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Shi Y, Xu L, Jiang H, Cai Y, Bao C, Liu W. Analysis of factors influencing influenza outbreaks in schools in Taicang City, China. Front Public Health 2024; 12:1409004. [PMID: 39100958 PMCID: PMC11294167 DOI: 10.3389/fpubh.2024.1409004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Objective This study aims to analyze the awareness of influenza prevention and control and the behavioral attitudes toward the work among parents and staff in schools in Taicang City and the impact of the vaccination rate among students on influenza outbreaks in schools. The findings can provide references for the development of effective control strategies for the spread of influenza. Methods An anonymous questionnaire survey was conducted on 10,962 students from 20 schools in Taicang City, with class as the unit of analysis. The survey investigated their awareness of influenza prevention and control, their attitudes, and the vaccination coverage. Results From January to June 2023, a total of 388 influenza outbreaks were reported in schools in Taicang City, involving 77 schools. There were 3,475 confirmed cases, with an average infection rate of 18.53%. In schools where influenza outbreaks had occurred, the incidence rate of those who received influenza vaccine was significantly lower than those who did not, and the vaccine protection rate was 28.22%. The knowledge awareness rates of "the main transmission routes of influenza" and "influenza vaccination can prevent influenza" among parents of students were 95.49 and 93.16%, respectively. The differences between schools involved in the epidemic and non-epidemic were statistically significant (p < 0.05). The correct attitudes of parents toward "actively reporting relevant symptoms to teachers when their children show symptoms" and "avoiding classes with diseases when their children are suspected to be sick" are 98.80 and 96.26%, respectively. The differences between schools with and without epidemic are statistically significant (p < 0.05). The correct attitudes of the class teacher toward "correct management and control of students with flu like symptoms in the class" and "taking correct prevention and control measures in the event of a flu epidemic in the class" were 89.36 and 92.55%, respectively. The differences between epidemic related and non-epidemic related classes were statistically significant (p < 0.05). Conclusion Enhance the knowledge level of influenza prevention and control among parents of students, Strengthening the training for class teachers in emergency response to infectious diseases and increasing vaccination coverage among students can effectively reduce the incidence of influenza and thereby the occurrence of cluster outbreaks in schools.
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Affiliation(s)
- Yao Shi
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
- Jiangsu Field Epidemiology Training Program, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Lei Xu
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Hai Jiang
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Yongbin Cai
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Changjun Bao
- Jiangsu Provincial Centre for Disease Control and Prevention, Jiangsu Institution of Public Health, Nanjing, Jiangsu, China
| | - Wendong Liu
- Jiangsu Provincial Centre for Disease Control and Prevention, Jiangsu Institution of Public Health, Nanjing, Jiangsu, China
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Hu Y, Yan R, Yin X, Gong E, Xin X, Gao A, Shi X, Wang J, Xue H, Feng L, Zhang J. Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake: A Cluster Randomized Trial. JAMA Netw Open 2024; 7:e243098. [PMID: 38526493 PMCID: PMC10964116 DOI: 10.1001/jamanetworkopen.2024.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Influenza vaccination rates remain low among primary school students and vary by school in Beijing, China. Theory-informed, multifaceted strategies are needed to improve influenza vaccination uptake. Objective To evaluate the effectiveness of multifaceted strategies in improving influenza vaccination uptake among primary school students. Design, Setting, and Participants This cluster randomized trial was conducted from September 2022 to May 2023 across primary schools in Beijing, China. Schools were allocated randomly in a 1:1 ratio to multifaceted strategies or usual practice. Schools were deemed eligible if the vaccination rates in the 2019 to 2020 season fell at or below the district-wide average for primary schools. Eligible participants included students in grades 2 and 3 with no medical contraindications for influenza vaccination. Intervention The multifaceted strategies intervention involved system-level planning and coordination (eg, developing an implementation blueprint, building social norms, and enhancing supervision), school-level training and educating school implementers (eg, conducting a 1-hour training and developing educational materials), and individual-level educating and reminding students and parents (eg, conducting educational activities and sending 4 reminders about vaccination). Main Outcomes and Measures The primary outcomes were influenza vaccination uptake at school reported by school clinicians as well as overall vaccine uptake either at school or outside of school as reported by parents at 3 months. Generalized linear mixed models were used for analysis. Results A total of 20 schools were randomized. One intervention school and 2 control schools did not administer vaccination on school grounds due to COVID-19, resulting in a total of 17 schools (9 intervention and 8 control). There was a total of 1691 students aged 7 to 8 years (890 male [52.6%]; 801 female [47.4%]) including 915 in the intervention group and 776 in the control group. Of all participants, 848 (50.1%) were in grade 2, and 1209 (71.5%) were vaccinated in the 2021 to 2022 season. Participants in the intervention and control groups shared similar characteristics. At follow-up, of the 915 students in the intervention group, 679 (74.5%) received a vaccination at school, and of the 776 students in the control group, 556 (71.7%) received a vaccination at school. The overall vaccination rates were 76.0% (695 of 915 students) for the intervention group and 71.3% (553 of 776 students) for the control group. Compared with the control group, there was significant improvement of vaccination uptake at school (odds ratio, 1.40; 95% CI, 1.06-1.85; P = .02) and overall uptake (odds ratio, 1.49; 95% CI, 1.12-1.99; P = .01) for the intervention group. Conclusions and Relevance In this study, multifaceted strategies showed modest effectiveness in improving influenza vaccination uptake among primary school students, which provides a basis for the implementation of school-located vaccination programs of other vaccines in China, and in other countries with comparable programs. Trial registration Chinese Clinical Trial Registry: ChiCTR2200062449.
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Affiliation(s)
- Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Aiyu Gao
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Xiaoyan Shi
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Jing Wang
- Department of Infectious Disease, Dongcheng Center for Disease Control and Prevention, Beijing, China
| | - Hao Xue
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, California
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
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Yan R, Yin X, Hu Y, Wang H, Sun C, Gong E, Xin X, Zhang J. Identifying implementation strategies to address barriers of implementing a school-located influenza vaccination program in Beijing. Implement Sci Commun 2023; 4:123. [PMID: 37821918 PMCID: PMC10566160 DOI: 10.1186/s43058-023-00501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The school-located influenza vaccinations (SLIV) can increase influenza vaccination and reduce influenza infections among school-aged children. However, the vaccination rate has remained low and varied widely among schools in Beijing, China. This study aimed to ascertain barriers and facilitators of implementing SLIV and to identify implementation strategies for SLIV quality improvement programs in this context. METHODS Semi-structured interviews were conducted with diverse stakeholders (i.e., representatives of both the Department of Health and the Department of Education, school physicians, class headteachers, and parents) involved in SLIV implementation. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research was adopted to facilitate data collection and analysis. Themes and subthemes regarding barriers and facilitators were generated using deductive and inductive approaches. Based on the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool, practical implementation strategies were proposed to address the identified barriers of SLIV delivery. RESULTS Twenty-four participants were interviewed. Facilitators included easy access to SLIV, clear responsibilities and close collaboration among government sectors, top-down authority, integrating SLIV into the routine of schools, and priority given to SLIV. The main barriers were parents' misconception, inefficient coordination for vaccine supply and vaccination dates, the lack of planning, and inadequate access to knowledge and information about the SLIV. CFIR-ERIC Matching tool suggested implementation strategies at the system (i.e., developing an implementation blueprint, and promoting network weaving), school (i.e., training and educating school implementers), and consumer (i.e., engaging students and parents) levels to improve SLIV implementation. CONCLUSIONS There were substantial barriers to the delivery of the SLIV program. Theory-driven implementation strategies developed in this pre-implementation study should be considered to address those identified determinants for successful SLIV implementation.
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Affiliation(s)
- Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Huan Wang
- Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Chris Sun
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, 5000 Oulu, Finland
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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: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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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Predictors of Influenza Vaccination among Chinese Middle School Students Based on the Health Belief Model: A Mixed-Methods Study. Vaccines (Basel) 2022; 10:vaccines10111802. [PMID: 36366312 PMCID: PMC9697411 DOI: 10.3390/vaccines10111802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/17/2022] Open
Abstract
Influenza vaccination rates among Chinese middle school students are low. This study aims to explore the influencing factors of vaccination among middle school students and promote vaccination. We conducted a mixed-methods study, integrating a questionnaire survey among 9145 middle school students in four cities in China and semi-structured interviews with 35 middle school students to understand their attitudes and perceptions toward vaccination based on the Health Belief Model. We found the overall vaccination rate was 38.2% (3493/9145), with students in Beijing, boarding at school, or senior high school showing higher values than their counterparts (p < 0.05). Multiple logistic regression results showed that non-boarding (OR = 0.46, 95%CI: 0.42−0.51) and perceived barriers (OR = 0.97, 95%CI: 0.96−0.98) were unfavorable factors for influenza vaccination, whereas perceived susceptibility (OR = 1.07, 95%CI: 1.05−1.08), perceived benefits (OR = 1.02, 95%CI: 1.01−1.04), cues to action (OR = 1.08, 95%CI: 1.05−1.11), and self-efficacy (OR = 1.04, 95%CI: 1.02−1.07) were facilitators. Qualitative results indicated that positive health beliefs, school, and the home environment contribute to vaccination. In conclusion, the influenza vaccination rate among middle school students remains low. The concerns about the safety and potential side effects of vaccines are the main barriers to vaccination, underscoring the need for strengthening communication, education, and information among students and their teachers/parents.
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Lin FH, Chou YC, Chien WC, Chung CH, Hsieh CJ, Yu CP. The Most Common Location of Schools with Viral Upper Respiratory Tract Infection Clusters in Taiwan, 2011-2019. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050720. [PMID: 35626897 PMCID: PMC9139427 DOI: 10.3390/children9050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 12/17/2022]
Abstract
Clusters of acute upper respiratory tract infections are mainly caused by type A or B influenza virus. Numerous factors modify the risk of upper respiratory tract infection (URTI) cluster transmission. The purpose of this study was to investigate the epidemiological characteristics, differences, and epidemic trends in influenza viruses and in non-influenza respiratory pathogens, and the distribution of the sites of URTI cluster events in Taiwan from 2011 to 2019. We examined the publicly available annual summary data on 1864 confirmed URTI clusters in the Taiwan Centers for Disease Control (Taiwan CDC) from 2011 to 2019. URTI clusters were mainly divided into 1295 clusters of influenza virus infections, 149 clusters of non-influenza respiratory pathogen infections, 341 clusters of pathogens not detected by routine tests, and 79 clusters of unchecked samples. There were statistically significant differences (p < 0.001) in the event numbers of URTI clusters among influenza and non-influenza respiratory pathogens between 2011 and 2019. There were statistically significant differences (p = 0.01) in instances of URTI clusters among non-influenza respiratory pathogens between 2011 and 2019. There were also statistically significant differences (p < 0.001) in instances of URTI clusters in different locations between 2011 and 2019. In all the pathogens of URTI clusters (odds ratio (OR) = 1.89−2.25, p = 0.002−0.004), most single infections were influenza A viruses (64.9%, 937/1444). Respiratory syncytial virus single infections were most numerous (43.0%, 64/149) among the non-influenza respiratory pathogens of URTI clusters. Of the institutions where URTI clusters occurred, schools had the most cases (50.1%, 933/1864) (OR = 1.41−3.02, p < 0.001−0.04). After the categorization of isolated virus strains by gene sequencing, it was found that, of the seasonal influenza A viruses, the H1N1 subtype viruses were predominantly A/California/07/2009, A/Michigan/45/2015, and A/Brisbane/02/2018, and the H3N2 subtype viruses were predominantly A/Hong Kong/4801/2014, A/Singapore/INFIMH-16−0019/2016, and A/Switzerland/8060/2017, during 2017−2019. Of the influenza B viruses, B/Brisbane/60/2008 (B/Vic) was the dominant type, and some were B/Massachusetts/02/2012 (B/Yam) and B/PHUKET/3073/2013 (B/Yam). This study is the first report of confirmed events of URTI clusters from surveillance data provided by the Taiwan CDC (2011−2019). This study highlights the importance of long-term, geographically extended studies, particularly for highly fluctuating pathogens, for understanding the implications of the transmission of URTI clusters in Taiwanese populations. Knowledge gaps and important data have been identified to inform future surveillance and research efforts in Taiwan.
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Affiliation(s)
- Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.); (W.-C.C.); (C.-H.C.)
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.); (W.-C.C.); (C.-H.C.)
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.); (W.-C.C.); (C.-H.C.)
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.); (W.-C.C.); (C.-H.C.)
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City 11490, Taiwan
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Asia Eastern University of Science and Technology, New Taipei City 22061, Taiwan;
| | - Chia-Peng Yu
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.); (W.-C.C.); (C.-H.C.)
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence:
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Kang M, Zanin M, Wong SS. Subtype H3N2 Influenza A Viruses: An Unmet Challenge in the Western Pacific. Vaccines (Basel) 2022; 10:vaccines10010112. [PMID: 35062773 PMCID: PMC8778411 DOI: 10.3390/vaccines10010112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023] Open
Abstract
Subtype H3N2 influenza A viruses (A(H3N2)) have been the dominant strain in some countries in the Western Pacific region since the 2009 influenza A(H1N1) pandemic. Vaccination is the most effective way to prevent influenza; however, low vaccine effectiveness has been reported in some influenza seasons, especially for A(H3N2). Antigenic mismatch introduced by egg-adaptation during vaccine production between the vaccine and circulating viral stains is one of the reasons for low vaccine effectiveness. Here we review the extent of this phenomenon, the underlying molecular mechanisms and discuss recent strategies to ameliorate this, including new vaccine platforms that may provide better protection and should be considered to reduce the impact of A(H3N2) in the Western Pacific region.
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Affiliation(s)
- Min Kang
- School of Public Health, Southern Medical University, Guangzhou 510515, China;
- Guangdong Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Mark Zanin
- State Key Laboratory for Respiratory Diseases and National Clinical Research Centre for Respiratory Disease, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou 511436, China;
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China
| | - Sook-San Wong
- State Key Laboratory for Respiratory Diseases and National Clinical Research Centre for Respiratory Disease, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou 511436, China;
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China
- Correspondence: ; Tel.: +86-178-2584-6078
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Yang X, Zhao H, Li Z, Zhu A, Ren M, Geng M, Li Y, Qin Y, Feng L, Peng Z, An Z, Zheng J, Li Z, Feng Z. Influenza Vaccine Effectiveness in Mainland China: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2021; 9:vaccines9020079. [PMID: 33498688 PMCID: PMC7912587 DOI: 10.3390/vaccines9020079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
Influenza endangers human health but can be prevented in part by vaccination. Assessing influenza vaccine effectiveness (VE) provides scientific evidence for developing influenza vaccination policy. We conducted a systematic review and meta-analysis of studies that evaluated influenza VE in mainland China. We searched six relevant databases as of 30 August 2019 to identify studies and used Review Manager 5.3 software to analyze the included studies. The Newcastle–Ottawa scale was used to assess the risk of publication bias. We identified 1408 publications, and after removing duplicates and screening full texts, we included 21 studies in the analyses. Studies were conducted in Beijing, Guangzhou, Suzhou, and Zhejiang province from the 2010/11 influenza season through the 2017/18 influenza season. Overall influenza VE for laboratory confirmed influenza was 36% (95% CI: 25–46%). In the subgroup analysis, VE was 45% (95% CI: 18–64%) for children 6–35 months who received one dose of influenza vaccine, and 57% (95% CI: 50–64%) who received two doses. VE was 47% (95% CI: 39–54%) for children 6 months to 8 years, and 18% (95% CI: 0–33%) for adults ≥60 years. For inpatients, VE was 21% (95% CI: −11–44%). We conclude that influenza vaccines that were used in mainland China had a moderate effectiveness, with VE being higher among children than the elderly. Influenza VE should be continuously monitored in mainland China to provide evidence for policy making and improving uptake of the influenza vaccine.
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Affiliation(s)
- Xiaokun Yang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Hongting Zhao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Zhili Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Aiqin Zhu
- Division of Infectious Disease Prevention and Disinfection Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai 200136, China;
| | - Minrui Ren
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Mengjie Geng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Ying Qin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Zhibin Peng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
| | - Jiandong Zheng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
- Correspondence: (J.Z.); (Z.L.); (Z.F.); Tel.: +86-010-5890-0541 (J.Z.); +86-010-5890-0543 (Z.L.); +86-010-5890-0309 (Z.F.)
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (X.Y.); (H.Z.); (Z.L.); (M.R.); (M.G.); (Y.L.); (Y.Q.); (Z.P.)
- Correspondence: (J.Z.); (Z.L.); (Z.F.); Tel.: +86-010-5890-0541 (J.Z.); +86-010-5890-0543 (Z.L.); +86-010-5890-0309 (Z.F.)
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
- Correspondence: (J.Z.); (Z.L.); (Z.F.); Tel.: +86-010-5890-0541 (J.Z.); +86-010-5890-0543 (Z.L.); +86-010-5890-0309 (Z.F.)
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Different Starting Dominant Strain of Seasonal Influenza in China and Other Neighboring Asian Countries in 2019-2020 Winter Season. China CDC Wkly 2020; 2:57-60. [PMID: 34594762 PMCID: PMC8393070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/19/2020] [Indexed: 11/24/2022] Open
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