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Jones-Gray E, Robinson EJ, Kucharski AJ, Fox A, Sullivan SG. Does repeated influenza vaccination attenuate effectiveness? A systematic review and meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2023; 11:27-44. [PMID: 36152673 PMCID: PMC9780123 DOI: 10.1016/s2213-2600(22)00266-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Influenza vaccines require annual readministration; however, several reports have suggested that repeated vaccination might attenuate the vaccine's effectiveness. We aimed to estimate the reduction in vaccine effectiveness associated with repeated influenza vaccination. METHODS In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and CINAHL Complete databases for articles published from Jan 1, 2016, to June 13, 2022, and Web of Science for studies published from database inception to June 13, 2022. For studies published before Jan 1, 2016, we consulted published systematic reviews. Two reviewers (EJ-G and EJR) independently screened, extracted data using a data collection form, assessed studies' risk of bias using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) and evaluated the weight of evidence by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included observational studies and randomised controlled trials that reported vaccine effectiveness against influenza A(H1N1)pdm09, influenza A(H3N2), or influenza B using four vaccination groups: current season; previous season; current and previous seasons; and neither season (reference). For each study, we calculated the absolute difference in vaccine effectiveness (ΔVE) for current season only and previous season only versus current and previous season vaccination to estimate attenuation associated with repeated vaccination. Pooled vaccine effectiveness and ∆VE were calculated by season, age group, and overall. This study is registered with PROSPERO, CRD42021260242. FINDINGS We identified 4979 publications, selected 681 for full review, and included 83 in the systematic review and 41 in meta-analyses. ΔVE for vaccination in both seasons compared with the current season was -9% (95% CI -16 to -1, I2=0%; low certainty) for influenza A(H1N1)pdm09, -18% (-26 to -11, I2=7%; low certainty) for influenza A(H3N2), and -7% (-14 to 0, I2=0%; low certainty) for influenza B, indicating lower protection with consecutive vaccination. However, for all types, A subtypes and B lineages, vaccination in both seasons afforded better protection than not being vaccinated. INTERPRETATION Our estimates suggest that, although vaccination in the previous year attenuates vaccine effectiveness, vaccination in two consecutive years provides better protection than does no vaccination. The estimated effects of vaccination in the previous year are concerning and warrant additional investigation, but are not consistent or severe enough to support an alternative vaccination regimen at this time. FUNDING WHO and the US National Institutes of Health.
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Affiliation(s)
- Elenor Jones-Gray
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth J Robinson
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene and Tropical Medicine, London, UK
| | - Annette Fox
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Sheena G Sullivan
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Epidemiology, University of California, Los Angeles, CA, USA.
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Kissling E, Pozo F, Martínez‐Baz I, Buda S, Vilcu A, Domegan L, Mazagatos C, Dijkstra F, Latorre‐Margalef N, Kurečić Filipović S, Machado A, Lazar M, Casado I, Dürrwald R, van der Werf S, O'Donnell J, Linares Dopido JA, Meijer A, Riess M, Višekruna Vučina V, Rodrigues AP, Mihai ME, Castilla J, Goerlitz L, Falchi A, Connell J, Castrillejo D, Hooiveld M, Carnahan A, Ilić M, Guiomar R, Ivanciuc A, Maurel M, Omokanye A, Valenciano M. Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021-2022 I-MOVE primary care multicentre study. Influenza Other Respir Viruses 2022; 17:e13069. [PMID: 36702797 PMCID: PMC9835407 DOI: 10.1111/irv.13069] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 2021-2022, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE). METHODS Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive, and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions. RESULTS Between week 40 2021 and week 20 2022, we included over 11 000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95% CI: 43-89) and 81% (95% CI: 45-93) among those aged 15-64 years. Overall VE against influenza A(H3N2) was 29% (95% CI: 12-42) and 25% (95% CI: -41 to 61), 33% (95% CI: 14-49), and 26% (95% CI: -22 to 55) among those aged 0-14, 15-64, and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95% CI: -6 to 39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but eight belonged to clade 3C.2a1b.2a.2. DISCUSSION Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021-2022 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.
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Affiliation(s)
| | - Francisco Pozo
- National Centre for MicrobiologyInstitute of Health Carlos IIIMadridSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Iván Martínez‐Baz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | - Ana‐Maria Vilcu
- INSERM, Sorbonne UniversitéInstitut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136)ParisFrance
| | - Lisa Domegan
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,National Centre for EpidemiologyInstitute of Health Carlos IIIMadridSpain
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | | | - Mihaela Lazar
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Itziar Casado
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut PasteurUniversité Paris Cité, UMR 3569 CNRSParisFrance,CNR virus des infections respiratoires, Institut PasteurParisFrance
| | - Joan O'Donnell
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Juan Antonio Linares Dopido
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de SaludExtremaduraSpain
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | | | - Maria Elena Mihai
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | | | - Jeff Connell
- National Virus Reference LaboratoryUniversity College DublinDublinIreland
| | - Daniel Castrillejo
- Servicio de Epidemiología, DGSP, Consejería de Políticas Sociales, Salud Pública y Bienestar Animal, Ciudad Autónoma de MelillaMelillaSpain
| | | | | | - Maja Ilić
- Croatian Institute of Public HealthZagrebCroatia
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo JorgeLisbonPortugal
| | - Alina Ivanciuc
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | | | - Ajibola Omokanye
- European Centre for Disease Prevention and ControlStockholmSweden
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Mena G, Casas I, Casañ C, Auñón M, Matas L, Mòdol JM, Esteve M. Influenza vaccination coverage and factors associated with severe laboratory-confirmed influenza-related illness in patients receiving care at a tertiary hospital in Catalonia (Spain) during the 2018-2019 epidemic season. PLoS One 2021; 16:e0260397. [PMID: 34855801 PMCID: PMC8638936 DOI: 10.1371/journal.pone.0260397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/09/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Influenza vaccination rates in risk groups remain suboptimal. Evidence supporting a significant association between influenza vaccination and severe illness is limited. METHODS We retrospectively analyzed the epidemiological characteristics of out- and inpatients with laboratory-confirmed influenza infection attended during the 2018-19 epidemic season. Influenza vaccination coverage by indication was analyzed. Logistic regression was used to compare the odds of vaccination between severe and non-severe influenza-positive patients. Severe cases were defined as presenting pneumonia, admission to critical care units and/or death. RESULTS The overall vaccination coverage among influenza-positive patients was 30.4%. In subjects with ≥ 1 indication for vaccination, the vaccination coverage was 42.4%. By indication, coverage rates were: 52.5% in patients aged ≥ 59 years, 42.2% in obese patients, 29.2% in immunosuppressed subjects and 6.5% in pregnant women. In patients with underlying chronic diseases, a higher coverage was found in patients with cognitive impairment (77%), muscular dystrophy (63.6%) and renal disease (60.4%). The multivariate logistic regression model showed severe influenza-related illness was associated with a lack of influenza vaccination before seeking care during the 2018-2019 season [0.59 (95%CI 0.36-0.97); p = 0.038], older age [1.01 (95%CI 1.00-1.02); p = 0.009] and current or former smoking status [1.63 (95%CI 0.84-3.18) and 2.03 (95%CI 1.16-3.57); p = 0.031], adjusted by underlying disease. CONCLUSION Adjusting by age, smoking status and underlying disease, a moderate association between the influenza vaccine and severe laboratory-confirmed influenza-related illness was found in an epidemic season in which there was matching between the vaccine and circulating strains. Protection against complications, especially in older subjects and in those with underlying disease is postulated as one of the strengths of annual influenza vaccination. However, influenza vaccination is a pending issue in these groups, especially in pregnant women and obese people. To avoid suboptimal vaccination coverages, health professionals should recommend the seasonal influenza vaccination according to the annual instructions of the health authorities.
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Affiliation(s)
- Guillermo Mena
- Servicio de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irma Casas
- Servicio de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Casañ
- Servicio de Microbiologia, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mario Auñón
- Servicio de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lurdes Matas
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Servicio de Microbiologia, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep-Maria Mòdol
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Dirección Médica, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - María Esteve
- Servicio de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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Kuliese M, Mickiene A, Jancoriene L, Zablockiene B, Gefenaite G. Age-Specific Seasonal Influenza Vaccine Effectiveness against Different Influenza Subtypes in the Hospitalized Population in Lithuania during the 2015-2019 Influenza Seasons. Vaccines (Basel) 2021; 9:vaccines9050455. [PMID: 34064455 PMCID: PMC8147944 DOI: 10.3390/vaccines9050455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Continuous monitoring of seasonal influenza vaccine effectiveness (SIVE) is needed due to the changing nature of influenza viruses and it supports the decision on the annual update of vaccine composition. Age-specific SIVE was evaluated against different influenza subtypes in the hospitalized population in Lithuania during four influenza seasons. Methods: A test-negative case-control study design was used. SIVE and its 95% confidence intervals (95% CI) were calculated as (1 – odds ratio (OR)) × 100%. Results: Adjusted SIVE in 18–64-year-old individuals against influenza A, A(H1N1)pdm09 and B/Yamagata were 78.0% (95% CI: 1.7; 95.1%), 88.6% (95% CI: −47.4; 99.1%), and 76.8% (95% CI: −109.9; 97.4%), respectively. Adjusted SIVE in individuals aged 65 years and older against influenza A, influenza B, and B/Yamagata were 22.6% (95% CI: −36.5; 56.1%), 75.3% (95% CI: 12.2; 93.1%) and 73.1% (95% CI: 3.2; 92.5%), respectively. Unadjusted SIVE against influenza A(H3N2) among 18–64-year-old patients was 44.8% (95% CI: −171.0; 88.8%) and among those aged 65 years and older was 5.0% (95% CI: −74.5; 48.3%). Conclusions: Point estimates suggest high SIVE against influenza A in 18–64-year-old participants, and against influenza B and B/Yamagata in those 65 years old and older.
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Affiliation(s)
- Monika Kuliese
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Baltijos Street 120, 47116 Kaunas, Lithuania; (A.M.); (G.G.)
- Correspondence:
| | - Aukse Mickiene
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Baltijos Street 120, 47116 Kaunas, Lithuania; (A.M.); (G.G.)
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariskiu Street 14, 08406 Vilnius, Lithuania; (L.J.); (B.Z.)
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu Street 14, 08406 Vilnius, Lithuania
| | - Birute Zablockiene
- Clinic of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariskiu Street 14, 08406 Vilnius, Lithuania; (L.J.); (B.Z.)
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu Street 14, 08406 Vilnius, Lithuania
| | - Giedre Gefenaite
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Baltijos Street 120, 47116 Kaunas, Lithuania; (A.M.); (G.G.)
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 22100 Lund, Sweden
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Okoli GN, Racovitan F, Abdulwahid T, Hyder SK, Lansbury L, Righolt CH, Mahmud SM, Nguyen-Van-Tam JS. Decline in Seasonal Influenza Vaccine Effectiveness With Vaccination Program Maturation: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2021; 8:ofab069. [PMID: 33738320 PMCID: PMC7953658 DOI: 10.1093/ofid/ofab069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence suggests that repeated influenza vaccination may reduce vaccine effectiveness (VE). Using influenza vaccination program maturation (PM; number of years since program inception) as a proxy for population-level repeated vaccination, we assessed the impact on pooled adjusted end-season VE estimates from outpatient test-negative design studies. METHODS We systematically searched and selected full-text publications from January 2011 to February 2020 (PROSPERO: CRD42017064595). We obtained influenza vaccination program inception year for each country and calculated PM as the difference between the year of deployment and year of program inception. We categorized PM into halves (cut at the median), tertiles, and quartiles and calculated pooled VE using an inverse-variance random-effects model. The primary outcome was pooled VE against all influenza. RESULTS We included 72 articles from 11 931 citations. Across the 3 categorizations of PM, a lower pooled VE against all influenza for all patients was observed with PM. Substantially higher reductions were observed in older adults (≥65 years). We observed similar results for A(H1N1)pdm09, A(H3N2), and influenza B. CONCLUSIONS The evidence suggests that influenza VE declines with vaccination PM. This study forms the basis for further discussions and examinations of the potential impact of vaccination PM on seasonal VE.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Florentin Racovitan
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tiba Abdulwahid
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Syed K Hyder
- Department of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Louise Lansbury
- Department of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan S Nguyen-Van-Tam
- Department of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, United Kingdom
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Mira-Iglesias A, López-Labrador FX, García-Rubio J, Mengual-Chuliá B, Tortajada-Girbés M, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J. Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031129. [PMID: 33514058 PMCID: PMC7908304 DOI: 10.3390/ijerph18031129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 12/29/2022]
Abstract
Influenza vaccination is annually recommended for specific populations at risk, such as older adults. We estimated the 2018/2019 influenza vaccine effectiveness (IVE) overall, by influenza subtype, type of vaccine, and by time elapsed since vaccination among subjects 65 years old or over in a multicenter prospective study in the Valencia Hospital Surveillance Network for the Study of Influenza and other Respiratory Viruses (VAHNSI, Spain). Information about potential confounders was obtained from clinical registries and/or by interviewing patients and vaccination details were only ascertained by registries. A test-negative design was performed in order to estimate IVE. As a result, IVE was estimated at 46% (95% confidence interval (CI): (16%, 66%)), 41% (95% CI: (−34%, 74%)), and 45% (95% CI: (7%, 67%)) against overall influenza, A(H1N1)pdm09 and A(H3N2), respectively. An intra-seasonal not relevant waning effect was detected. The IVE for the adjuvanted vaccine in ≥75 years old was 45% (2%, 69%) and for the non-adjuvanted vaccine in 65–74 years old was 59% (−16%, 86%). Thus, our data revealed moderate vaccine effectiveness against influenza A(H3N2) and not significant against A(H1N1)pdm09. Significant protection was conferred by the adjuvanted vaccine to patients ≥75 years old. Moreover, an intra-seasonal not relevant waning effect was detected, and a not significant IVE decreasing trend was observed over time.
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Affiliation(s)
- Ainara Mira-Iglesias
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), 46020 Valencia, Spain; (F.X.L.-L.); (J.G.-R.); (B.M.-C.); (J.P.-B.); (J.D.-D.)
- Correspondence:
| | - F. Xavier López-Labrador
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), 46020 Valencia, Spain; (F.X.L.-L.); (J.G.-R.); (B.M.-C.); (J.P.-B.); (J.D.-D.)
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier García-Rubio
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), 46020 Valencia, Spain; (F.X.L.-L.); (J.G.-R.); (B.M.-C.); (J.P.-B.); (J.D.-D.)
| | - Beatriz Mengual-Chuliá
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), 46020 Valencia, Spain; (F.X.L.-L.); (J.G.-R.); (B.M.-C.); (J.P.-B.); (J.D.-D.)
| | | | | | - Mario Carballido-Fernández
- Hospital General Universitario de Castellón, 12004 Castellón, Spain;
- Departamento Medicina, Universidad CEU Cardenal Herrera, 12006 Castellón, Spain
| | | | - Joan Puig-Barberà
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), 46020 Valencia, Spain; (F.X.L.-L.); (J.G.-R.); (B.M.-C.); (J.P.-B.); (J.D.-D.)
- Centro de Salud Pública de Castellón, 12003 Castellón, Spain
| | - Javier Díez-Domingo
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), 46020 Valencia, Spain; (F.X.L.-L.); (J.G.-R.); (B.M.-C.); (J.P.-B.); (J.D.-D.)
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Okoli GN, Racovitan F, Abdulwahid T, Righolt CH, Mahmud SM. Variable seasonal influenza vaccine effectiveness across geographical regions, age groups and levels of vaccine antigenic similarity with circulating virus strains: A systematic review and meta-analysis of the evidence from test-negative design studies after the 2009/10 influenza pandemic. Vaccine 2021; 39:1225-1240. [PMID: 33494964 DOI: 10.1016/j.vaccine.2021.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We examined the influence of some factors on seasonal influenza vaccine effectiveness (VE) from test-negative design (TND) studies. METHODS We systematically searched for full-text publications of VE against laboratory-confirmed influenza from TND studies in outpatient settings after the 2009/10 influenza pandemic. Two reviewers independently selected and extracted data from the included studies. We calculated pooled adjusted VE across geographical regions, age groups and levels of vaccine antigenic similarity with circulating virus strains, using an inverse variance, random-effects model. RESULTS We included 76 full-text articles from 11,931 citations. VE estimates against A(H1N1)pdm09, A(H3N2), influenza B, and all influenza were homogenous and point pooled VE higher in the Southern hemisphere compared with the Northern hemisphere. The difference in pooled VE between the Southern and Northern hemispheres was statistically significant for A(H3N2), influenza B, and all influenza. A consistent pattern was observed in pooled VE across both hemispheres and continents, with the highest point pooled VE being against A(H1N1)pdm09, followed by influenza B, and lowest against A(H3N2). A nearly consistent pattern was observed in pooled VE across age groups in the Northern hemisphere, with pooled VE mostly decreasing with age. Point pooled VE against A(H3N2), influenza B, and all influenza were statistically significantly higher when vaccine was antigenically similar to circulating virus strains compared with when antigenically dissimilar. Similar pattern was observed in the Northern hemisphere, but there was a lack of data from the Southern hemisphere. CONCLUSION Consistent patterns appear to exist in seasonal influenza VE across regions, age groups, and levels of vaccine antigenic similarity with circulating virus strains, with best vaccine performance against A(H1N1)pdm09 and worst against A(H3N2). The evidence highlights the need to consider geographical location, age, and vaccine antigenic similarity with circulating virus strains when designing and evaluating influenza VE studies.
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Affiliation(s)
- G N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - F Racovitan
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - T Abdulwahid
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - C H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada; Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - S M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada; Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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