. A "case-case" case-control design was used, in which patients with typhoid comprised the "cases" and those with paratyphoid acted as "controls." RESULTS The overall effectiveness of the vaccine, adjusted for age group, sex, ethnicity, birth in a typhoid-endemic country, and year (of receipt of specimen), was 65% (95% confidence interval 53%-73%). Effectiveness did not vary across subgroups of any of the factors in the model, but there was some evidence of waning effectiveness of the vaccine with increasing time since receipt (trend p = 0.05). CONCLUSIONS The vaccine has been demonstrated to have a similar effectiveness in travelers as that found in endemic populations. It appears to be protective in all ages, including in young children (aged 2-5 years), a finding not consistently replicated in other studies. However, good hygiene practices are necessary in addition to vaccination to prevent infection. The "case-case" case-control design provides a valuable method of calculating the effectiveness of this vaccine in travelers, given the availability of paratyphoid controls, a population with similar demographics and risk exposures.
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Affiliation(s)
- Karen S Wagner
- Immunisation, Hepatitis and Blood Safety Department, London, UK
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40
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Affiliation(s)
- S van der Werf
- Unit of Molecular Genetics of RNA viruses, Institut Pasteur, Universite Paris Diderot-Sorbonne Paris Cite, Paris, France
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41
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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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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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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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Goka EA, Vallely PJ, Mutton KJ, Klapper PE. Mutations associated with severity of the pandemic influenza A(H1N1)pdm09 in humans: a systematic review and meta-analysis of epidemiological evidence. Arch Virol 2014; 159:3167-83. [PMID: 25078388 DOI: 10.1007/s00705-014-2179-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
Abstract
Mutations in the haemagglutinin (HA), non-structural protein 1 (NS1) and polymerase basic protein 2 (PB2) of influenza viruses have been associated with virulence. This study investigated the association between mutations in these genes in influenza A(H1N1)pdm09 virus and the risk of severe or fatal disease. Searches were conducted on the MEDLINE, EMBASE and Web of Science electronic databases and the reference lists of published studies. The PRISMA and STROBE guidelines were followed in assessing the quality of studies and writing-up. Eighteen (18) studies, from all continents, were included in the systematic review (recruiting patients 0 - 77 years old). The mutation D222G was associated with a significant increase in severe disease (pooled RD: 11 %, 95 % CI: 3.0 % - 18.0 %, p = 0.004) and the risk of fatality (RD: 23 %, 95 % CI: 14.0 %-31.0 %, p = < 0.0001). No association was observed between the mutations HA-D222N, D222E, PB2-E627K and NS1-T123V and severe/fatal disease. The results suggest that no virus quasispecies bearing virulence-conferring mutations in the HA, PB2 and NS1 predominated. However issues of sampling bias, and bias due to uncontrolled confounders such as comorbidities, and viral and bacterial coinfection, should be born in mind. Influenza A viruses should continue to be monitored for the occurrence of virulence-conferring mutations in HA, PB2 and NS1. There are suggestions that respiratory virus coinfections also affect virus virulence. Studies investigating the role of genetic mutations on disease outcome should make efforts to also investigate the role of respiratory virus coinfections.
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Affiliation(s)
- E A Goka
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, 1st Floor Stopford building, Oxford Road, Manchester, M13 9PL, UK,
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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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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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Minodier L, Blanchon T, Souty C, Turbelin C, Leccia F, Varesi L, Falchi A. Influenza vaccine effectiveness: best practice and current limitations of the screening method and their implications for the clinic. Expert Rev Vaccines 2014; 13:1039-48. [DOI: 10.1586/14760584.2014.930666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes: Results from the Community-Acquired Pneumonia Organization (CAPO) international cohort study. Vaccine 2014; 32:2198-203. [DOI: 10.1016/j.vaccine.2014.02.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 11/23/2022]
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49
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Castilla J, Martínez-Baz I, Navascués A, Fernandez-Alonso M, Reina G, Guevara M, Chamorro J, Ortega MT, Albéniz E, Pozo F, Ezpeleta C. Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis. ACTA ACUST UNITED AC 2014; 19. [PMID: 24556347 DOI: 10.2807/1560-7917.es2014.19.6.20700] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: -14 to 50). The VE was 40% (95% CI: -12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: -36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).
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Affiliation(s)
- J Castilla
- Instituto de Salud Publica de Navarra (Public Health Institute of Navarre), Pamplona, Spain
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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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