1
|
Yang T, Tong F, Tang L, Li P, Li B, Ye L, Zhou J. Repeated vaccination does not appear to significantly weaken the protective effect of influenza vaccine in the elderly: A test-negative case-control study in China. Vaccine 2024:S0264-410X(24)00593-0. [PMID: 38762359 DOI: 10.1016/j.vaccine.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/02/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The impact of repeated influenza vaccination on vaccine effectiveness has been a topic of debate. Conducting more multinational, multicenter studies in different influenza seasons is crucial for a better understanding of this issue. There is a lack of comprehensive related research reports in China. METHODS Using the Regional Health Information Platform, we conducted a test-negative case-control study to evaluate the impact of repeated vaccination on the prevention of laboratory-confirmed influenza in individuals aged 60 and above in Ningbo during four influenza seasons from 2018-19 to 2021-22. Influenza-positive cases and negative controls were matched in a 1:1 ratio based on the visiting hospital and the date of influenza testing. Propensity score adjustment and multivariable logistic regression were used to estimate risk and address confounding effects. RESULTS During the study period, a total of 30,630 elderly patients underwent influenza virus nucleic acid or antigen testing. After exclusions, we included 1976 cases of influenza-positive and 1976 cases of influenza-negative controls. Multivariable logistic regression analysis revealed that individuals receiving the vaccine in two consecutive seasons did not exhibit a significantly increased risk of influenza illness compared to those receiving the vaccine only in the current season (adjusted odds ratio: 1.22, 95% confidence interval: 0.94-1.58). However, the risk of influenza illness was found to be elevated in individuals who received the vaccine only in the previous season (adjusted odds ratio: 1.56, 95% confidence interval: 1.15-2.10) and even further elevated in those who had not received the vaccine in either of the consecutive two seasons (adjusted odds ratio: 3.39, 95% confidence interval: 2.80-4.09). CONCLUSIONS Regardless of the vaccination history in the previous season, receiving the current season influenza vaccine is the best choice for the elderly population. Our study supports the initiative to vaccinate elderly individuals against influenza annually.
Collapse
Affiliation(s)
- Tianchi Yang
- Institute of Immunization and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Zhejiang, China
| | - Feng Tong
- Ningbo Municipal Center for Disease Control and Prevention, Zhejiang, China
| | - Ling Tang
- Ningbo Health Information Center, Zhejiang, China
| | - Pingping Li
- Jiangbei District Center for Disease Control and Prevention, Zhejiang, China
| | - Baojun Li
- Haishu District Center for Disease Control and Prevention, Zhejiang, China
| | - Lixia Ye
- Institute of Immunization and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Zhejiang, China.
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China.
| |
Collapse
|
2
|
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: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Influenza vaccines require annual readministration; however, several reports have suggested that repeated vaccination might attenuate the vaccine's effectiveness. We aimed to estimate the reduction in vaccine effectiveness associated with repeated influenza vaccination. METHODS In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and CINAHL Complete databases for articles published from Jan 1, 2016, to June 13, 2022, and Web of Science for studies published from database inception to June 13, 2022. For studies published before Jan 1, 2016, we consulted published systematic reviews. Two reviewers (EJ-G and EJR) independently screened, extracted data using a data collection form, assessed studies' risk of bias using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) and evaluated the weight of evidence by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included observational studies and randomised controlled trials that reported vaccine effectiveness against influenza A(H1N1)pdm09, influenza A(H3N2), or influenza B using four vaccination groups: current season; previous season; current and previous seasons; and neither season (reference). For each study, we calculated the absolute difference in vaccine effectiveness (ΔVE) for current season only and previous season only versus current and previous season vaccination to estimate attenuation associated with repeated vaccination. Pooled vaccine effectiveness and ∆VE were calculated by season, age group, and overall. This study is registered with PROSPERO, CRD42021260242. FINDINGS We identified 4979 publications, selected 681 for full review, and included 83 in the systematic review and 41 in meta-analyses. ΔVE for vaccination in both seasons compared with the current season was -9% (95% CI -16 to -1, I2=0%; low certainty) for influenza A(H1N1)pdm09, -18% (-26 to -11, I2=7%; low certainty) for influenza A(H3N2), and -7% (-14 to 0, I2=0%; low certainty) for influenza B, indicating lower protection with consecutive vaccination. However, for all types, A subtypes and B lineages, vaccination in both seasons afforded better protection than not being vaccinated. INTERPRETATION Our estimates suggest that, although vaccination in the previous year attenuates vaccine effectiveness, vaccination in two consecutive years provides better protection than does no vaccination. The estimated effects of vaccination in the previous year are concerning and warrant additional investigation, but are not consistent or severe enough to support an alternative vaccination regimen at this time. FUNDING WHO and the US National Institutes of Health.
Collapse
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.
| |
Collapse
|
3
|
Ertesvåg NU, Cox RJ, Lartey SL, Mohn KGI, Brokstad KA, Trieu MC. Seasonal influenza vaccination expands hemagglutinin-specific antibody breadth to older and future A/H3N2 viruses. NPJ Vaccines 2022; 7:67. [PMID: 35750781 PMCID: PMC9232600 DOI: 10.1038/s41541-022-00490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/13/2022] [Indexed: 11/09/2022] Open
Abstract
History of influenza A/H3N2 exposure, especially childhood infection, shape antibody responses after influenza vaccination and infection, but have not been extensively studied. We investigated the breadth and durability of influenza A/H3N2-specific hemagglutinin-inhibition antibodies after live-attenuated influenza vaccine in children (aged 3-17 years, n = 42), and after inactivated influenza vaccine or infection in adults (aged 22-61 years, n = 42) using 14 antigenically distinct A/H3N2 viruses circulating from 1968 to 2018. We found that vaccination and infection elicited cross-reactive antibody responses, predominantly directed against newer or future strains. Childhood H3-priming increased the breadth and magnitude of back-boosted A/H3N2-specific antibodies in adults. Broader and more durable A/H3N2-specific antibodies were observed in repeatedly vaccinated adults than in children and previously unvaccinated adults. Our findings suggest that early A/H3N2 exposure and frequent seasonal vaccination could increase the breadth and seropositivity of antibody responses, which may improve vaccine protection against future viruses.
Collapse
Affiliation(s)
- Nina Urke Ertesvåg
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Sarah Larteley Lartey
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin G-I Mohn
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karl Albert Brokstad
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mai-Chi Trieu
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.
| |
Collapse
|
4
|
Tuberculosis of abdominal lymph nodes, peritoneum, and GI tract: a malignancy mimic. Abdom Radiol (NY) 2022; 47:1775-1787. [PMID: 35292843 DOI: 10.1007/s00261-022-03472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the lymph nodes, peritoneum, and the GI tract. CONCLUSION Awareness of the pathophysiology and imaging appearance on various modalities of abdominal tuberculosis involving the lymph nodes, peritoneum, and the GI tract that may simulate malignancy can aid differentiation, diagnosis, and therapy, particularly in areas where tuberculosis is endemic.
Collapse
|
5
|
Vaccine strain affects seroconversion after influenza vaccination in COPD patients and healthy older people. NPJ Vaccines 2022; 7:8. [PMID: 35075113 PMCID: PMC8786852 DOI: 10.1038/s41541-021-00422-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
Though clinical guidelines recommend influenza vaccination for chronic obstructive pulmonary disease (COPD) patients and other high-risk populations, it is unclear whether current vaccination strategies induce optimal antibody responses. This study aimed to identify key variables associated with strain-specific antibody responses in COPD patients and healthy older people. 76 COPD and 72 healthy participants were recruited from two Australian centres and inoculated with influenza vaccine. Serum strain-specific antibody titres were measured pre- and post-inoculation. Seroconversion rate was the primary endpoint. Antibody responses varied between vaccine strains. The highest rates of seroconversion were seen with novel strains (36-55%), with lesser responses to strains included in the vaccine in more than one consecutive year (27-33%). Vaccine responses were similar in COPD patients and healthy participants. Vaccine strain, hypertension and latitude were independent predictors of seroconversion. Our findings reassure that influenza vaccination is equally immunogenic in COPD patients and healthy older people; however, there is room for improvement. There may be a need to personalise the yearly influenza vaccine, including consideration of pre-existing antibody titres, in order to target gaps in individual antibody repertoires and improve protection.
Collapse
|
6
|
Shapiro JR, Li H, Morgan R, Chen Y, Kuo H, Ning X, Shea P, Wu C, Merport K, Saldanha R, Liu S, Abrams E, Chen Y, Kelly DC, Sheridan-Malone E, Wang L, Zeger SL, Klein SL, Leng SX. Sex-specific effects of aging on humoral immune responses to repeated influenza vaccination in older adults. NPJ Vaccines 2021; 6:147. [PMID: 34887436 PMCID: PMC8660902 DOI: 10.1038/s41541-021-00412-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/02/2021] [Indexed: 01/16/2023] Open
Abstract
Older adults (≥65 years of age) bear a significant burden of severe disease and mortality associated with influenza, despite relatively high annual vaccination coverage and substantial pre-existing immunity to influenza. To test the hypothesis that host factors, including age and sex, play a role in determining the effect of repeated vaccination and levels of pre-existing humoral immunity to influenza, we evaluated pre- and post-vaccination strain-specific hemagglutination inhibition (HAI) titers in adults over 75 years of age who received a high-dose influenza vaccine in at least four out of six influenza seasons. Pre-vaccination titers, rather than host factors and repeated vaccination were significantly associated with post-vaccination HAI titer outcomes, and displayed an age-by-sex interaction. Pre-vaccination titers to H1N1 remained constant with age. Titers to H3N2 and influenza B viruses decreased substantially with age in males, whereas titers in females remained constant with age. Our findings highlight the importance of pre-existing immunity in this highly vaccinated older adult population and suggest that older males are particularly vulnerable to reduced pre-existing humoral immunity to influenza.
Collapse
Affiliation(s)
- Janna R Shapiro
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yiyin Chen
- Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Helen Kuo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaoxuan Ning
- Department of Geriatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Patrick Shea
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cunjin Wu
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, Hebei, China
| | - Katherine Merport
- Zanvyl Krieger School of Arts and Science, Johns Hopkins University, Baltimore, MD, USA
| | - Rayna Saldanha
- Zanvyl Krieger School of Arts and Science, Johns Hopkins University, Baltimore, MD, USA
| | - Suifeng Liu
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Engle Abrams
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yan Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Denise C Kelly
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eileen Sheridan-Malone
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lan Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
7
|
Influence of Prior Influenza Vaccination on Current Influenza Vaccine Effectiveness in Children Aged 1 to 5 Years. Vaccines (Basel) 2021; 9:vaccines9121447. [PMID: 34960193 PMCID: PMC8706378 DOI: 10.3390/vaccines9121447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although annual influenza vaccination is an important strategy used to prevent influenza-related morbidity and mortality, some studies have reported the negative influence of prior vaccination on vaccine effectiveness (VE) for current seasons. Currently, the influence of prior vaccination is not conclusive, especially in children. METHODS We evaluated the association between current-season VE and prior season vaccination using a test-negative design in children aged 1-5 years presenting at nine outpatient clinics in Japan during the 2016/17 and 2017/18 influenza seasons. Children with influenza-like illness were enrolled prospectively and tested for influenza using real-time RT-PCR. Their recent vaccination history was categorized into six groups according to current vaccination doses (0/1/2) and prior vaccination status (unvaccinated = 0 doses/vaccinated = 1 dose or 2 doses): (1) 0 doses in the current season and unvaccinated in prior seasons (reference group); (2) 0 doses in the current season and vaccinated in a prior season; (3) 1 dose in the current season and unvaccinated in a prior season; (4) 1 dose in the current season and vaccinated in a prior season; (5) 2 doses in the current season and unvaccinated in a prior season, and (6) 2 doses in the current season and vaccinated in a prior season. RESULTS A total of 799 cases and 1196 controls were analyzed. The median age of the subjects was 3 years, and the proportion of males was 54%. Overall, the vaccination rates (any vaccination in the current season) in the cases and controls were 36% and 53%, respectively. The VEs of the groups were: (2) 29% (95% confidence interval: -25% to 59%); (3) 53% (6% to 76%); (4) 70% (45% to 83%); (5) 56% (32% to 72%), and (6) 61% (42% to 73%). The one- and two-dose VEs of the current season were significant regardless of prior vaccination status. The results did not differ when stratified by influenza subtype/lineage. CONCLUSION Prior vaccination did not attenuate the current-season VE in children aged 1 to 5 years, supporting the annual vaccination strategy.
Collapse
|
8
|
Pang Y, Yu M, Lv M, Lu M, Wu J, Xie Z, Huang Y. Repeated influenza vaccination and hospitalization outcomes among older patients with cardiovascular or respiratory diseases. Hum Vaccin Immunother 2021; 17:5522-5528. [PMID: 35133241 PMCID: PMC8903947 DOI: 10.1080/21645515.2021.2007012] [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] [Indexed: 10/19/2022] Open
Abstract
Influenza vaccination in a single season protects against hospitalization outcomes among older adults hospitalized for cardiovascular or respiratory diseases, but the effectiveness of repeated influenza vaccination is less clear. Four hospitalization outcomes (in-hospital death, re-admission, length of stay, and direct medical costs) were extracted from the Beijing Urban Employee Basic Medical Insurance database in 2015-2016 for adults aged ≥60 years hospitalized for cardiovascular or respiratory diseases. Vaccination status during three influenza seasons (2013/2014-2015/2016) was ascertained through linkages to the Beijing Elderly Influenza Vaccination database. The summer months (June-August) were used as a reference period to control unmeasured confounders during the influenza season. There were 99,135 periods of observation in the analysis, with 8.3% participants receiving influenza vaccination in all three seasons. After adjusting for confounders, influenza vaccination in all three seasons was associated with a lower risk of re-admission among patients with cardiovascular diseases (odds ratio 0.71 [95% CI 0.53-0.96]) and a lower risk of death among patients with respiratory diseases (0.68 [0.46-0.98]) compared with those unvaccinated in any season. Among patients with cardiovascular diseases, influenza vaccination in all three seasons was also associated with a non-significant lower risk of death (0.66 [0.44-1.03]) in addition to shorter hospital stays and lower direct medical costs. When stratified by history of vaccination, the effectiveness of current season vaccination was similar among patients with cardiovascular or respiratory diseases (p-value for heterogeneity all >0.05). Repeated influenza vaccination protected against hospitalization outcomes among older adults with cardiovascular or respiratory diseases.
Collapse
Affiliation(s)
- Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Mengke Yu
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Min Lv
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Ming Lu
- Department of Biomedical Informatics, School of Basic Medicine, Peking University, Beijing, China
| | - Jiang Wu
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Zheng Xie
- Department of Global Health, School of Public Health, Peking University, Beijing, China,CONTACT Min Lv Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, 16 Hepinglizhong Road, Beijing 100013, China
| | - Yangmu Huang
- Department of Global Health, School of Public Health, Peking University, Beijing, China,Yangmu Huang School of Public Health, Peking University, 38 Xueyuan Road, Beijing100191, China
| |
Collapse
|
9
|
Roy D, Ehtesham NZ, Hasnain SE. Is Mycobacterium tuberculosis carcinogenic to humans? FASEB J 2021; 35:e21853. [PMID: 34416038 DOI: 10.1096/fj.202001581rr] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 05/20/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022]
Abstract
We highlight the ability of the tuberculosis (TB) causing bacterial pathogen, Mycobacterium tuberculosis (Mtb), to induce key characteristics that are associated with established IARC classified Group 1 and Group 2A carcinogenic agents. There is sufficient evidence from epidemiological case-control, cohort and meta-analysis studies of increased lung cancer (LC) risk in pre-existing/active/old TB cases. Similar to carcinogens and other pathogenic infectious agents, exposure to aerosol-containing Mtb sprays in mice produce malignant transformation of cells that result in squamous cell carcinoma. Convincing, mechanistic data show several characteristics shared between TB and LC which include chronic inflammation, genomic instability and replicative immortality, just to name a few cancer hallmarks. These hallmarks of cancer may serve as precursors to malignant transformation. Together, these findings form the basis of our postulate that Mtb is a complete human pulmonary carcinogen. We also discuss how Mtb may act as both an initiating agent and promoter of tumor growth. Forthcoming experimental studies will not only serve as proof-of-concept but will also pivot our understanding of how to manage/treat TB cases as well as offer solutions to clinical conundrums of TB lesions masquerading as tumors. Clinical validation of our concept may also help pave the way for next generation personalized medicine for the management of pulmonary TB/cancer particularly for cases that are not responding well to conventional chemotherapy or TB drugs.
Collapse
Affiliation(s)
- Deodutta Roy
- Department of Environmental Health Sciences, Florida International University, Miami, FL, USA
| | - Nasreen Z Ehtesham
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Seyed Ehtesham Hasnain
- Department of Life Sciences, School of Basic Sciences and Research, Sharda University, Greater Noida, India.,Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Delhi (IIT-D), New Delhi, India
| |
Collapse
|
10
|
Affiliation(s)
- Guozhi Xiao
- State Key Laboratory of Phytochemistry and Plant Resources in West China Kunming Institute of Botany University of Chinese Academy of Science Chinese Academy of Sciences 132 Lanhei Road Kunming 650201 China
| | - Haiqing He
- State Key Laboratory of Phytochemistry and Plant Resources in West China Kunming Institute of Botany University of Chinese Academy of Science Chinese Academy of Sciences 132 Lanhei Road Kunming 650201 China
| |
Collapse
|
11
|
McLean HQ, Belongia EA. Influenza Vaccine Effectiveness: New Insights and Challenges. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a038315. [PMID: 31988202 DOI: 10.1101/cshperspect.a038315] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Methods for assessing influenza vaccine efficacy and effectiveness have evolved over six decades. Randomized trials remain the gold standard for licensure, but observational studies are needed for annual assessment of vaccine effectiveness (VE). The test-negative design (TND) has become the de facto standard for these field studies. Patients who seek medical care with acute respiratory illness are tested for influenza, and VE is estimated from the odds of vaccination among influenza cases versus test-negative controls. VE varies across seasons, populations, age groups, and products, but VE estimates are consistently higher for A(H1N1)pdm09 and type B compared with A(H3N2). VE studies are increasingly used in combination with molecular epidemiology to understand the viral and immune system factors that drive clinical efficacy and effectiveness. The emerging field of immunoepidemiology offers the potential to understand complex host-virus interactions that affect vaccine protection, and this knowledge will contribute to universal vaccine development.
Collapse
Affiliation(s)
- Huong Q McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin 54449, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin 54449, USA
| |
Collapse
|
12
|
Verschoor CP, Haynes L, Pawelec G, Loeb M, Andrew MK, Kuchel GA, McElhaney JE. Key Determinants of Cell-Mediated Immune Responses: A Randomized Trial of High Dose Vs. Standard Dose Split-Virus Influenza Vaccine in Older Adults. FRONTIERS IN AGING 2021; 2. [PMID: 35128529 PMCID: PMC8813165 DOI: 10.3389/fragi.2021.649110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Efforts to improve influenza vaccine effectiveness in older adults have resulted in some successes, such as the introduction of high-dose split-virus influenza vaccine (HD-SVV), yet studies of cell-mediated immune responses to these vaccines remain limited. We have shown that granzyme B (GrB) activity in influenza A/H3N2 challenged peripheral blood mononuclear cells (PBMC) correlates with protection against influenza following standard dose vaccination (SD-SVV) in older adults. Further, the interferon-γ (IFNγ) to interleukin-10 (IL-10) ratio can be a correlate of protection. Methods: In a double-blind trial (ClinicalTrials.gov NCT02297542) older adults (≥65 years, n = 582) were randomized to receive SD-SVV or HD-SVV (Fluzone®) from 2014/15 to 2017/18. Young adults (20–40 years, n = 79) received SD-SVV. At 0, 4, 10, and 20 weeks post-vaccination, serum antibody titers, IFNγ, IL-10, and inducible GrB (iGrB) were measured in ex vivo influenza-challenged PBMC. iGrB is defined as the fold change in GrB activity from baseline levels (bGrB) in circulating T cells. Responses of older adults were compared to younger controls, and in older adults, we analyzed effects of age, sex, cytomegalovirus (CMV) serostatus, frailty, and vaccine dose. Results: Prior to vaccination, younger compared to older adults produced significantly higher IFNγ, IL-10, and iGrB levels. Relative to SD-SVV recipients, older HD-SVV recipients exhibited significantly lower IFNγ:IL-10 ratios at 4 weeks post-vaccination. In contrast, IFNγ and iGrB levels were higher in younger SD vs. older SD or HD recipients; only the HD group showed a significant IFNγ response to vaccination compared to the SD groups; all three groups showed a significant iGrB response to vaccination. In a regression analysis, frailty was associated with lower IFNγ levels, whereas female sex and HD-SVV with higher IL-10 levels. Age and SD-SVV were associated with lower iGrB levels. The effect of prior season influenza vaccination was decreased iGrB levels, and increased IFNγ and IL-10 levels, which correlated with influenza A/H3N2 hemagglutination inhibition antibody titers. Conclusion: Overall, HD-SVV amplified the IL-10 response consistent with enhanced antibody responses, with little effect on the iGrB response relative to SD-SVV in either younger or older adults. These results suggest that enhanced protection with HD-SVV is largely antibody-mediated. Clinical Trial Registration: ClinicalTrials.gov (NCT02297542).
Collapse
Affiliation(s)
- Chris P. Verschoor
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Laura Haynes
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Graham Pawelec
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| | - George A. Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Janet E. McElhaney
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
- *Correspondence: Janet E. McElhaney,
| |
Collapse
|
13
|
Nichols MK, Andrew MK, Ye L, Hatchette TF, Ambrose A, Boivin G, Bowie W, Dos Santos G, Elsherif M, Green K, Haguinet F, Katz K, Leblanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Powis J, Richardson D, Semret M, Sharma R, Shinde V, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA. The Impact of Prior Season Vaccination on Subsequent Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations Over 4 Influenza Seasons in Canada. Clin Infect Dis 2020; 69:970-979. [PMID: 30508064 DOI: 10.1093/cid/ciy1009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated the possibility of negative associations between prior influenza vaccines and subsequent influenza vaccine effectiveness (VE), depending on season and strain. We investigated this association over 4 consecutive influenza seasons (2011-2012 through 2014-2015) in Canada. METHODS Using a matched test-negative design, laboratory-confirmed influenza cases and matched test-negative controls admitted to hospitals were enrolled. Patients were stratified into 4 groups according to influenza vaccine history (not vaccinated current and prior season [referent], vaccinated prior season only, vaccinated current season only, and vaccinated both current and prior season). Conditional logistic regression was used to estimate VE; prior vaccine impact was assessed each season for overall effect and effect stratified by age (<65 years, ≥65 years) and type/subtype (A/H1N1, A/H3N2, influenza B). RESULTS Overall, mainly nonsignificant associations were observed. Trends of nonsignificant decreased VE among patients repeatedly vaccinated in both prior and current season relative to the current season only were observed in the A/H3N2-dominant seasons of 2012-2013 and 2014-2015. Conversely, in 2011-2012, during which B viruses circulated, and in 2013-2014, when A/H1N1 circulated, being vaccinated in both seasons tended to result in a high VE in the current season against the dominant circulating subtype. CONCLUSIONS Prior vaccine impact on subsequent VE among Canadian inpatients was mainly nonsignificant. Even in circumstances where we observed a trend of negative impact, being repeatedly vaccinated was still more effective than not receiving the current season's vaccine. These findings favor continuation of annual influenza vaccination recommendations, particularly in older adults. CLINICAL TRIALS REGISTRATION NCT01517191.
Collapse
Affiliation(s)
- M K Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - M K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - L Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - T F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - A Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - G Boivin
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | - W Bowie
- University of British Columbia, Vancouver, Canada
| | - G Dos Santos
- Business and Decision Life Sciences, Bruxelles, Belgium.,Present affiliation: GSK, Wavre, Belgium
| | - M Elsherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - K Green
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - K Katz
- North York General Hospital, Toronto
| | - J Leblanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - M Loeb
- McMaster University, Hamilton
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | | | | | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J Powis
- Michael Garron Hospital, Toronto
| | | | - M Semret
- McGill University, Montreal, Québec
| | - R Sharma
- GSK, Mississauga, Ontario, Canada
| | - V Shinde
- GSK, King of Prussia, Pennsylvania.,Present affiliation: Novavax Vaccines, Washington, D.C
| | - D Smyth
- The Moncton Hospital, New Brunswick
| | - S Trottier
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | | | - D Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | | |
Collapse
|
14
|
Kwong JC, Chung H, Jung JK, Buchan SA, Campigotto A, Campitelli MA, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Schwartz KL, Simor A, Smieja M, Zahariadis G, On Behalf Of The Canadian Immunization Research Network Cirn Investigators. The impact of repeated vaccination using 10-year vaccination history on protection against influenza in older adults: a test-negative design study across the 2010/11 to 2015/16 influenza seasons in Ontario, Canada. ACTA ACUST UNITED AC 2020; 25. [PMID: 31937397 PMCID: PMC6961264 DOI: 10.2807/1560-7917.es.2020.25.1.1900245] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Annual influenza vaccination is recommended for older adults, but evidence regarding the impact of repeated vaccination has been inconclusive. Aim We investigated vaccine effectiveness (VE) against laboratory-confirmed influenza and the impact of repeated vaccination over 10 previous seasons on current season VE among older adults. Methods We conducted an observational test-negative study in community-dwelling adults aged > 65 years in Ontario, Canada for the 2010/11 to 2015/16 seasons by linking laboratory and health administrative data. We estimated VE using multivariable logistic regression. We assessed the impact of repeated vaccination by stratifying by previous vaccination history. Results We included 58,304 testing episodes for respiratory viruses, with 11,496 (20%) testing positive for influenza and 31,004 (53%) vaccinated. Adjusted VE against laboratory-confirmed influenza for the six seasons combined was 21% (95% confidence interval (CI): 18 to 24%). Patients who were vaccinated in the current season, but had received no vaccinations in the previous 10 seasons, had higher current season VE (34%; 95%CI: 9 to 52%) than patients who had received 1–3 (26%; 95%CI: 13 to 37%), 4–6 (24%; 95%CI: 15 to 33%), 7–8 (13%; 95%CI: 2 to 22%), or 9–10 (7%; 95%CI: −4 to 16%) vaccinations (trend test p = 0.001). All estimates were higher after correcting for misclassification of current season vaccination status. For patients who were not vaccinated in the current season, residual protection rose significantly with increasing numbers of vaccinations received previously. Conclusions Although VE appeared to decrease with increasing numbers of previous vaccinations, current season vaccination likely provides some protection against influenza regardless of the number of vaccinations received over the previous 10 influenza seasons.
Collapse
Affiliation(s)
- Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | - Sarah A Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Aaron Campigotto
- Hospital for Sick Children, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | | | - Natasha S Crowcroft
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- Sinai Health System, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J Dayre McNally
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Andrew Simor
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - George Zahariadis
- Newfoundland & Labrador Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada.,London Health Sciences Centre, London, Ontario, Canada
| | | |
Collapse
|
15
|
Epidemiology and clinical outcomes of latent tuberculosis infection in adults affected with acute leukemia or aplastic anemia: a retrospective single-center study. Ann Hematol 2020; 99:2201-2203. [PMID: 32699943 DOI: 10.1007/s00277-020-04191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
|
16
|
Mira-Iglesias A, López-Labrador FX, Baselga-Moreno V, Tortajada-Girbés M, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J, On Behalf Of The Valencia Hospital Network For The Study Of Influenza And Respiratory Viruses Disease. Influenza vaccine effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, Spain, 2017/18 influenza season. ACTA ACUST UNITED AC 2020; 24. [PMID: 31387672 PMCID: PMC6685101 DOI: 10.2807/1560-7917.es.2019.24.31.1800461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Influenza immunisation is recommended for elderly people each season. The influenza vaccine effectiveness (IVE) varies annually due to influenza viruses evolving and the vaccine composition. Aim To estimate, in inpatients ≥ 60 years old, the 2017/18 trivalent IVE, overall, by vaccine type and by strain. The impact of vaccination in any of the two previous seasons (2016/17 and 2015/16) on current (2017/18) IVE was also explored. Methods This was a multicentre prospective observational study within the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI, Spain). The test-negative design was applied taking laboratory-confirmed influenza as outcome and vaccination status as main exposure. Information about potential confounders was obtained from clinical registries and/or by interviewing patients; vaccine information was only ascertained by registries. Results Overall, 2017/18 IVE was 9.9% (95% CI: −15.5 to 29.6%), and specifically, 48.3% (95% CI: 13.5% to 69.1%), −29.9% (95% CI: −79.1% to 5.8%) and 25.7% (95% CI: −8.8% to 49.3%) against A(H1N1)pdm09, A(H3N2) and B/Yamagata lineage, respectively. For the adjuvanted and non-adjuvanted vaccines, overall IVE was 10.0% (95% CI: −24.4% to 34.9%) and 7.8% (95% CI: −23.1% to 31.0%) respectively. Prior vaccination significantly protected against influenza B/Yamagata lineage (IVE: 50.2%; 95% CI: 2.3% to 74.6%) in patients not vaccinated in the current season. For those repeatedly vaccinated against influenza A(H1N1)pdm09, IVE was 46.4% (95% CI: 6.8% to 69.2%). Conclusion Our data revealed low vaccine effectiveness against influenza in hospitalised patients ≥60 years old in 2017/18. Prior vaccination protected against influenza A(H1N1)pdm09 and B/Yamagata-lineage.
Collapse
Affiliation(s)
- Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - F Xavier López-Labrador
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | | | - Mario Carballido-Fernández
- Universidad CEU Cardenal Herrera, Castellón, Spain.,Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Joan Puig-Barberà
- Centro de Salud Pública de Castellón, Castellón, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | |
Collapse
|
17
|
Top KA, Macartney K, Bettinger JA, Tan B, Blyth CC, Marshall HS, Vaudry W, Halperin SA, McIntyre P. Active surveillance of acute paediatric hospitalisations demonstrates the impact of vaccination programmes and informs vaccine policy in Canada and Australia. ACTA ACUST UNITED AC 2020; 25. [PMID: 32613939 PMCID: PMC7331140 DOI: 10.2807/1560-7917.es.2020.25.25.1900562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sentinel surveillance of acute hospitalisations in response to infectious disease emergencies such as the 2009 influenza A(H1N1)pdm09 pandemic is well described, but recognition of its potential to supplement routine public health surveillance and provide scalability for emergency responses has been limited. We summarise the achievements of two national paediatric hospital surveillance networks relevant to vaccine programmes and emerging infectious diseases in Canada (Canadian Immunization Monitoring Program Active; IMPACT from 1991) and Australia (Paediatric Active Enhanced Disease Surveillance; PAEDS from 2007) and discuss opportunities and challenges in applying their model to other contexts. Both networks were established to enhance capacity to measure vaccine preventable disease burden, vaccine programme impact, and safety, with their scope occasionally being increased with emerging infectious diseases’ surveillance. Their active surveillance has increased data accuracy and utility for syndromic conditions (e.g. encephalitis), pathogen-specific diseases (e.g. pertussis, rotavirus, influenza), and adverse events following immunisation (e.g. febrile seizure), enabled correlation of biological specimens with clinical context and supported responses to emerging infections (e.g. pandemic influenza, parechovirus, COVID-19). The demonstrated long-term value of continuous, rather than incident-related, operation of these networks in strengthening routine surveillance, bridging research gaps, and providing scalable public health response, supports their applicability to other countries.
Collapse
Affiliation(s)
- Karina A Top
- These authors contributed equally.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Kristine Macartney
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia.,These authors contributed equally
| | - Julie A Bettinger
- University of British Columbia and Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, Canada
| | - Ben Tan
- University of Saskatchewan, Royal University Hospital, Saskatoon, Canada
| | - Christopher C Blyth
- Telethon Kids Institute and School of Medicine, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and VIRTU Women's and Children's Health Network, Adelaide, Australia
| | - Wendy Vaudry
- University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Peter McIntyre
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia
| | -
- The IMPACT and PAEDS investigators are acknowledged at the end of this article
| |
Collapse
|
18
|
Leung CY, Huang HL, Rahman MM, Nomura S, Krull Abe S, Saito E, Shibuya K. Cancer incidence attributable to tuberculosis in 2015: global, regional, and national estimates. BMC Cancer 2020; 20:412. [PMID: 32398031 PMCID: PMC7218646 DOI: 10.1186/s12885-020-06891-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Background Tuberculosis is associated with increased risk of cancer. However, the impact of tuberculosis on global cancer burden is unknown. Methods We performed random-effects meta-analyses and meta-regressions of studies reporting the association between tuberculosis and cancer risks by searching PubMed, Web of Science, Embase, Cochrane library, and CINAHL from inception to 1 June 2019. Population attributable fractions (PAFs) of cancer incidence attributable to tuberculosis were calculated using relative risks from our meta-analyses and tuberculosis prevalence data from Global Health Data Exchange by age, sex, and country. The study has been registered with PROSPERO (CRD42016050691). Results Fourty nine studies with 52,480 cancer cases met pre-specified inclusion criteria. Tuberculosis was associated with head and neck cancer (RR 2.64[95% CI 2.00–3.48]), hepatobiliary cancer (2.43[1.82–3.25]), Hodgkin’s lymphoma (2.19[1.62–2.97]), lung cancer (1.69[1.46–1.95]), gastrointestinal cancer (1.62[1.26–2.08]), non-Hodgkin’s lymphoma (1.61[1.34–1.94]), pancreatic cancer (1.58[1.28–1.96]), leukaemia (1.55[1.25–1.93]), kidney and bladder cancer (1.54[1.21–1.97]), and ovarian cancer (1.43[1.04–1.97]). We estimated that 2.33%(1.14–3.81) or 381,035(187145–623,404) of global cancer incidences in 2015 were attributable to tuberculosis. The PAFs varied by Socio-demographic Index (SDI)—ranging from 1.28% (0.57–2.31%) in the high-SDI countries to 3.51% (1.84–5.42%) in the middle-SDI countries. Individually, China and India accounted for 47% of all tuberculosis-related cancer cases. Conclusions Tuberculosis is associated with increased risk of cancer at ten sites. The burden of tuberculosis attributable cancer skewed towards lower resource countries. Research priorities are to better understand regional disparities and underlying mechanism linking tuberculosis and cancer development.
Collapse
Affiliation(s)
- Chi Yan Leung
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Hsi-Lan Huang
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Sarah Krull Abe
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Eiko Saito
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,University Institute for Population Health, King's College London, London, UK
| |
Collapse
|
19
|
Trieu MC, Jul-Larsen Å, Sævik M, Madsen A, Nøstbakken JK, Zhou F, Skrede S, Cox RJ. Antibody Responses to Influenza A/H1N1pdm09 Virus After Pandemic and Seasonal Influenza Vaccination in Healthcare Workers: A 5-Year Follow-up Study. Clin Infect Dis 2020; 68:382-392. [PMID: 29893797 PMCID: PMC6336911 DOI: 10.1093/cid/ciy487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/05/2018] [Indexed: 11/12/2022] Open
Abstract
Background The 2009 influenza pandemic was caused by the A/H1N1pdm09 virus, which was subsequently included in the seasonal vaccine, up to 2016/2017, as the A/H1N1 strain. This provided a unique opportunity to investigate the antibody response to H1N1pdm09 over time. Methods Healthcare workers (HCWs) were immunized with the AS03-adjuvanted H1N1pdm09 vaccine in 2009 (N = 250), and subsequently vaccinated with seasonal vaccines containing H1N1pdm09 for 4 seasons (repeated group), <4 seasons (occasional group), or no seasons (single group). Blood samples were collected pre and at 21 days and 3, 6, and 12 months after each vaccination, or annually (pre-season) from 2010 in the single group. The H1N1pdm09-specific antibodies were measured by the hemagglutination inhibition (HI) assay. Results Pandemic vaccination robustly induced HI antibodies that persisted above the 50% protective threshold (HI titers ≥ 40) over 12 months post-vaccination. Previous seasonal vaccination and the duration of adverse events after the pandemic vaccination influenced the decision to vaccinate in subsequent seasons. During 2010/2011-2013/2014, antibodies were boosted after each seasonal vaccination, although no significant difference was observed between the repeated and occasional groups. In the single group without seasonal vaccination, 32% of HCWs seroconverted (≥4-fold increase in HI titers) during the 4 subsequent years, most of whom had HI titers <40 prior to seroconversion. When excluding these seroconverted HCWs, HI titers gradually declined from 12 to 60 months post-pandemic vaccination. Conclusions Pandemic vaccination elicited durable antibodies, supporting the incorporation of adjuvant. Our findings support the current recommendation of annual influenza vaccination in HCWs. Clinical Trials Registration NCT01003288.
Collapse
Affiliation(s)
- Mai-Chi Trieu
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Åsne Jul-Larsen
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marianne Sævik
- Division for Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anders Madsen
- Influenza Centre, Department of Clinical Science, University of Bergen
| | | | - Fan Zhou
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Steinar Skrede
- Division for Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
20
|
Shu CC, Wei YF, Yeh YC, Lin HH, Chen CY, Wang PH, Cheng SL, Wang JY, Yu CJ. The impact on incident tuberculosis by kidney function impairment status: analysis of severity relationship. Respir Res 2020; 21:51. [PMID: 32050967 PMCID: PMC7017479 DOI: 10.1186/s12931-020-1294-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background The risk of tuberculosis (TB) in patients with impaired kidney function remains unclear by different stages of renal function impairment. Methods We retrospectively recruited all patients with kidney function in a tertiary-care referral center from January 2008 to December 2013 and followed them till December 2016. We defined the primary outcome as active TB development and analyzed the impact of kidney function impairment. Results During the study period, a total of 289,579 patients were enrolled for analysis, and of them, 1012 patients had active TB events in an average of 4.13 years of follow-up. According to kidney function impairment, the incidence rate of TB was similar in patients with no chronic kidney disease (CKD) or stage 1 and stage 2, and it increased apparently at stage 3a (167.68 per 100,000 person-years) to stage 3b, stage 4 and stage 5 (229.25, 304.95 and 349.29 per 100,000 person-years, respectively). In a Cox proportional hazard regression model, the dose response of TB risk among different stages of kidney function impairment increased significantly from CKD stage 3a to stage 5. Patients with long-term dialysis had a hazard ratio of 2.041 (1.092–3.815, p = 0.0254), which is similar to that of stage 4 CKD but lower than that of stage 5. Conclusion In patients with impaired kidney function, the risk of TB increases from CKD stage 3, and in stage 5, the risk is even higher than that of those receiving dialysis. Further strategies of TB control need to consider this high-risk group.
Collapse
Affiliation(s)
- Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, NO 7, Chung-Shan South Road, Taipei, Taiwan, 100, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Feng Wei
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chung-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, NO 7, Chung-Shan South Road, Taipei, Taiwan, 100, Taiwan. .,College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
| | - Ping-Huai Wang
- Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei, city, Taiwan
| | - Shih-Lung Cheng
- Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei, city, Taiwan.,Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, NO 7, Chung-Shan South Road, Taipei, Taiwan, 100, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, NO 7, Chung-Shan South Road, Taipei, Taiwan, 100, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
21
|
Chua H, Feng S, Lewnard JA, Sullivan SG, Blyth CC, Lipsitch M, Cowling BJ. The Use of Test-negative Controls to Monitor Vaccine Effectiveness: A Systematic Review of Methodology. Epidemiology 2020; 31:43-64. [PMID: 31609860 PMCID: PMC6888869 DOI: 10.1097/ede.0000000000001116] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The test-negative design is an increasingly popular approach for estimating vaccine effectiveness (VE) due to its efficiency. This review aims to examine published test-negative design studies of VE and to explore similarities and differences in methodological choices for different diseases and vaccines. METHODS We conducted a systematic search on PubMed, Web of Science, and Medline, for studies reporting the effectiveness of any vaccines using a test-negative design. We screened titles and abstracts and reviewed full texts to identify relevant articles. We created a standardized form for each included article to extract information on the pathogen of interest, vaccine(s) being evaluated, study setting, clinical case definition, choices of cases and controls, and statistical approaches used to estimate VE. RESULTS We identified a total of 348 articles, including studies on VE against influenza virus (n = 253), rotavirus (n = 48), pneumococcus (n = 24), and nine other pathogens. Clinical case definitions used to enroll patients were similar by pathogens of interest but the sets of symptoms that defined them varied substantially. Controls could be those testing negative for the pathogen of interest, those testing positive for nonvaccine type of the pathogen of interest, or a subset of those testing positive for alternative pathogens. Most studies controlled for age, calendar time, and comorbidities. CONCLUSIONS Our review highlights similarities and differences in the application of the test-negative design that deserve further examination. If vaccination reduces disease severity in breakthrough infections, particular care must be taken in interpreting vaccine effectiveness estimates from test-negative design studies.
Collapse
Affiliation(s)
- Huiying Chua
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Benjamin J Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
22
|
Kmeid J, Kulkarni PA, Batista MV, El Chaer F, Prayag A, Ariza-Heredia EJ, Mulanovich VE, Chemaly RF. Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006-2014. BMC Infect Dis 2019; 19:934. [PMID: 31694567 PMCID: PMC6836382 DOI: 10.1186/s12879-019-4586-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
Background Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.
Collapse
Affiliation(s)
- Joumana Kmeid
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prathit A Kulkarni
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Marjorie V Batista
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Firas El Chaer
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, Baltimore, MD, USA
| | - Amrita Prayag
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ella J Ariza-Heredia
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
23
|
Saito N, Komori K, Suzuki M, Kishikawa T, Yasaka T, Ariyoshi K. Dose-Dependent Negative Effects of Prior Multiple Vaccinations Against Influenza A and Influenza B Among Schoolchildren: A Study of Kamigoto Island in Japan During the 2011-2012, 2012-2013, and 2013-2014 Influenza Seasons. Clin Infect Dis 2019. [PMID: 29528389 DOI: 10.1093/cid/ciy202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background We investigated the negative effects of prior multiple vaccinations on influenza vaccine effectiveness (VE) and analyzed the association of VE with prior vaccine doses. Methods Patients aged 9-18 years presenting with influenza-like illness at a community hospital on a remote Japanese island during the 2011-2012, 2012-2013, and 2013-2014 influenza seasons were tested for influenza using a rapid diagnostic test (RDT). A test-negative, case-control study design was used to estimate the VEs of trivalent inactivated influenza vaccine. Histories of vaccination and medically attended influenza (MA-flu) A and B during 3 previous seasons were collected from registry systems. VE was calculated using multilevel mixed-effects logistic regression models adjusted for the history of RDT-confirmed MA-flu. Results During 3 influenza seasons, 1668 influenza-like illness episodes were analyzed, including 421 and 358 episodes of MA-fluA and MA-fluB, respectively. The adjusted VE (95% confidence interval) yielded significant dose-dependent attenuations by prior vaccinations against both MA-fluA (0 doses during previous 3 seasons: 96% [69%-100%], 1 dose: 48% [-7% to 74%], 2 doses: 52% [11%-74%], 3 doses: 21% [-25% to 51%]; P for trend < .05) and MA-fluB (0 doses: 66% [-5% to 89%], 1 dose: 48% [-14% to 76%], 2 doses: 34% [-33% to 67%], 3 doses: -7% [-83% to 37%]; P for trend < .05). After excluding episodes of MA-flu during prior 3 seasons, similar trends were observed. Conclusions Repeated previous vaccinations over multiple seasons had significant dose-dependent negative impacts on VE against both MA-fluA and MA-fluB. Further studies to confirm this finding are necessary.
Collapse
Affiliation(s)
- Nobuo Saito
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
24
|
Song JY, Noh JY, Lee JS, Wie SH, Kim YK, Lee J, Jeong HW, Kim SW, Lee SH, Park KH, Choi WS, Cheong HJ, Kim WJ. Effectiveness of repeated influenza vaccination among the elderly population with high annual vaccine uptake rates during the three consecutive A/H3N2 epidemics. Vaccine 2019; 38:318-322. [PMID: 31690467 DOI: 10.1016/j.vaccine.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Annually, about 80% of the Korean elderly aged ≥65 years receive influenza vaccination. Repeated annual vaccination has been suggested as an important factor of poor influenza vaccine effectiveness (VE), though reported conflicting results. METHODS During the consecutive A/H3N2-dominant influenza seasons between 2012 and 2015, we comparatively evaluated the VE (repeated vs. current season only) against laboratory-confirmed influenza, pneumonia and hospitalization in the elderly aged ≥65 years with influenza-like illness (ILI). Clinical and demographic data were collected prospectively, and vaccination status of prior and current seasons was verified using the immunization registry data of Korean Centers for Disease Control and Prevention. RESULTS During the first A/H3N2-dominant season in 2012-2013, influenza vaccine showed statistically significant effectiveness against influenza A infection only and when vaccinated in the current season only (VE 53%, 95% CI 15-77). In the latter two seasons (2013-2015 years), the adjusted VE for influenza A was indistinguishable between repeated vaccination and vaccination in the current season only. CONCLUSION During consecutive influenza A/H3N2 epidemics, poor influenza vaccine effectiveness may be more pronounced among the elderly population with a high annual vaccine uptake rate.
Collapse
Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Jin Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, Catholic University Medical College, St. Vincent's Hospital, Suwon, South Korea
| | - Young Keun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Shin Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sun Hee Lee
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University School of Medicine, Pusan, South Korea
| | - Kyung-Hwa Park
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea.
| |
Collapse
|
25
|
Anastasopoulou A, Ziogas DC, Samarkos M, Kirkwood JM, Gogas H. Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendations. J Immunother Cancer 2019; 7:239. [PMID: 31484550 PMCID: PMC6727332 DOI: 10.1186/s40425-019-0717-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/23/2019] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors (ICBs) have revolutionized cancer treatment producing remarkable and durable responses for a range of malignancies. However, the additional modulation of immune response by ICBs may rarely cause immune-related infectious complications, including re-activation of latent tuberculosis infection (LTBC) with detrimental effects on those patients’ outcome. Here, we present two “real-world” melanoma cases that were treated in our department with blockade of PD-1/PD-L1 and developed active Mycobacterium tuberculosis (MTB) during immunotherapy. In view of these cases, we review the literature for ICB-associated MTB reactivation and discuss our considerations about the possible interactions of immunotherapy and the underlying co-existent mycobacterial infection. Based on the current evidence from preclinical findings prior to this experience, we raise questions regarding cancer patients who are at higher risk for developing MTB infection, whether ICB-treated patients should be considered immunocompromised, and how they should be managed for latent and/or active tuberculosis. Aside from the well-established clinical benefit of immunotherapy, the blockade of PD-1/PD-L1 axis may concurrently disrupt the immune control of specific opportunistic infections such as tuberculosis that should be carefully and expectantly managed in order to avoid compromising the outcome of cancer treatment and the affected patient’s survival.
Collapse
Affiliation(s)
- Amalia Anastasopoulou
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece
| | - Dimitrios C Ziogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece
| | - John M Kirkwood
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Helen Gogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece.
| |
Collapse
|
26
|
The burdens of tuberculosis on patients with malignancy: incidence, mortality and relapse. Sci Rep 2019; 9:11901. [PMID: 31417132 PMCID: PMC6695428 DOI: 10.1038/s41598-019-48395-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/02/2019] [Indexed: 12/28/2022] Open
Abstract
Population with malignancy is growing worldwide; however, its tuberculosis (TB) burden including remains unclear regarding incidence, mortality, and relapse. We retrieved information and identified patients with malignancy and TB between 2000 and 2015 from the Taiwanese National Health Insurance reimbursement datasets, Taiwan cancer registry and death registration. We analyzed the incidence of new TB in patients with malignancy and their mortality as well as TB recurrence. During study period, we reviewed 1,105,009 patients after exclusion and among them, 19,906 had newly diagnosed TB. The TB incidence in cancer patients divided all TB events increased annually, from 3% in 2000 to 13% in 2015. The standard incidence rates (SIR) were highest in cancer of respiratory tract (5.45), hematology (3.70) and then head and neck area (2.58). The mortality directly due to TB was defined as 0.83% and all-cause mortality were approximately 10.5% at 3 months and 20.56% at 12 months. After completing TB treatment, recurrence was diagnosed in 626 (3.14%), and 1001 (5.03%) patients within the first and the first two years, respectively. In conclusion, the incidence of TB in patients with malignancy increase yearly as well as its proportion within overall cases. The twelve-month all-cause mortality during TB and the two-year recurrence are as high as 20.56% and 5.03%, respectively. It indicates the importance of this population in future TB control, especially for those with malignancy of respiratory tract, and hematology as well as head and neck area.
Collapse
|
27
|
Ainslie KEC, Haber M, Orenstein WA. Challenges in estimating influenza vaccine effectiveness. Expert Rev Vaccines 2019; 18:615-628. [PMID: 31116070 PMCID: PMC6594904 DOI: 10.1080/14760584.2019.1622419] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
Abstract
Introduction: Influenza vaccination is regarded as the most effective way to prevent influenza infection. Due to the rapid genetic changes that influenza viruses undergo, seasonal influenza vaccines must be reformulated and re-administered annually necessitating the evaluation of influenza vaccine effectiveness (VE) each year. The estimation of influenza VE presents numerous challenges. Areas Covered: This review aims to identify, discuss, and, where possible, offer suggestions for dealing with the following challenges in estimating influenza VE: different outcomes of interest against which VE is estimated, study designs used to assess VE, sources of bias and confounding, repeat vaccination, waning immunity, population level effects of vaccination, and VE in at-risk populations. Expert Opinion: The estimation of influenza VE has improved with surveillance networks, better understanding of sources of bias and confounding, and the implementation of advanced statistical methods. Future research should focus on better estimates of the indirect effects of vaccination, the biological effects of vaccination, and how vaccines interact with the immune system. Specifically, little is known about how influenza vaccination impacts an individual's infectiousness, how vaccines wane over time, and the impact of repeated vaccination.
Collapse
Affiliation(s)
- Kylie E. C. Ainslie
- Research Associate in Influenza Disease Dynamics, MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Michael Haber
- Professor, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Walt A. Orenstein
- Professor, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 1462 Clifton Rd NE, Atlanta, GA 30322, USA
| |
Collapse
|
28
|
Matsuo M. Development of active tuberculosis during treatment of head and neck carcinoma: a case series. J Med Case Rep 2019; 13:162. [PMID: 31122266 PMCID: PMC6533729 DOI: 10.1186/s13256-019-2055-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/15/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with head and neck carcinoma are considered to be at high risk of developing tuberculosis, since the risk of morbidity due to tuberculosis in these patients is 2.86 to 16 times the risk in the general population. CASE PRESENTATION This case series describes an 83-year-old Japanese man, a 60-year-old Japanese man, and a 69-year-old Japanese man who developed active pulmonary tuberculosis while being treated for head and neck carcinoma. Two had previously developed tuberculosis and were treated for more than 50 years, but no symptoms or imaging findings suggested tuberculosis onset in the patients at initiation of treatment for head and neck carcinoma. Initially, local radiotherapy was performed for all three patients. Chemotherapy was continued for two patients who had pulmonary metastasis since initial consultation. For the other patient, surgery was performed for recurrence. In all three cases, active tuberculosis infection was observed during maintenance chemotherapy or immediately following surgery. CONCLUSIONS Due to the high risk of developing tuberculosis, the possibility of prophylactic administration of anti-tuberculosis agents to patients with head and neck carcinoma should be investigated, although prophylactic administration is not a cost-effective option for all patients with head and neck carcinoma. However, if tuberculosis onset occurs, it leads to various problems; it has a major impact on not only patients with cancer but also various people in the social environment. In the future, it is essential to consider prophylactic administration in patients requiring long-term maintenance drug therapy, especially in those who are treated at out-patient chemotherapy clinics, where there are several patients with cancer with low disease resistance.
Collapse
Affiliation(s)
- Mioko Matsuo
- Department of Head and Neck Surgery, Japan Community Health Care Organization Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu City, Fukuoka, 806-8501, Japan.
| |
Collapse
|
29
|
Zaffina S, Gilardi F, Rizzo C, Sannino S, Brugaletta R, Santoro A, Castelli Gattinara G, Ciofi degli Atti ML, Raponi M, Vinci MR. Seasonal influenza vaccination and absenteeism in health-care workers in two subsequent influenza seasons (2016/17 and 2017/18) in an Italian pediatric hospital. Expert Rev Vaccines 2019; 18:411-418. [DOI: 10.1080/14760584.2019.1586541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Salvatore Zaffina
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesco Gilardi
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Caterina Rizzo
- Unit of Innovation and Clinical Pathways, Direction of Clinical Departments, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Serena Sannino
- Health Directorate, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita Brugaletta
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annapaola Santoro
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Guido Castelli Gattinara
- Vaccination Unit, University Hospital Paediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | | | | |
Collapse
|
30
|
Lei N, Wang HB, Zhang YS, Zhao JH, Zhong Y, Wang YJ, Huang LY, Ma JX, Sun Q, Yang L, Shu YL, Li SM, Sun LL. Molecular evolution of influenza B virus during 2011-2017 in Chaoyang, Beijing, suggesting the free influenza vaccine policy. Sci Rep 2019; 9:2432. [PMID: 30792414 PMCID: PMC6384887 DOI: 10.1038/s41598-018-38105-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/10/2018] [Indexed: 11/15/2022] Open
Abstract
Two influenza B virus lineages, B/Victoria and B/Yamagata, are co-circulating in human population. While the two lineages are serologically distinct and TIV only contain one lineage. It is important to investigate the epidemiological and evolutionary dynamics of two influenza B virus lineages in Beijing after the free influenza vaccine policy from 2007. Here, we collected the nasopharyngeal swabs of 12657 outpatients of influenza-like illness and subtyped by real-time RT-PCR during 2011–2017. The HA and NA genes of influenza B were fully sequenced. The prevalence is the highest in the 6–17 years old group among people infected with influenza B. Yamagata-lineage virus evolved to two inter-clade from 2011–2014 to 2014–2017. The amino acids substitutions of HA1 region were R279K in strains of 2011–2014 and L173Q, M252V in strains of 2014–2017. Substitutions L58P, I146V were observed in HA1 region of Victoria-lineage virus in 2011–2012 and I117V, N129D were showed in 2015–2017. Phylogenetic analysis of NA showed Yamagata-Victoria inter-lineage reassortant occurred in 2013–2014. Influenza B mainly infect the school-aged children in Beijing and the free influenza vaccine inoculation does not seem to block school-age children from infection with influenza B. The antigen characteristics of circulating influenza B were different to the recommended vaccine strains. We concluded that the Victoria-lineage vaccine strain should been changed and the free influenza vaccine should be revalued.
Collapse
Affiliation(s)
- Na Lei
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China.,National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, 102206, China
| | - Hai-Bin Wang
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Yu-Song Zhang
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Jian-Hong Zhao
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Yi Zhong
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Yuan-Jie Wang
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Li-Yong Huang
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Jian-Xin Ma
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China
| | - Qiang Sun
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, 102206, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, 510275, China
| | - Lei Yang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, 102206, China
| | - Yue-Long Shu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, 102206, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, 510275, China
| | - Shu-Ming Li
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China.
| | - Ling-Li Sun
- Chaoyang District Center for Disease Prevention and Control, Beijing, 100021, China.
| |
Collapse
|
31
|
de Hoog MLA, Venekamp RP, Damoiseaux RAMJ, Schilder AGM, Sanders EAM, Smit HA, Bruijning-Verhagen PCJL. Impact of Repeated Influenza Immunization on Respiratory Illness in Children With Preexisting Medical Conditions. Ann Fam Med 2019; 17:7-13. [PMID: 30670389 PMCID: PMC6342594 DOI: 10.1370/afm.2340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/19/2018] [Accepted: 11/15/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Annual influenza immunization in medical risk groups is recommended in many countries. Recent evidence suggests that repeated inactivated influenza vaccine (IIV) immunization throughout childhood may impair long-term immunity against influenza. We assessed whether prior immunization altered the effect of IIV in children with preexisting medical conditions on primary care-diagnosed respiratory illness (RI) episodes during the influenza season. METHODS Electronic records of IIV-immunized children who met the criteria for annual IIV immunization according to Dutch guidelines were extracted from a primary care database from 2004 to 2015. For each year, we collected information on IIV immunization status, primary care-attended RI episodes (including influenza-like illness, acute RI, and asthma exacerbation), and potential confounders. Generalized estimating equations were used to model the association between prior IIV and occurrence of at least one RI episode during the influenza season, with "current year immunized but without IIV history" as reference group. RESULTS A total of 4,183 children (follow-up duration: 11,493 child-years) were IIV immunized at least once. Adjusted estimates showed lower odds for RI in current year-immunized children with prior IIV compared with those without (odds ratio [OR] = 0.61; 95% CI, 0.47-0.78 for "current year immunized and one IIV in previous 2 years"; OR = 0.85; 95% CI, 0.68-1.07 for "current year immunized and ≥2 IIVs in previous 3 years, including prior year"). CONCLUSION Repeated IIV immunization in children with preexisting medical conditions has no negative impact on, and may even increase, long-term protection against RI episodes diagnosed during the influenza season in primary care.
Collapse
Affiliation(s)
- Marieke L A de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands
| | - Roger A M J Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands
| | - Anne G M Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands.,evidENT, Ear Institute, University College London, London, United Kingdom
| | - Elisabeth A M Sanders
- Wilhelmina Children's Hospital, University Medical Center, Utrecht University, The Netherlands.,Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands
| | - Patricia C J L Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands.,Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
32
|
Shinjoh M, Sugaya N, Yamaguchi Y, Iibuchi N, Kamimaki I, Goto A, Kobayashi H, Kobayashi Y, Shibata M, Tamaoka S, Nakata Y, Narabayashi A, Nishida M, Hirano Y, Munenaga T, Morita K, Mitamura K, Takahashi T. Inactivated influenza vaccine effectiveness and an analysis of repeated vaccination for children during the 2016/17 season. Vaccine 2018; 36:5510-5518. [DOI: 10.1016/j.vaccine.2018.07.065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 01/13/2023]
|
33
|
Örtqvist Å, Brytting M, Leval A, Hergens MP. Impact of repeated influenza vaccinations in persons over 65 years of age: A large population-based cohort study of severe influenza over six consecutive seasons, 2011/12-2016/17. Vaccine 2018; 36:5556-5564. [PMID: 30076104 DOI: 10.1016/j.vaccine.2018.07.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/14/2018] [Accepted: 07/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND A forty-year debate on the potential negative effects of repeated seasonal influenza vaccination has been inconclusive, with multiple observational studies of various design providing heterogeneous results too inadequate to inform vaccination policy. METHODS A large population-based cohort study including over one-million observations in individuals over age 65 from six consecutive seasons (2011/12-2016/17) in Stockholm County, Sweden. Current season vaccine effectiveness (VE) against severe, mostly hospital-attended, influenza was assessed using Cox multivariate regression analyses adjusting for demographic variables, comorbidities and previous seasonal influenza vaccination status. RESULTS In none of the six seasons was VE significantly different in persons vaccinated in the current season only, compared to those who had been vaccinated in both the current and the previous season. Neither were there any differences in VE during the seasons 2014/15-2016/17 when comparing persons vaccinated during the current season only vs. those vaccinated during one-three or four-five previous influenza seasons. In contrast, persons only vaccinated during one or more previous years had no protection during the current season. CONCLUSIONS Persons above 65 years are the largest group at risk for severe or complicated influenza and policy should support their yearly seasonal influenza vaccination, which is to-date the best preventive measure available for all risk groups. No negative effects of repeated seasonal vaccination were seen in this large population-based cohort of older persons with severe influenza, which strengthens the recommendation that persons belonging to this age group should be vaccinated yearly.
Collapse
Affiliation(s)
- Åke Örtqvist
- Department of Communicable Disease Control and Prevention, Stockholm County Council, and Karolinska Institutet, Department of Medicine Karolinska Solna, Unit of Infectious Diseases, Stockholm, Sweden.
| | - Mia Brytting
- Unit for Laboratory Surveillance of Viral Pathogens and Vaccine Preventable Diseases, Department of Microbiology, The Public Health Agency of Sweden, Solna, Sweden
| | - Amy Leval
- Janssen-Cilag AB, Solna, Sweden(1); Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden(2); Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
| | - Maria-Pia Hergens
- Department of Communicable Disease Control and Prevention, Stockholm County Council, and Karolinska Institutet, Department of Medicine Karolinska Solna, Unit of Infectious Diseases, Stockholm, Sweden.
| |
Collapse
|
34
|
Imai C, Toizumi M, Hall L, Lambert S, Halton K, Merollini K. A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers. PLoS One 2018; 13:e0198685. [PMID: 29879206 PMCID: PMC5991711 DOI: 10.1371/journal.pone.0198685] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. METHODS We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings. RESULTS Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness. DISCUSSION Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.
Collapse
MESH Headings
- Absenteeism
- Cost-Benefit Analysis
- Health Personnel/economics
- Health Personnel/statistics & numerical data
- Humans
- Incidence
- Infectious Disease Transmission, Patient-to-Professional/economics
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data
- Infectious Disease Transmission, Professional-to-Patient/economics
- Infectious Disease Transmission, Professional-to-Patient/prevention & control
- Infectious Disease Transmission, Professional-to-Patient/statistics & numerical data
- Influenza Vaccines/therapeutic use
- Influenza, Human/economics
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Influenza, Human/transmission
- Seasons
- Vaccination/economics
- Vaccination/statistics & numerical data
Collapse
Affiliation(s)
- Chisato Imai
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lisa Hall
- Epidemiology and Biostatistics Division, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen Lambert
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katharina Merollini
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| |
Collapse
|
35
|
Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. Vaccine 2018; 36:3434-3444. [DOI: 10.1016/j.vaccine.2018.04.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 01/06/2023]
|
36
|
Gagneux-Brunon A, Lucht F, Launay O, Berthelot P, Botelho-Nevers E. Vaccines for healthcare-associated infections: present, future, and expectations. Expert Rev Vaccines 2018; 17:421-433. [DOI: 10.1080/14760584.2018.1470507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Amandine Gagneux-Brunon
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Frédéric Lucht
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Odile Launay
- Inserm CIC 1417, I-REIVAC, University of Paris-Descartes, University Hospital of Cochin-Broca-Hôtel-Dieu, Paris, France
| | - Philippe Berthelot
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
- Infection control unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| |
Collapse
|