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Seasonal influenza vaccination among cancer patients during the COVID-19 pandemic in Poland. Contemp Oncol (Pozn) 2021; 25:168-173. [PMID: 34729036 PMCID: PMC8547183 DOI: 10.5114/wo.2021.109417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction In the era of the COVID-19 pandemic overlapping with the influenza season, the number of infections with the abovementioned viruses may result in overload in the healthcare system, difficulties in the diagnosis of respiratory diseases, poorer access to appropriate therapy, and increased mortality. Aim of the study The aim of this study was to analyze the influence of the COVID-19 pandemic on the decision to be vaccinated against seasonal influenza in cancer patients. Material and methods An anonymous survey prepared by the authors was made available to patients at the Chemotherapy Department at the Greater Poland Cancer Center. The survey covered 236 respondents, both female (67.4%, n = 159) and male (32.6%, n =77). A 0–10 point numerical scale was used to assess the fear of coronavirus infection and the influenza. Data were collected from June 8 to September 30, 2020. The survey included 25 questions. The patients were informed by physicians about the voluntary and anonymous nature of the survey, to which they gave their oral consent. IBM SPSS Statistics 26 was used for the analysis. Results The vast majority of patients (69.5%, n = 164) have never been vaccinated against influenza and 30.5% (n = 72) have been vaccinated at least once in the past. In the face of the COVID-19 pandemic, almost ¼ of the patients (24.6%, n = 58) stated that they wanted to be vaccinated against influenza. Only 33.5% (n = 79) of the respondents believed that the influenza vaccine was effective. Conclusions Action is needed to increase the percentage of cancer patients who will be regularly vaccinated against the influenza. The COVID-19 pandemic may raise the interest of cancer patients in influenza vaccination.
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Tong KK, He M, Wu AMS, Dang L, Chen JH. Cognitive Factors Influencing COVID-19 Vaccination Intentions: An Application of the Protection Motivation Theory Using a Probability Community Sample. Vaccines (Basel) 2021; 9:vaccines9101170. [PMID: 34696278 PMCID: PMC8537765 DOI: 10.3390/vaccines9101170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 01/21/2023] Open
Abstract
COVID-19 vaccines have been shown to provide protection against severe disease and death. However, substantial individual differences in vaccination intentions have hindered achieving optimal vaccination rates across the population. To look for efficient strategies to promote vaccination, this study tested whether the protection motivation theory (PMT), a cognitive model based upon threat and coping appraisals, would account for the differences in vaccination intentions under three scenarios (i.e., in the context of getting vaccinated in general, and in the context of high- and low- efficacy for reducing COVID-19 transmission risk). A phone survey was conducted in early 2021 and obtained a probability community sample (n = 472; 49.2% men) in Macao, China. We found that 54.0% of respondents indicated their relatively strong intention to receive COVID-19 vaccination for high-efficacy vaccines, compared to 29.5% for low-efficacy vaccines and 31.0% for vaccines in general. After adjusting for demographics, self-efficacy (i.e., the perceived capability of receiving COVID-19 vaccines) and maladaptive response reward (i.e., the perceived benefits of not receiving COVID-19 vaccines) were consistently associated with COVID-19 vaccination intentions under all three scenarios. The perceived severity of COVID-19 infection and response cost (i.e., the perceived costs of receiving COVID-19 vaccines) were significantly associated with vaccination intention for high-efficacy vaccines, while the response efficacy of lowering the COVID-19 impact with COVID-19 vaccination was positively associated with vaccination intention for general and low-efficacy vaccines. Given that the relative strength of PMT constructs depends on perceived vaccine efficacy, we recommend taking PMT constructs and vaccine efficacy into account for encouraging vaccination.
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Affiliation(s)
- Kwok Kit Tong
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China; (K.K.T.); (M.H.); (A.M.S.W.); (L.D.)
| | - Mu He
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China; (K.K.T.); (M.H.); (A.M.S.W.); (L.D.)
| | - Anise M. S. Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China; (K.K.T.); (M.H.); (A.M.S.W.); (L.D.)
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
| | - Le Dang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China; (K.K.T.); (M.H.); (A.M.S.W.); (L.D.)
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
- Faculty of Teacher Education, Pingdingshan University, Pingdingshan 467000, China
| | - Juliet Honglei Chen
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China; (K.K.T.); (M.H.); (A.M.S.W.); (L.D.)
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
- Correspondence:
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Currat M, Lazor-Blanchet C, Zanetti G. Promotion of the influenza vaccination to hospital staff during pre-employment health check: a prospective, randomised, controlled trial. J Occup Med Toxicol 2020; 15:34. [PMID: 33292400 PMCID: PMC7672907 DOI: 10.1186/s12995-020-00285-w] [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: 06/26/2020] [Accepted: 11/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Vaccination is the most effective prevention of seasonal influenza. Despite its recommendation and active promotion, vaccination coverage remains low among healthcare staff. The goal of the study was to test if a pre-employment health check is a good opportunity to promote future vaccination against influenza among healthcare workers newly hired by a university hospital. Methods All new hospital employees active at the bedside who underwent a pre-employment health check between the end of 2016’s influenza epidemic and the start of the next influenza vaccination campaign were randomly allocated to a control group or an intervention group. The intervention consisted of a semi-structured dialog and the release of an information leaflet about influenza and influenza vaccination during the check-up, and the shipment of a postcard reminder 2 weeks before the next vaccination campaign. Vaccination rates during the campaign were compared among the two groups. Results Three hundred fifty-seven employees were included. Vaccination rates were similar in both groups: 79/172 (46%) in the control and 92/185 (50%) in the intervention group. A significantly higher rate of vaccination was noted among physicians (70/117, 60%) than among other employees (101/240, 42%, p = 0.001). In a pre-defined exploratory analysis among physicians, the vaccination rate was higher in the intervention group (36/51, 71%) than in the control group (34/65, 52%, p = 0.046). Conclusions Promotion of the influenza vaccine during pre-employment health check did not improve the vaccination rate of newly hired hospital healthcare workers overall during the next influenza vaccination campaign. Results suggest a favourable impact on the vaccination rate of physicians. Thus, there may be an interest in using communication strategies tailored to the different categories of healthcare workers to promote the influenza vaccine during pre-employment health check. Trial registration ClinicalTrials, NCT02758145. Registered 26 April 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-020-00285-w.
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Affiliation(s)
- Michael Currat
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Occupational Medicine Unit BH-08, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Catherine Lazor-Blanchet
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Occupational Medicine Unit BH-08, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Giorgio Zanetti
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Occupational Medicine Unit BH-08, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, CH-1015, Lausanne, Switzerland
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Flanagan P, Dowling M, Gethin G. Barriers and facilitators to seasonal influenza vaccination uptake among nurses: A mixed methods study. J Adv Nurs 2020; 76:1746-1764. [PMID: 32202315 DOI: 10.1111/jan.14360] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/04/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
AIM To identify the barriers and facilitators to seasonal influenza vaccination uptake among nurses. BACKGROUND Seasonal influenza causes significant mortality and morbidity among older people and high-risk groups. Vaccinating nurses against influenza is an essential public health measure to reduce the burden of disease. Yet despite annual recommendations, nurses' influenza vaccine uptake rates remain low. DESIGN An explanatory sequential mixed methods study design. DATA SOURCES Qualified nurses attending mandatory training in two large acute hospitals in Ireland. METHODS A paper-based questionnaire assessing nurses' knowledge, risk perception, health beliefs and influenza vaccination practices was distributed to a convenience sample of qualified nurses (N = 462) between September 2017 - February 2018. A self-selected sample of 35 nurses who completed the questionnaire participated in five focus groups to explore in depth the barriers and facilitating factors associated with their vaccination practices between September 2018 - October 2018. The questionnaire data were analysed statistically and thematic analysis was applied to the qualitative data. The quantitative and qualitative findings were integrated using the Pillar Integration Process. RESULTS Seven themes emerged: (a) the influence of nurses' knowledge on vaccine uptake; (b) dissemination of information; (c) vaccine fears and concerns; (d) protection, risk and vulnerability: self and others; (e) influencers; (f) accessibility; and (g) organizational pressure. CONCLUSION Achieving high vaccine uptake rates among nurses through voluntary vaccination programmes remains a challenge. Multi-faceted influenza campaigns based on the HBM should be prioritized to address dissemination of evidence-based knowledge, accessibility, and external cues to action. IMPACT Low influenza vaccine uptake among nurses compromises patient safety and contributes to a significant burden on health services. This study identified factors associated with vaccine practices among nurses and will inform the development of specific tailored interventions for nurses.
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Affiliation(s)
| | - Maura Dowling
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland.,School of Nursing, Monash University, Clayton, Vic., Australia.,Alliance for Research and Innovation in Wounds NUI Galway, Galway, Ireland
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5
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Kempe A, Saville AW, Albertin C, Helmkamp L, Zhou X, Vangela S, Dickinson LM, Tseng CH, Campbell JD, Whittington M, Gurfinkel D, Roth H, Hoefer D, Szilagyi P. Centralized Reminder/Recall to Increase Influenza Vaccination Rates: A Two-State Pragmatic Randomized Trial. Acad Pediatr 2020; 20:374-383. [PMID: 31698085 PMCID: PMC7477488 DOI: 10.1016/j.acap.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Centralized reminder/recall (C-R/R) by health departments using immunization information systems is more effective and cost effective than practice-based approaches for increasing childhood vaccines but has not been studied for influenza vaccination. We assessed effectiveness and cost of C-R/R for increasing childhood influenza vaccination compared with usual care. METHODS Within Colorado (CO) and New York (NY), random samples of primary care practices (pediatric, family medicine, and health center) were selected proportionate to where children are served-65 practices (N = 54,353 children) in CO; 101 practices (N = 65,777) in NY. We conducted 4-arm RCTs per state (1, 2, or 3 autodial reminders vs usual care), with randomization at the patient level within practices from 10/2016 to 1/2017. RESULTS In CO, the maximum absolute difference in receipt of ≥1 influenza vaccine was 1.7% between the 2 R/R group and control (adjusted risk ratio [ARR] of 1.06 [1.01, 1.10]); other R/R arms did not differ significantly. In NY, ARRs for the study arms versus control varied from 1.05 (1.01, 1.10) for 3 R/R to 1.06 (1.01, 1.11) for 1-2 R/R groups and maximum absolute increase in vaccination was 0.6%. In time-to-event analyses, study arm was a significant predictor of vaccination in CO (P = .001) but not in NY. Costs/child randomized to one message were $.17 in CO and $.23 in NY. CONCLUSIONS C-R/R for influenza vaccine using autodial had low-level effects on increasing influenza rates in 2 states. Given the feasibility and low cost of C-R/R in previous trials, its utility for influenza should be re-examined using different modalities.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Sitaram Vangela
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Family Medicine, University of Colorado School of Medicine (LM Dickinson), Aurora, Colo
| | - Chi-Hong Tseng
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Jonathan D Campbell
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Melanie Whittington
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment (H Roth), Denver, Colo
| | - Dina Hoefer
- New York State Immunization Information System, New York State Department of Health (D Hoefer), Albany, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
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Mouratidou E, Lambrou A, Andreopoulou A, Gioula G, Exindari M, Kossyvakis A, Pogka V, Mentis A, Georgakopoulou T, Lytras T. Influenza vaccine effectiveness against hospitalization with laboratory-confirmed influenza in Greece: A pooled analysis across six seasons, 2013-2014 to 2018-2019. Vaccine 2020; 38:2715-2724. [PMID: 32033848 DOI: 10.1016/j.vaccine.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monitoring seasonal influenza Vaccine Effectiveness (VE) is key to inform vaccination strategies and sustain uptake. Pooling data across multiple seasons increases precision and allows for subgroup analyses, providing more conclusive evidence. Our aim was to assess VE against hospitalization with laboratory-confirmed influenza in Greece over six seasons, from 2013 to 2014 to 2018-2019, using routinely collected surveillance data. METHODS Swab samples from hospitalized patients across the country were tested for influenza by RT-PCR. We used the test-negative design, with patients testing positive for influenza serving as cases and those testing negative serving as controls. VE was calculated as one minus the Odds Ratio (OR) for influenza vaccination, estimated by mixed-effects logistic regression and adjusted for age, sex, hospitalization type (being in intensive care or not), time from symptom onset to swabbing, and calendar time. Stratified estimates by age and hospitalization type were obtained, and also subgroup estimates by influenza type/subtype and season. Antigenic and genetic characterization of a subset of circulating influenza strains was performed. RESULTS A total of 3,882 test-positive cases and 5,895 test-negative controls were analyzed. Across all seasons, adjusted VE was 45.5% (95% CI: 31.6-56.6) against all influenza, 62.8% against A(H1N1)pdm09 (95% CI: 40.7-76.7), 28.2% against A(H3N2) (95% CI: 12.0-41.3) and 45.5% against influenza B (95% CI: 29.1-58.1). VE was slightly lower for patients aged 60 years and over, and similar between patients hospitalized inside or outside intensive care. Circulating A(H1N1)pdm09 and B strains were antigenically similar to the vaccine strains, whereas A(H3N2) were not. CONCLUSION Our results confirm the public health benefits from seasonal influenza vaccination, despite the suboptimal effectiveness against A(H3N2) strains. Continued monitoring of VE is essential, and routinely collected surveillance data can be valuable in this regard.
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Affiliation(s)
- Elisavet Mouratidou
- National Public Health Organization, Athens, Greece; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | | | | | - Georgia Gioula
- National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Exindari
- National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Kossyvakis
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Vasiliki Pogka
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Andreas Mentis
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
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Halpin C, Reid B. Attitudes and beliefs of healthcare workers about influenza vaccination. Nurs Older People 2019; 31:32-39. [PMID: 31468782 DOI: 10.7748/nop.2019.e1154] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Annual influenza vaccination is recommended for all healthcare workers (HCWs) to help reduce the risk of contracting the virus and transmitting it to vulnerable people, especially older adults in residential care facilities. Vaccination uptake among HCWs remains low. AIM To investigate HCWs' attitudes towards, and beliefs about, seasonal influenza vaccination in a residential care facility for older adults in the Republic of Ireland. METHOD Data were collected using a self-administered questionnaire. RESULTS A total of 95 questionnaires were distributed, and 35 (37%) HCWs completed and returned them. During the 2016-17 flu season, 20 (57%) respondents were vaccinated. Primary predictors of vaccination acceptance were the belief that being healthy should not mitigate against requiring the vaccine ( r =0.7, P =0.01), protection of self and family ( r =0.67, P =0.01), protection of patients ( r =0.592, P =0.01) and agreement with mandatory vaccination ( r =0.351, P =0.039). Reasons for vaccination avoidance were misconceptions about the need for vaccination among healthy HCWs (67%), efficacy of the vaccine (60%), lack of trust in the vaccine (47%) and a belief that the vaccine may cause flu (47%). CONCLUSION Addressing HCWs' beliefs relating to the personal benefits of vaccination while simultaneously correcting misconceptions may help to increase uptake among those working in residential care settings for older adults.
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Affiliation(s)
- Carmel Halpin
- Health Service Executive Dublin North East, Dublin, Republic of Ireland
| | - Bernie Reid
- School of Nursing, University of Ulster, Northern Ireland
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Vilches TN, Jaberi-Douraki M, Moghadas SM. Risk of influenza infection with low vaccine effectiveness: the role of avoidance behaviour. Epidemiol Infect 2019; 147:e75. [PMID: 30869007 PMCID: PMC6518843 DOI: 10.1017/s0950268818003540] [Citation(s) in RCA: 6] [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: 08/22/2018] [Revised: 10/25/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Low vaccine-effectiveness has been recognised as a key factor undermining efforts to improve strategies and uptake of seasonal influenza vaccination. Aiming to prevent disease transmission, vaccination may influence the perceived risk-of-infection and, therefore, alter the individual-level behavioural responses, such as the avoidance of contact with infectious cases. We asked how the avoidance behaviour of vaccinated individuals changes disease dynamics, and specifically the epidemic size, in the context of imperfect vaccination. For this purpose, we developed an agent-based simulation model, and parameterised it with published estimates and relevant databases for population demographics and agent characteristics. Encapsulating an age-stratified structure, we evaluated the per-contact risk-of-infection and estimated the epidemic size. Our results show that vaccination could lead to a larger epidemic size if the level of avoidance behaviour in vaccinated individuals reduces below that of susceptible individuals. Furthermore, the risk-of-infection in vaccinated individuals, which follows the pattern of age-dependent frailty index of the population, increases for older age groups, and may reach, or even exceed, the risk-of-infection in susceptible individuals. Our findings indicate that low engagement in avoidance behaviour can potentially offset the benefits of vaccination even for vaccines with high effectiveness. While highlighting the protective effects of vaccination, seasonal influenza immunisation programmes should enhance strategies to promote avoidance behaviour despite being vaccinated.
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Affiliation(s)
- Thomas N. Vilches
- Department of Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu SP 18618-689, Brazil
| | - Majid Jaberi-Douraki
- Department of Mathematics, and Department of Anatomy and Physiology, Institute of Computational Comparative Medicine, Kansas State University, Manhattan, KS 66506, USA
| | - Seyed M. Moghadas
- Agent-Based modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
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Lee MD, Lin CH, Lei WT, Chang HY, Lee HC, Yeung CY, Chiu NC, Chi H, Liu JM, Hsu RJ, Cheng YJ, Yeh TL, Lin CY. Does Vitamin D Deficiency Affect the Immunogenic Responses to Influenza Vaccination? A Systematic Review and Meta-Analysis. Nutrients 2018; 10:E409. [PMID: 29587438 PMCID: PMC5946194 DOI: 10.3390/nu10040409] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Influenza virus infection is a major global public health problem, and the efficacy of influenza vaccination is not satisfactory. Vitamin D is involved in many immune-mediated inflammatory processes. The impact of vitamin D levels on the immunogenic response to influenza vaccination is not clear. We performed a comprehensive literature search and systematic review of studies that investigated vitamin D and influenza vaccination. Data pertaining to study population, vaccine components, vitamin D levels, and immunogenic response were analyzed. Nine studies, with a combined study population of 2367 patients, were included in the systematic review. Four studies were included in the meta-analysis to investigate the influence of vitamin D deficiency (VDD) on the seroprotection (SP) rates and seroconversion (SC) rates following influenza vaccination. We found no significant association between vitamin D level and the immunogenic response to influenza vaccination. However, strain-specific differences may exist. We observed lower SP rates of influenza A virus subtype H3N2 (A/H3N2) and B strain in VDD patients than patients with normal vitamin D levels (A/H3N2: 71.8% vs. 80.1%, odds ratio (OR): 0.63, 95% confidence interval (CI): 0.43-0.91, p = 0.01; B strain: 69.6% vs. 76.4%, OR: 0.68, 95% CI: 0.5-0.93, p = 0.01). However, the SP rates of A/H1N1 and SC rates of all three strains were not significantly different in VDD and control groups. In conclusion, no association was observed between VDD and immunogenic response to influenza vaccination.
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Affiliation(s)
- Ming-Dar Lee
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Chao-Hsu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Hung-Chang Lee
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Chun-Yan Yeung
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Jui-Ming Liu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan.
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan.
- Department of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan.
| | - Yu-Jyun Cheng
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Tzu-Lin Yeh
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
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Yeh TL, Shih PC, Liu SJ, Lin CH, Liu JM, Lei WT, Lin CY. The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:217-230. [PMID: 29416317 PMCID: PMC5790137 DOI: 10.2147/dddt.s155110] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Influenza infection is a common disease with a huge disease burden. Influenza vaccination has been widely used, but concerns regarding vaccine efficacy exist, especially in the elderly. Probiotics are live microorganisms with immunomodulatory effects and may enhance the immune responses to influenza vaccination. Methods We conducted a systematic review and meta-analysis to determine the influence of prebiotics/probiotics/synbiotics supplementation on vaccine responses to influenza vaccination. Studies were systematically identified from electronic databases up to July 2017. Information regarding study population, influenza vaccination, components of supplements, and immune responses were extracted and analyzed. Twelve studies, investigating a total of 688 participants, were included in this review. Results Patients with prebiotics/probiotics supplements were found to have higher influenza hemagglutination inhibition antibody titers after vaccination (for A/H1N1, 42.89 vs 35.76, mean difference =7.14, 95% CI =2.73, 11.55, P=0.002; for A/H3N2, 105.4 vs 88.25, mean difference =17.19, 95% CI =3.39, 30.99, P=0.01; for B strain, 34.87 vs 30.73, mean difference =4.17, 95% CI =0.37, 7.96, P=0.03). Conclusion Supplementation with prebiotics or probiotics may enhance the influenza hemagglutination inhibition antibody titers in all A/H1N1, A/H3N2, and B strains (20%, 19.5%, and 13.6% increases, respectively). Concomitant prebiotics or probiotics supplementation with influenza vaccination may hold great promise for improving vaccine efficacy. However, high heterogeneity was observed and further studies are warranted.
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Affiliation(s)
- Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Pei-Ching Shih
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Shu-Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City
| | - Chao-Hsu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Jui-Ming Liu
- Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu
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11
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Wang YY, Harit D, Subramani DB, Arora H, Kumar PA, Lai SK. Influenza-binding antibodies immobilise influenza viruses in fresh human airway mucus. Eur Respir J 2017; 49:13993003.01709-2016. [PMID: 28122865 DOI: 10.1183/13993003.01709-2016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/05/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Ying-Ying Wang
- Dept of Biophysics, Johns Hopkins University, Baltimore, MD, USA.,These authors contributed equally
| | - Dimple Harit
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.,These authors contributed equally
| | - Durai B Subramani
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Harendra Arora
- Dept of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Priya A Kumar
- Dept of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Samuel K Lai
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA .,UNC/NCSU Joint Dept of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA.,Dept of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
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12
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Ludolph R, Nobile M, Hartung U, Castaldi S, Schulz PJ. H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run? J Public Health Res 2015; 4:559. [PMID: 26425501 PMCID: PMC4568430 DOI: 10.4081/jphr.2015.559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/03/2015] [Indexed: 11/23/2022] Open
Abstract
Background The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians’ willingness to get vaccinated in case of a novel influenza pandemic. Design and Methods We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012. Results Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one’s life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance. Conclusions The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter. Significance for public health Whereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people’s willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public’s concerns when having to communicate during the next outbreak of pandemic influenza.
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Affiliation(s)
- Ramona Ludolph
- Institute of Communication and Health, University of Lugano , Switzerland
| | - Marta Nobile
- Institute of Communication and Health, University of Lugano , Switzerland ; Phd Program in Public Health, University of Milan , Italy
| | - Uwe Hartung
- Institute of Communication and Health, University of Lugano , Switzerland
| | - Silvana Castaldi
- IRCC Foundation Ca' Cranda Major Hospital of Milan, Department of Biomedical Sciences for Health, University of Milan , Italy
| | - Peter J Schulz
- Institute of Communication and Health, University of Lugano , Switzerland
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13
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Minor PD. Assaying the Potency of Influenza Vaccines. Vaccines (Basel) 2015; 3:90-104. [PMID: 26344948 PMCID: PMC4494238 DOI: 10.3390/vaccines3010090] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/03/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022] Open
Abstract
The potency of vaccines must be determined to ensure that the appropriate dose is given. The manufacture and assessment of influenza vaccines are complicated by the continuously changing nature of the pathogen, which makes efficacy estimates difficult but also confounds attempts to produce a well-validated, consistent potency assay. Single radial diffusion has been used for decades and provides a relatively simple way to measure the amount of biologically active materials present in the vaccine. It requires reagents, which are updated on a regular, frequently yearly, basis and alternative methods continue to be sought.
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Affiliation(s)
- Philip D Minor
- National Institute for Biological Standards and Control/MHRA, Blanche Lane, Potters Bar, Hertfordshire EN6 3QG, UK.
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14
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Egli A, Santer DM, O'Shea D, Barakat K, Syedbasha M, Vollmer M, Baluch A, Bhat R, Groenendyk J, Joyce MA, Lisboa LF, Thomas BS, Battegay M, Khanna N, Mueller T, Tyrrell DLJ, Houghton M, Humar A, Kumar D. IL-28B is a key regulator of B- and T-cell vaccine responses against influenza. PLoS Pathog 2014; 10:e1004556. [PMID: 25503988 PMCID: PMC4263767 DOI: 10.1371/journal.ppat.1004556] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/05/2014] [Indexed: 12/11/2022] Open
Abstract
Influenza is a major cause of morbidity and mortality in immunosuppressed persons, and vaccination often confers insufficient protection. IL-28B, a member of the interferon (IFN)-λ family, has variable expression due to single nucleotide polymorphisms (SNPs). While type-I IFNs are well known to modulate adaptive immunity, the impact of IL-28B on B- and T-cell vaccine responses is unclear. Here we demonstrate that the presence of the IL-28B TG/GG genotype (rs8099917, minor-allele) was associated with increased seroconversion following influenza vaccination (OR 1.99 p = 0.038). Also, influenza A (H1N1)-stimulated T- and B-cells from minor-allele carriers showed increased IL-4 production (4-fold) and HLA-DR expression, respectively. In vitro, recombinant IL-28B increased Th1-cytokines (e.g. IFN-γ), and suppressed Th2-cytokines (e.g. IL-4, IL-5, and IL-13), H1N1-stimulated B-cell proliferation (reduced 70%), and IgG-production (reduced>70%). Since IL-28B inhibited B-cell responses, we designed antagonistic peptides to block the IL-28 receptor α-subunit (IL28RA). In vitro, these peptides significantly suppressed binding of IFN-λs to IL28RA, increased H1N1-stimulated B-cell activation and IgG-production in samples from healthy volunteers (2-fold) and from transplant patients previously unresponsive to vaccination (1.4-fold). Together, these findings identify IL-28B as a key regulator of the Th1/Th2 balance during influenza vaccination. Blockade of IL28RA offers a novel strategy to augment vaccine responses.
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Affiliation(s)
- Adrian Egli
- Infection Biology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Deanna M. Santer
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Daire O'Shea
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Khaled Barakat
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Pharmacy, University of Alberta, Canada
| | | | - Madeleine Vollmer
- Infection Biology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Aliyah Baluch
- Division of Infectious Diseases, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Rakesh Bhat
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Jody Groenendyk
- Department of Biochemistry, School of Translational Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A. Joyce
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Luiz F. Lisboa
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Brad S. Thomas
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel Battegay
- Infection Biology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | - Nina Khanna
- Infection Biology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | - Thomas Mueller
- Division of Nephrology, University Hospital of Zurich, Zurich, Switzerland
| | - D. Lorne J. Tyrrell
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Houghton
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Atul Humar
- Department of Medicine and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Deepali Kumar
- Department of Medicine and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
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15
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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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16
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Preaud E, Durand L, Macabeo B, Farkas N, Sloesen B, Palache A, Shupo F, Samson SI. Annual public health and economic benefits of seasonal influenza vaccination: a European estimate. BMC Public Health 2014; 14:813. [PMID: 25103091 PMCID: PMC4141103 DOI: 10.1186/1471-2458-14-813] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination is currently the most effective means of preventing influenza infection. Yet evidence of vaccine performance, and the impact and value of seasonal influenza vaccination across risk groups and between seasons, continue to generate much discussion. Moreover, vaccination coverage is below recommended levels. METHODS A model was generated to assess the annual public health benefits and economic importance of influenza vaccination in 5 WHO recommended vaccination target groups (children 6 - 23 months of age; persons with underlying chronic health conditions; pregnant women; health care workers; and, the elderly, 65 years of age) in 27 countries of the European Union. Model estimations were based on standard calculation methods, conservative assumptions, age-based and country-specific data. RESULTS Out of approximately 180 million Europeans for whom influenza vaccination is recommended, only about 80 million persons are vaccinated. Seasonal influenza vaccination currently prevents an annual average of between 1.6 million and 2.1 million cases of influenza, 45,300 to 65,600 hospitalizations, and 25,200 to 37,200 deaths. To reach the 75% vaccination coverage target set by the EU Council Recommendation in 2009, an additional 57.4 million person would need to be vaccinated in the elderly and other risk groups. By achieving the 75% target rate set in EU-27 countries, average annual influenza- related events averted would increase from current levels to an additional +1.6 to +1.7 million cases, +23,800 to +31,400 hospitalization, +9,800 to +14,300 deaths, +678,500 to +767,800 physician visits, and +883,800 to +1,015,100 lost days of work yearly. Influenza-related costs averted because of vaccination would increase by an additional + €190 to + €226 million yearly, in vaccination target groups. CONCLUSIONS Full implementation of current influenza vaccination recommendations of 75% vaccination coverage rate (VCR) in Europe by the 2014-2015 influenza season could immediately reduce an important public health and economic burden.
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Affiliation(s)
| | - Laure Durand
- />Sanofi Pasteur, 2, Avenue Pont Pasteur, Lyon, 69007 France
| | | | - Norbert Farkas
- />Novartis Vaccines & Diagnostics AG, Lichtstrasse 35, 4056 Basel, Switzerland
| | | | - Abraham Palache
- />Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands
| | - Francis Shupo
- />Creativ-Ceutical Ltd, The Bank Chambers, Borough High Street, London, SE1 9QQ UK
| | | | - on behalf of Vaccines Europe influenza working group
- />Sanofi Pasteur MSD, 162 av Jean Jaures, Lyon, 69367 France
- />Sanofi Pasteur, 2, Avenue Pont Pasteur, Lyon, 69007 France
- />Novartis Vaccines & Diagnostics AG, Lichtstrasse 35, 4056 Basel, Switzerland
- />GlaxoSmithKline, Rue de l’Institut 89, Rixensart, Belgium
- />Abbott, C.J. van Houtenlaan 36, 1381 CP Weesp, The Netherlands
- />Creativ-Ceutical Ltd, The Bank Chambers, Borough High Street, London, SE1 9QQ UK
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17
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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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18
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Mereckiene J, Cotter S, Nicoll A, Lopalco P, Noori T, Weber J, D'Ancona F, Levy-Bruhl D, Dematte L, Giambi C, Valentiner-Branth P, Stankiewicz I, Appelgren E, O Flanagan D. Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11). ACTA ACUST UNITED AC 2014; 19:20780. [PMID: 24786262 DOI: 10.2807/1560-7917.es2014.19.16.20780] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since 2008, annual surveys of influenza vaccination policies, practices and coverage have been undertaken in 29 European Union (EU)/ European Economic Area (EEA) countries. After 2009, this monitored the impact of European Council recommendation to increase vaccination coverage to 75% among risk groups. This paper summarises the results of three seasonal influenza seasons: 2008/09, 2009/10 and 2010/11. In 2008/09, 27/29 countries completed the survey; in 2009/10 and 2010/11, 28/29 completed it. All or almost all countries recommended vaccination of older people (defined as those aged ≥50, ≥55, ≥59, ≥60 or ≥65 years), and people aged ≥6 months with clinical risk and healthcare workers. A total of 23 countries provided vaccination coverage data for older people, but only 7 and 10 had data for the clinical risk groups and healthcare workers, respectively. The number of countries recommending vaccination for some or all pregnant women increased from 10 in 2008/09 to 22 in 2010/11. Only three countries could report coverage among pregnant women. Seasonal influenza vaccination coverage during and after the pandemic season in older people and clinical groups remained unchanged in countries with higher coverage. However, small decreases were seen in most countries during this period. The results of the surveys indicate that most EU/EEA countries recommend influenza vaccination for the main target groups; however, only a few countries have achieved the target of 75% coverage among risk groups. Coverage among healthcare workers remained low.
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Affiliation(s)
- J Mereckiene
- Health Protection Surveillance Centre, Dublin, Ireland
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19
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Jiménez-Jorge S, de Mateo S, Delgado-Sanz C, Pozo F, Casas I, Garcia-Cenoz M, Castilla J, Pérez E, Gallardo V, Rodriguez C, Vega T, Quiñones C, Martínez E, Vanrell JM, Giménez J, Castrillejo D, Serrano MDC, Ramos JM, Larrauri A. Effectiveness of influenza vaccine against laboratory-confirmed influenza, in the late 2011-2012 season in Spain, among population targeted for vaccination. BMC Infect Dis 2013; 13:441. [PMID: 24053661 PMCID: PMC3848794 DOI: 10.1186/1471-2334-13-441] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/13/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Spain, the influenza vaccine effectiveness (VE) was estimated in the last three seasons using the observational study cycEVA conducted in the frame of the existing Spanish Influenza Sentinel Surveillance System. The objective of the study was to estimate influenza vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza-like illness (ILI) among the target groups for vaccination in Spain in the 2011-2012 season. We also studied influenza VE in the early (weeks 52/2011-7/2012) and late (weeks 8-14/2012) phases of the epidemic and according to time since vaccination. METHODS Medically attended patients with ILI were systematically swabbed to collect information on exposure, laboratory outcome and confounding factors. Patients belonging to target groups for vaccination and who were swabbed <8 days after symptom onset were included. Cases tested positive for influenza and controls tested negative for any influenza virus. To examine the effect of a late season, analyses were performed according to the phase of the season and according to the time between vaccination and symptoms onset. RESULTS The overall adjusted influenza VE against A(H3N2) was 45% (95% CI, 0-69). The estimated influenza VE was 52% (95% CI, -3 to 78), 40% (95% CI, -40 to 74) and 22% (95% CI, -135 to 74) at 3.5 months, 3.5-4 months, and >4 months, respectively, since vaccination. A decrease in VE with time since vaccination was only observed in individuals aged ≥ 65 years. Regarding the phase of the season, decreasing point estimates were only observed in the early phase, whereas very low or null estimates were obtained in the late phase for the shortest time interval. CONCLUSIONS The 2011-2012 influenza vaccine showed a low-to-moderate protective effect against medically attended, laboratory-confirmed influenza in the target groups for vaccination, in a late season and with a limited match between the vaccine and circulating strains. The suggested decrease in influenza VE with time since vaccination was mostly observed in the elderly population. The decreasing protective effect of the vaccine in the late part of the season could be related to waning vaccine protection because no viral changes were identified throughout the season.
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Affiliation(s)
- Silvia Jiménez-Jorge
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
| | - Salvador de Mateo
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
| | - Concha Delgado-Sanz
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Majadahonda, Madrid 28220, Spain
| | - Inmaculada Casas
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Majadahonda, Madrid 28220, Spain
| | - Manuel Garcia-Cenoz
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
- Instituto de Salud Pública de Navarra, Navarra, Spain
| | - Jesús Castilla
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
- Instituto de Salud Pública de Navarra, Navarra, Spain
| | - Esteban Pérez
- Servicio de Epidemiología y Salud Laboral. Secretaría General de Salud Pública y Participación. Consejería de Salud de Andalucía, Consejería, Spain
| | - Virtudes Gallardo
- Servicio de Epidemiología y Salud Laboral. Secretaría General de Salud Pública y Participación. Consejería de Salud de Andalucía, Consejería, Spain
| | - Carolina Rodriguez
- Dirección General de Salud Pública, Consejería de Sanidad de Castilla y León, Spain
| | - Tomás Vega
- Dirección General de Salud Pública, Consejería de Sanidad de Castilla y León, Spain
| | - Carmen Quiñones
- Servicio de Epidemiología, Subdirección de Salud Pública de La Rioja, La Rioja, Spain
| | - Eva Martínez
- Servicio de Epidemiología, Subdirección de Salud Pública de La Rioja, La Rioja, Spain
| | - Juana María Vanrell
- Servicio de Epidemiología, Dirección General de Salut Pública, Baleares, Spain
| | - Jaume Giménez
- Servicio de Epidemiología, Dirección General de Salut Pública, Baleares, Spain
| | - Daniel Castrillejo
- Servicio de Epidemiología. Dirección General de Sanidad y Consumo, Consejería de Bienestar Social y Sanidad, Ciudad Autónoma de Melilla, Spain
| | | | - Julián Mauro Ramos
- Dirección General de Salud Pública, Servicio Extremeño de Salud, Junta de Extremadura, Spain
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, c/Monforte de Lemos no. 5, Madrid 28029, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Ministry of Science and Innovation, Institute of Health Carlos III, Madrid, Spain
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20
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Kelly HA, Kelley N. Evidence-based policies for the control of influenza. Med J Aust 2013; 198:349-50. [PMID: 23581940 DOI: 10.5694/mja13.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/21/2013] [Indexed: 11/17/2022]
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