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Rashiti-Bytyçi A, White Johansson E, Kaçaniku-Gunga P, Danis K, Schoeps A, Dörre A, Fetaj F, Kalaveshi A. Estimation of COVID-19 vaccine effectiveness against infections and severe outcomes using routine surveillance data in Kosovo, July-September 2021. PLoS One 2024; 19:e0305629. [PMID: 39046982 PMCID: PMC11268608 DOI: 10.1371/journal.pone.0305629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/30/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND COVID-19 vaccines have proven effective against severe outcomes in many settings, yet vaccine effectiveness (VE) estimates remain lacking for Kosovo. We aimed to estimate VE against COVID-19 infections, hospitalisations, and deaths for one and two vaccine doses during the fourth pandemic wave in July-September 2021, the period when vaccination initially became widely available. METHODS We analysed routine surveillance data to define cases and vaccination status as partially (one dose) or completely (two doses) vaccinated. We used the screening method to calculate the proportion of cases with the outcomes vaccinated (PCV). The proportion of the population vaccinated (PPV) was based on numbers vaccinated and the Kosovo population estimate on 30/09/2021. RESULTS Between July-September 2021, 51,804 COVID-19 cases were reported in Kosovo with 9.3% of cases partially and 3.4% completely vaccinated. Estimated vaccine effectiveness for one dose was 93.1% (95%CI:92.9-93.2%) for infections, 90.3% (95%CI:88.8-91.7%) for hospitalisations, and 90.3% (95%CI:88.4-92.1%) for deaths. Estimated vaccine effectiveness for two doses was 97.8% (95%CI:97.6-97.9%) for infections, 94.5% (95%CI:93.3-95.6%) for hospitalisations, and 94.2% (95%CI: 93.7-96.5%) for deaths. CONCLUSIONS This study provides real-world evidence for COVID-19 vaccine effectiveness in Kosovo using routine administrative data sources and the screening method. COVID-19 vaccine effectiveness against infections and severe outcomes in Kosovo was higher with two vaccine doses than one dose, which is in accordance with findings from other study designs and settings. Using the screening method in our study reflects an important initial methodology for estimating vaccine effectiveness with routine surveillance that may be particularly important for low- and middle-income settings with less robust surveillance systems or fewer opportunities to conduct more robust vaccine effectiveness study designs.
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Affiliation(s)
- Albiona Rashiti-Bytyçi
- National Institute of Public Health, (NIPHK), Prishtina, Kosovo
- The Mediterranean and Black Sea Programme for Intervention Epidemiology Training (MediPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | - Kostas Danis
- The Mediterranean and Black Sea Programme for Intervention Epidemiology Training (MediPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anja Schoeps
- Landesuntersuchungsamt Rheinland-Pfalz, Koblenz, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute (RKI), Berlin, Germany
| | - Achim Dörre
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute (RKI), Berlin, Germany
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Fetije Fetaj
- National Institute of Public Health, (NIPHK), Prishtina, Kosovo
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Huo Y, Yang Y, Halloran ME, Longini IM, Dean NE. Hypothesis testing and sample size considerations for the test-negative design. BMC Med Res Methodol 2024; 24:151. [PMID: 39014324 PMCID: PMC11251325 DOI: 10.1186/s12874-024-02277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/05/2024] [Indexed: 07/18/2024] Open
Abstract
The test-negative design (TND) is an observational study design to evaluate vaccine effectiveness (VE) that enrolls individuals receiving diagnostic testing for a target disease as part of routine care. VE is estimated as one minus the adjusted odds ratio of testing positive versus negative comparing vaccinated and unvaccinated patients. Although the TND is related to case-control studies, it is distinct in that the ratio of test-positive cases to test-negative controls is not typically pre-specified. For both types of studies, sparse cells are common when vaccines are highly effective. We consider the implications of these features on power for the TND. We use simulation studies to explore three hypothesis-testing procedures and associated sample size calculations for case-control and TND studies. These tests, all based on a simple logistic regression model, are a standard Wald test, a continuity-corrected Wald test, and a score test. The Wald test performs poorly in both case-control and TND when VE is high because the number of vaccinated test-positive cases can be low or zero. Continuity corrections help to stabilize the variance but induce bias. We observe superior performance with the score test as the variance is pooled under the null hypothesis of no group differences. We recommend using a score-based approach to design and analyze both case-control and TND. We propose a modification to the TND score sample size to account for additional variability in the ratio of controls over cases. This work enhances our understanding of the data generating mechanism in a test-negative design (TND) and how it is distinct from that of a case-control study due to its passive recruitment of controls.
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Affiliation(s)
- Yanan Huo
- Gilead Sciences, Inc, Foster City, CA, USA
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - M Elizabeth Halloran
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ira M Longini
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Natalie E Dean
- Department of Biostatistics & Bioinformatics, Emory University, Atlanta, GA, USA.
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Urquidi C, Sepúlveda-Peñaloza A, Valenzuela MT, Ponce A, Menares V, Cortes CP, Benítez R, Santelices E, Anfossi R, Moller A, Santolaya ME. Vaccine effectiveness in reducing COVID-19-related hospitalization after a risk-age-based mass vaccination program in a Chilean municipality: A comparison of observational study designs. Vaccine 2024; 42:3851-3856. [PMID: 38749822 DOI: 10.1016/j.vaccine.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Case-control studies involving test-negative (TN) and syndrome-negative (SN) controls are reliable for evaluating influenza and rotavirus vaccine effectiveness (VE) during a random vaccination process. However, there is no empirical evidence regarding the impact in real-world mass vaccination campaigns against SARS-CoV-2 using TN and SN controls. OBJECTIVE To compare in the same population the effectiveness of SARS-CoV-2 vaccination on COVID-19-related hospitalization rates across a cohort design, TN and SN designs. METHOD We conducted an unmatched population-based cohort, TN and SN case-control designs linking data from four data sources (public primary healthcare system, hospitalization registers, epidemiological surveillance systems and the national immunization program) in a Chilean municipality (Rancagua) between March 1, 2021 and August 31, 2021. The outcome was COVID-19-related hospitalization. To ensure sufficient sample size in the unexposed group, completion of follow-up in the cohort design, and sufficient time between vaccination and hospitalization in the case-control design, VE was estimated comparing 8-week periods for each individual. RESULTS Among the 191,505 individuals registered in the primary healthcare system of Rancagua in Chile on March 1, 2021; 116,453 met the cohort study's inclusion criteria. Of the 9,471 hospitalizations registered during the study period in the same place, 526 were COVID-19 cases, 108 were TN controls, and 1,628 were SN controls. For any vaccine product, the age- and sex-adjusted vaccine effectiveness comparing fully and nonvaccinated individuals was 67.2 (55.7-76.3) in the cohort design, whereas it was 67.8 (44.1-81.4) and 77.9 (70.2-83.8) in the TN and SN control designs, respectively. CONCLUSION The VE of a COVID-19 vaccination program based on age and risk groups tended to differ across the three observational study designs. The SN case-control design may be an efficient option for evaluating COVID-19 VE in real-world settings.
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Affiliation(s)
- Cinthya Urquidi
- Department of Epidemiology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | | | - María T Valenzuela
- Department of Epidemiology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Alexander Ponce
- Information Technology Services, Development Department, Universidad de O'Higgins, Rancagua, Chile
| | | | - Claudia P Cortes
- Department of Internal Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Rosana Benítez
- Infectious Diseases Department, Clínica Dávila, Santiago, Chile
| | - Emilio Santelices
- Policy and Innovation Center, Universidad de Desarrollo, Santiago, Chile
| | - Renato Anfossi
- Hospital Regional Libertador Bernardo ÓHiggins, Rancagua, Chile
| | - Andrea Moller
- Hospital Regional Libertador Bernardo ÓHiggins, Rancagua, Chile
| | - María E Santolaya
- Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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Kirsebom FCM, Andrews N, Stowe J, Dabrera G, Ramsay M, Lopez Bernal J. Effectiveness of the Sanofi/GSK (VidPrevtyn Beta) and Pfizer-BioNTech (Comirnaty Original/Omicron BA.4-5) bivalent vaccines against hospitalisation in England. EClinicalMedicine 2024; 71:102587. [PMID: 38618208 PMCID: PMC11015482 DOI: 10.1016/j.eclinm.2024.102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Background The Sanofi/GSK AS03-adjuvanted (VidPrevtyn Beta) vaccine and the Pfizer-BioNTech mRNA (Comirnaty Original/Omicron BA.4-5) bivalent vaccine were offered to adults aged 75 years and over in England from 3rd April 2023. This is the first time an adjuvanted COVID-19 vaccine has been administered as part of a UK COVID-19 vaccination programme. In clinical trials, antibody levels generated were comparable with mRNA vaccines but there are no real-world data on the effectiveness or duration of protection. Methods We used a test-negative case-control study design to estimate the incremental vaccine effectiveness of the Sanofi/GSK and Pfizer bivalent BA.4-5 boosters against hospitalisation amongst those aged 75 years and older in England. Cases (those testing positive) and controls (those testing negative) were identified from the national COVID-19 PCR testing data undertaken in hospital settings. The study period included tests from 3rd April 2023 to 27th August 2023. Tests were linked to the COVID-19 vaccination register and to the national hospital admission database, restricting to those with an acute respiratory infection coded in the primary diagnosis field. Vaccine effectiveness was estimated using multivariable logistic regression amongst those who had last received an autumn 2022 booster given at least 3 months prior. The test result was the outcome and vaccination status the exposure. Analyses were adjusted for week of test, gender, age, clinical risk group status, care home resident status, region, index of multiple deprivation, ethnicity, influenza vaccination status and recent COVID-19 positivity. Findings There were 14,169 eligible tests from hospitalised individuals aged 75 years and older; 3005 cases (positive tests) and 11,164 controls (negative tests). Effectiveness was highest in the period 9-13 days post vaccination for both manufacturers at about 50%; 43.7% (95% CI, 20.1-60.3%) and 56.1% (95% CI, 25.2-74.2%) for Sanofi/GSK and Pfizer BA.4-5, respectively. There was evidence of waning with a reduction to about 30% for both manufacturers after 5-9 weeks. The longest time interval post vaccination for which we were able to estimate effectiveness was 10+ weeks post vaccination, at which point vaccine effectiveness was 17.6% (95% CI, -3.6 to 34.5%) and 37.9% (95% CI, 13.2-55.5%) for the Sanofi/GSK and Pfizer BA.4-5 boosters, respectively. Interpretation Both boosters provided good protection against hospitalisation amongst older adults. The finding that the adjuvanted vaccine targeting the distant Beta strain had similar effectiveness to the bivalent mRNA vaccine targeting more closely matched Omicron sub-lineages is notable and highlights the need for further real-world studies into the effectiveness of vaccines from different vaccine platforms and formulations in the presence of matched and unmatched strains. Funding No external funding.
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Affiliation(s)
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, London, United Kingdom
| | | | - Mary Ramsay
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jamie Lopez Bernal
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, United Kingdom
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5
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de Waure C, Alti E, Baldo V, Bonanni P, Conversano M, Fedele A, Gabutti G, Ieraci R, Landi F, Landolfi R, Orsi A, Rizzo C, Rossi A, Villani A, Vitale F, Domnich A. Mapping and ranking outcomes for the evaluation of seasonal influenza vaccine efficacy and effectiveness: a delphi study. Expert Rev Vaccines 2024; 23:636-644. [PMID: 38869028 DOI: 10.1080/14760584.2024.2367457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/10/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Protection provided by seasonal influenza vaccination (SIV) may be measured against numerous outcomes, and their heterogeneity may hamper decision-making. The aim of this study was to explore outcomes used for estimation of SIV efficacy/effectiveness (VE) and obtain expert consensus on their importance. RESEARCH DESIGN AND METHODS An umbrella review was first conducted to collect and map outcomes considered in systematic reviews of SIV VE. A Delphi study was then performed to reach expert convergence on the importance of single outcomes, measured on a 9-point Likert scale, in principal target groups, namely children, working-age adults, older adults, subjects with co-morbidities and pregnant women. RESULTS The literature review identified 489 outcomes. Following data reduction, 20 outcomes were selected for the Delphi process. After two Delphi rounds and a final consensus meeting, convergence was reached. All 20 outcomes were judged to be important or critically important. More severe outcomes, such as influenza-related hospital encounters and mortality with or without laboratory confirmation, were generally top-ranked across all target groups (median scores ≥8 out of 9). CONCLUSIONS Rather than focusing on laboratory-confirmed infection per se, experimental and observational VE studies should include more severe influenza-related outcomes because they are expected to exercise a greater impact on decision-making.
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Affiliation(s)
- Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisabetta Alti
- Department of General Practice, Local Health Unit Toscana Centro, Florence, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Michele Conversano
- Prevention Department, Local Health Authority of Taranto, Taranto, Italy
| | - Alberto Fedele
- Prevention Department, Hygiene and Public Health Service, Local Health Unit, Lecce, Italy
| | - Giovanni Gabutti
- Coordinator Working Group "Vaccines and Immunization Policies", Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Cogorno (Ge), Italy
| | | | - Francesco Landi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raffaele Landolfi
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- System Medicine Department, Tor Vergata University of Rome, Rome, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
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6
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Huo Y, Yang Y, Halloran ME, Longini IM, Dean NE. Hypothesis testing and sample size considerations for the test-negative design. RESEARCH SQUARE 2023:rs.3.rs-3783493. [PMID: 38234799 PMCID: PMC10793497 DOI: 10.21203/rs.3.rs-3783493/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
The test-negative design (TND) is an observational study design to evaluate vaccine effectiveness (VE) that enrolls individuals receiving diagnostic testing for a target disease as part of routine care. VE is estimated as one minus the adjusted odds ratio of testing positive versus negative comparing vaccinated and unvaccinated patients. Although the TND is related to case-control studies, it is distinct in that the ratio of test-positive cases to test-negative controls is not typically pre-specified. For both types of studies, sparse cells are common when vaccines are highly effective. We consider the implications of these features on power for the TND. We use simulation studies to explore three hypothesis-testing procedures and associated sample size calculations for case-control and TND studies. These tests, all based on a simple logistic regression model, are a standard Wald test, a continuity-corrected Wald test, and a score test. The Wald test performs poorly in both case-control and TND when VE is high because the number of vaccinated test-positive cases can be low or zero. Continuity corrections help to stabilize the variance but induce bias. We observe superior performance with the score test as the variance is pooled under the null hypothesis of no group differences. We recommend using a score-based approach to design and analyze both case-control and TND. We propose a modification to the TND score sample size to account for additional variability in the ratio of controls over cases. This work expands our understanding of the data mechanisms of the TND.
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Affiliation(s)
- Yanan Huo
- Gilead Sciences, Foster City, CA, USA
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | | | - Ira M Longini
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Natalie E Dean
- Department of Biostatistics & Bioinformatics, Emory University, Atlanta, GA, USA
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7
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Tsuzuki S, Murata F, Maeda M, Asai Y, Koizumi R, Ohmagari N, Fukuda H. Association between seasonal influenza vaccination and antimicrobial use in Japan from the 2015-16 to 2020-21 seasons: from the VENUS study. J Antimicrob Chemother 2023; 78:2976-2982. [PMID: 37897719 PMCID: PMC10689917 DOI: 10.1093/jac/dkad340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Seasonal influenza vaccination might be considered an antimicrobial resistance (AMR) countermeasure because it can reduce unnecessary antimicrobial use for acute respiratory infection by mitigating the burden of such diseases. OBJECTIVES To examine the association between seasonal influenza vaccination and antimicrobial use (AMU) in Japan at the community level and to examine the impact of influenza vaccination on the frequency of unnecessary antimicrobial prescription for upper respiratory infection. METHODS For patients who visited any healthcare facility in one of the 23 wards of Tokyo, Japan, due to upper respiratory infection and who were aged 65 years or older, we extracted data from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study database, which includes all claims data and vaccination records from the 2015-16 to 2020-21 seasons. We used the average treatment effect (ATE) with 1:1 propensity score matching to examine the association of vaccination status with frequency of antibiotic prescription, frequency of healthcare facility consultation, risk of admission and risk of death in the follow-up period of the same season (from 1 January to 31 March). RESULTS In total, 244 642 people were enrolled. Matched data included 101 734 people in each of the unvaccinated and vaccinated groups. The ATE of vaccination was -0.004 (95% CI -0.006 to -0.002) for the frequency of antibiotic prescription, -0.005 (-0.007 to -0.004) for the frequency of healthcare facility consultation, -0.001 (-0.002 to -0.001) for the risk of admission and 0.00 (0.00 to 0.00) for the risk of death. CONCLUSIONS Our results suggest that seasonal influenza vaccination is associated with lower frequencies of unnecessary antibiotic prescription and of healthcare facility consultation.
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Affiliation(s)
- Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Fumiko Murata
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Megumi Maeda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryuji Koizumi
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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8
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Graham S, Tessier E, Stowe J, Bernal JL, Parker EPK, Nitsch D, Miller E, Andrews N, Walker JL, McDonald HI. Bias assessment of a test-negative design study of COVID-19 vaccine effectiveness used in national policymaking. Nat Commun 2023; 14:3984. [PMID: 37414791 PMCID: PMC10325974 DOI: 10.1038/s41467-023-39674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
National test-negative-case-control (TNCC) studies are used to monitor COVID-19 vaccine effectiveness in the UK. A questionnaire was sent to participants from the first published TNCC COVID-19 vaccine effectiveness study conducted by the UK Health Security Agency, to assess for potential biases and changes in behaviour related to vaccination. The original study included symptomatic adults aged ≥70 years testing for COVID-19 between 08/12/2020 and 21/02/2021. A questionnaire was sent to cases and controls tested from 1-21 February 2021. In this study, 8648 individuals responded to the questionnaire (36.5% response). Using information from the questionnaire to produce a combined estimate that accounted for all potential biases decreased the original vaccine effectiveness estimate after two doses of BNT162b2 from 88% (95% CI: 79-94%) to 85% (95% CI: 68-94%). Self-reported behaviour demonstrated minimal evidence of riskier behaviour after vaccination. These findings offer reassurance to policy makers and clinicians making decisions based on COVID-19 vaccine effectiveness TNCC studies.
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Affiliation(s)
- Sophie Graham
- London School of Hygiene and Tropical Medicine, London, UK.
- UK Health Security Agency, London, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK.
| | | | | | | | | | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, UK
- UK Renal Registry, Bristol, UK
- Renal Unit, Royal Free London NHS Foundation Trust, Hertfordshire, UK
| | - Elizabeth Miller
- London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Nick Andrews
- UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Jemma L Walker
- London School of Hygiene and Tropical Medicine, London, UK
- UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Helen I McDonald
- London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
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9
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Habibzadeh F. Correction of vaccine effectiveness derived from test-negative case-control studies. BMC Med Res Methodol 2023; 23:137. [PMID: 37301843 DOI: 10.1186/s12874-023-01962-0] [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: 01/25/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Determining the vaccine effectiveness (VE) is an important part of studying every new vaccine. Test-negative case-control (TNCC) studies have recently been used to determine the VE. However, the estimated VE derived from a TNCC design depends on the test sensitivity and specificity. Herein, a method for correction of the value of VE derived from a TNCC study is presented. METHODS An analytical method is presented to compute the corrected VE based on the sensitivity and specificity of the diagnostic test utilized. To show the application of the method proposed, a hypothetical TNCC study is presented. In this in silico study, 100 000 individuals referring to a healthcare system for COVID-19-like illness were tested with diagnostic tests with sensitivities of 0.6, 0.8, and 1.0, and specificities ranging from 0.85 to 1.00. A vaccination coverage of 60%, an attack rate of 0.05 for COVID-19 in unvaccinated group, and a true VE of 0.70, were assumed. In this simulation, a COVID-19-like illness with an attack rate of 0.30 could also affect all the studied population regardless of their vaccination status. RESULTS The observed VE ranged from 0.11 (computed for a test sensitivity of 0.60 and specificity of 0.85) to 0.71 (computed for a test sensitivity and specificity of 1.0). The mean computed corrected VE derived from the proposed method was 0.71 (the standard deviation of 0.02). CONCLUSIONS The observed VE derived from TNCC studies can be corrected easily. An acceptable estimate for VE can be computed regardless of the diagnostic test sensitivity and specificity used in the study.
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10
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Eusebi P, Speybroeck N, Hartnack S, Stærk-Østergaard J, Denwood MJ, Kostoulas P. Addressing misclassification bias in vaccine effectiveness studies with an application to Covid-19. BMC Med Res Methodol 2023; 23:55. [PMID: 36849911 PMCID: PMC9969950 DOI: 10.1186/s12874-023-01853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023] Open
Abstract
Safe and effective vaccines are crucial for the control of Covid-19 and to protect individuals at higher risk of severe disease. The test-negative design is a popular option for evaluating the effectiveness of Covid-19 vaccines. However, the findings could be biased by several factors, including imperfect sensitivity and/or specificity of the test used for diagnosing the SARS-Cov-2 infection. We propose a simple Bayesian modeling approach for estimating vaccine effectiveness that is robust even when the diagnostic test is imperfect. We use simulation studies to demonstrate the robustness of our method to misclassification bias and illustrate the utility of our approach using real-world examples.
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Affiliation(s)
- Paolo Eusebi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy. .,Modus Outcomes, a division of THREAD, Lyon, France.
| | - Niko Speybroeck
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Jacob Stærk-Østergaard
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Matthew J Denwood
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
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Liang Y, Driscoll AJ, Patel PD, Datta S, Voysey M, French N, Jamka LP, Henrion MYR, Ndeketa L, Laurens MB, Heyderman RS, Gordon MA, Neuzil KM. Typhoid conjugate vaccine effectiveness in Malawi: evaluation of a test-negative design using randomised, controlled clinical trial data. Lancet Glob Health 2023; 11:e136-e144. [PMID: 36442498 PMCID: PMC9748309 DOI: 10.1016/s2214-109x(22)00466-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Typhoid conjugate vaccines are being introduced in low-income and middle-income countries to prevent typhoid illness in children. Vaccine effectiveness studies assess vaccine performance after introduction. The test-negative design is a commonly used method to estimate vaccine effectiveness that has not been applied to typhoid vaccines because of concerns over blood culture insensitivity. The overall aim of the study was to evaluate the appropriateness of using a test-negative design to assess typhoid Vi polysaccharide-tetanus toxoid conjugate vaccine (Vi-TT) effectiveness using a gold standard randomised controlled trial database. METHODS Using blood culture data from a randomised controlled trial of Vi-TT in Malawi, we simulated a test-negative design to derive vaccine effectiveness estimates using three different approaches and compared these to randomised trial efficacy results. In the randomised trial, 27 882 children aged 9 months to 12 years were randomly assigned (1:1) to receive a single dose of Vi-TT or meningococcal capsular group A conjugate vaccine between Feb 21 and Sept 27, 2018, and were followed up for blood culture-confirmed typhoid fever until Sept 30, 2021. FINDINGS For all three test-negative design approaches, vaccine effectiveness estimates (test-negative design A, 80·3% [95% CI 66·2 to 88·5] vs test-negative design B, 80·5% [66·5 to 88·6] vs test-negative design C, 80·4% [66·9 to 88·4]) were almost identical to the randomised trial results (80·4% [95% CI 66·4 to 88·5]). Receipt of Vi-TT did not affect the risk of non-typhoid fever (vaccine efficacy against non-typhoid fever -0·4% [95% CI -4·9 to 3·9] vs -1% [-5·6 to 3·3] vs -2·5% [-6·4 to 1·3] for test-negative design A, test-negative design B, and test-negative design C, respectively). INTERPRETATION This study validates the test-negative design core assumption for typhoid vaccine effectiveness estimation and shows the accuracy and precision of the estimates compared with the randomised controlled trial. These results show that the test-negative design is suitable for assessing typhoid conjugate vaccine effectiveness in post-introduction studies using blood culture surveillance. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Priyanka D Patel
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Shrimati Datta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Latif Ndeketa
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Matthew B Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, UK
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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12
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Comparison of test-negative and syndrome-negative controls in SARS-CoV-2 vaccine effectiveness evaluations for preventing COVID-19 hospitalizations in the United States. Vaccine 2022; 40:6979-6986. [PMID: 36374708 PMCID: PMC9595377 DOI: 10.1016/j.vaccine.2022.10.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Test-negative design (TND) studies have produced validated estimates of vaccine effectiveness (VE) for influenza vaccine studies. However, syndrome-negative controls have been proposed for differentiating bias and true estimates in VE evaluations for COVID-19. To understand the use of alternative control groups, we compared characteristics and VE estimates of syndrome-negative and test-negative VE controls. METHODS Adults hospitalized at 21 medical centers in 18 states March 11-August 31, 2021 were eligible for analysis. Case patients had symptomatic acute respiratory infection (ARI) and tested positive for SARS-CoV-2. Control groups were test-negative patients with ARI but negative SARS-CoV-2 testing, and syndrome-negative controls were without ARI and negative SARS-CoV-2 testing. Chi square and Wilcoxon rank sum tests were used to detect differences in baseline characteristics. VE against COVID-19 hospitalization was calculated using logistic regression comparing adjusted odds of prior mRNA vaccination between cases hospitalized with COVID-19 and each control group. RESULTS 5811 adults (2726 cases, 1696 test-negative controls, and 1389 syndrome-negative controls) were included. Control groups differed across characteristics including age, race/ethnicity, employment, previous hospitalizations, medical conditions, and immunosuppression. However, control-group-specific VE estimates were very similar. Among immunocompetent patients aged 18-64 years, VE was 93 % (95 % CI: 90-94) using syndrome-negative controls and 91 % (95 % CI: 88-93) using test-negative controls. CONCLUSIONS Despite demographic and clinical differences between control groups, the use of either control group produced similar VE estimates across age groups and immunosuppression status. These findings support the use of test-negative controls and increase confidence in COVID-19 VE estimates produced by test-negative design studies.
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13
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Horváth JK, Ferenci T, Ferenczi A, Túri G, Röst G, Oroszi B. Real-Time Monitoring of the Effectiveness of Six COVID-19 Vaccines against Laboratory-Confirmed COVID-19 in Hungary in 2021 Using the Screening Method. Vaccines (Basel) 2022; 10:1824. [PMID: 36366334 PMCID: PMC9697606 DOI: 10.3390/vaccines10111824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 08/15/2023] Open
Abstract
Several studies have reported the waning effectiveness of COVID-19 vaccines. This study aims to demonstrate the applicability of the screening method for estimating vaccine effectiveness (VE) in a pandemic. We report VE in Hungary, estimated with the screening method, in 2021, covering a period of Alpha and the Delta variant, including the booster dose roll-out. Hungary is in a unique position to use six different vaccines in the same population. All vaccines provided a high level of protection initially, which declined over time. While the picture is different in each age group, the waning of immunity is apparent for all vaccines, especially in the younger age groups and the Sinopharm, Sputnik-V, and AstraZeneca vaccines, which performed similarly. This is clearly reversed by booster doses, more prominent for those three vaccines, where the decline in protection is more evident. Overall, two vaccines, Pfizer/BioNTech and Moderna, tend to produce the best results in all age groups, even with waning immunity considered. Using the screening method in future pandemic waves is worthwhile, especially in countries struggling with a lack of resources or when there is a need to deliver VE results within a short timeframe due to urgent decision-making.
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Affiliation(s)
- Judit K. Horváth
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
| | - Tamás Ferenci
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
- Physiological Controls Research Center, Óbuda University, 1034 Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Annamária Ferenczi
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
| | - Gergő Túri
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
| | - Gergely Röst
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
- Bolyai Institute, University of Szeged, 6720 Szeged, Hungary
| | - Beatrix Oroszi
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
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Carazo S, Skowronski DM, Brisson M, Sauvageau C, Brousseau N, Gilca R, Ouakki M, Barkati S, Fafard J, Talbot D, Gilca V, Deceuninck G, Garenc C, Carignan A, De Wals P, De Serres G. Estimated Protection of Prior SARS-CoV-2 Infection Against Reinfection With the Omicron Variant Among Messenger RNA-Vaccinated and Nonvaccinated Individuals in Quebec, Canada. JAMA Netw Open 2022; 5:e2236670. [PMID: 36239934 PMCID: PMC9568797 DOI: 10.1001/jamanetworkopen.2022.36670] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE The Omicron variant is phylogenetically and antigenically distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron reinfection, with and without vaccination, requires quantification. OBJECTIVE To estimate the protection against Omicron reinfection and hospitalization conferred by prior heterologous non-Omicron SARS-CoV-2 infection and/or up to 3 doses of an ancestral, Wuhan-like messenger RNA (mRNA) vaccine. DESIGN, SETTING, AND PARTICIPANTS This test-negative, population-based case-control study was conducted between December 26, 2021, and March 12, 2022, and included community-dwelling individuals aged 12 years or older who were tested for SARS-CoV-2 infection in the province of Quebec, Canada. EXPOSURES Prior laboratory-confirmed SARS-CoV-2 infection with or without mRNA vaccination. MAIN OUTCOMES AND MEASURES The main outcome was laboratory-confirmed SARS-CoV-2 reinfection and associated hospitalization, presumed to be associated with the Omicron variant according to genomic surveillance. The odds of prior infection with or without vaccination were compared for case participants with Omicron infection and associated hospitalizations vs test-negative control participants. Estimated protection was derived as 1 - the odds ratio, adjusted for age, sex, testing indication, and epidemiologic week. Analyses were stratified by severity and time since last non-Omicron infection or vaccine dose. RESULTS This study included 696 439 individuals (224 007 case participants and 472 432 control participants); 62.2% and 63.9% were female and 87.4% and 75.5% were aged 18 to 69 years, respectively. Prior non-Omicron SARS-CoV-2 infection was detected for 9505 case participants (4.2%) and 29 712 control participants (6.3%). Among nonvaccinated individuals, prior non-Omicron infection was associated with a 44% reduction (95% CI, 38%-48%) in Omicron reinfection risk, which decreased from 66% (95% CI, 57%-73%) at 3 to 5 months to 35% (95% CI, 21%-47%) at 9 to 11 months postinfection and was below 30% thereafter. The more severe the prior infection, the greater the risk reduction. Estimated protection (95% CI) against Omicron infection was consistently significantly higher among vaccinated individuals with prior infection compared with vaccinated infection-naive individuals, with 65% (63%-67%) vs 20% (16%-24%) for 1 dose, 68% (67%-70%) vs 42% (41%-44%) for 2 doses, and 83% (81%-84%) vs 73% (72%-73%) for 3 doses. For individuals with prior infection, estimated protection (95% CI) against Omicron-associated hospitalization was 81% (66%-89%) and increased to 86% (77%-99%) with 1, 94% (91%-96%) with 2, and 97% (94%-99%) with 3 mRNA vaccine doses, without signs of waning. CONCLUSIONS AND RELEVANCE The findings of this study suggest that vaccination with 2 or 3 mRNA vaccine doses among individuals with prior heterologous SARS-CoV-2 infection provided the greatest protection against Omicron-associated hospitalization. In the context of program goals to prevent severe outcomes and preserve health care system capacity, a third mRNA vaccine dose may add limited protection in twice-vaccinated individuals with prior SARS-CoV-2 infection.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Danuta M. Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marc Brisson
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Sapha Barkati
- Division of Infectious Diseases, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Denis Talbot
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Vladimir Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Christophe Garenc
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrook University, Sherbrook, Quebec, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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15
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Halme J, Syrjänen RK, Baum U, Palmu AA. Effectiveness of trivalent influenza vaccines against hospitalizations due to laboratory-confirmed influenza a in the elderly: Comparison of test-negative design with register-based designs. Vaccine 2022; 40:4242-4252. [PMID: 35691869 DOI: 10.1016/j.vaccine.2022.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Measuring influenza vaccine effectiveness (IVE) seasonally is important and has been conducted utilizing several observational study designs. The active test-negative design has been most widely used and the validity of passive register-based studies has been debated. We aimed to explore the potential differences, advantages, and weaknesses of different study designs in estimating influenza vaccine effectiveness. METHODS We compared three study designs in estimating IVE against hospitalization in the elderly aged 65 years or more over three influenza seasons 2015/16, 2016/17 and 2017/18. Designs compared were active test-negative design (TND), register-based cohort design and register-based case-control design with different selection criteria for cases and controls. RESULTS Adjusted IVE estimates for the three consecutive seasons 2015-18 in active test-negative design were 82% (95% confidence interval 26, 96), 21% (-179, 77), 15% (-113, 66). For case-control design, estimates from different analyses ranged in 2015/16 from 47% (-16, 76) to 52% (-48, 84), in 2016/17 from 10% (-42, 43) to 29% (-20, 58), and in 2017/18 from -27% (-91, 15) to 1% (-40, 30). In the cohort design, the adjusted IVE estimates were 48% (-9, 75), 29% (1, 49), 13% (-21, 37) for the three seasons. CONCLUSIONS The register-based cohort design produced results more concordant with the active test-negative design than the case-control design. Furthermore, the register-based cohort design yielded most precise estimates with narrower confidence intervals. In Finland with the availability of near real-time nationwide register data, the register-based cohort design is the method of choice to continue the annual surveillance of influenza vaccine effectiveness.
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Affiliation(s)
- Jussi Halme
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Biokatu 6, 33520 Tampere, Finland
| | - Ritva K Syrjänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Biokatu 6, 33520 Tampere, Finland.
| | - Ulrike Baum
- Department of Health Security, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Biokatu 6, 33520 Tampere, Finland
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Widdifield J, Kwong JC, Chen S, Eder L, Benchimol EI, Kaplan GG, Hitchon C, Aviña-Zubieta JA, Lacaille D, Chung H, Bernatsky S. Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes among individuals with immune-mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population-based analysis. THE LANCET RHEUMATOLOGY 2022; 4:e430-e440. [PMID: 35441151 PMCID: PMC9009845 DOI: 10.1016/s2665-9913(22)00096-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We estimated COVID-19 vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19 outcomes among individuals with immune-mediated inflammatory diseases in Ontario, Canada. Methods In this population-based analysis, we used a test-negative design across four immune-mediated inflammatory disease population-based cohorts, comprising individuals with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and inflammatory bowel disease. We identified all SARS-CoV-2 tests done in these populations between March 1 and Nov 22, 2021 (a period in which there was rapid uptake of vaccines, and the alpha [B.1.1.7] and delta [B.1.617.2] SARS-CoV-2 variants were predominantly circulating in Canada) and separately assessed outcomes of SARS-CoV-2 infection and severe COVID-19 outcomes (hospitalisation due to COVID-19 and death due to COVID-19) for each disease group. We used multivariable logistic regression to estimate the effectiveness of one, two, and three doses of mRNA-based COVID-19 vaccine (BNT162b2 [Pfizer–BioNTech], or mRNA-1273 [Moderna]) among individuals at the time of SARS-CoV-2 testing. Findings Between March 1 and Nov 22, 2021, we identified 2127 (5·9%) test-positive cases among 36 145 individuals (26 476 [73·2%] were female and 9669 [26·8%] were male) with rheumatoid arthritis tested, 476 (6·1%) test-positive cases among 7863 individuals (4130 [52·5%] were female and 3733 [47·5%] were male) with ankylosing spondylitis tested, 3089 (6·5%) test-positive cases among 47 199 individuals (26 062 [55·2%] were female and 21 137 [44·8%] were male) with psoriasis tested, and 1702 (5·4%) test-positive cases among 31 311 individuals (17 716 [56·6%] were female and 13 595 [43·4%] were male) with inflammatory bowel disease tested. Adjusted vaccine effectiveness of two doses against infection was 83% (95% CI 80–86) in those with rheumatoid arthritis, 89% (83–93) among those with ankylosing spondylitis, 84% (81–86) among those with psoriasis, and 79% (74–82) among those with inflammatory bowel disease. After two vaccine doses, effectiveness against infection generally peaked 31–60 days after vaccination and waned gradually with each additional month. Vaccine effectiveness against severe outcomes after two doses was 92% (95% CI 88–95) in those with rheumatoid arthritis, 97% (83–99) among those with ankylosing spondylitis, 92% (86–95) among those with psoriasis, and 94% (88–97) among those with inflammatory bowel disease. Vaccine effectiveness after a third dose against infection was similar to or higher than after the second dose (ranging from 76% [47–89] to 96% [72–99]), although due to a paucity of events, estimates could not be calculated for some subgroups for severe outcomes. Interpretation Two vaccine doses were found to be highly effective against both SARS-CoV-2 infection and severe COVID-19 outcomes in patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and inflammatory bowel disease during the study period. Research is needed to determine the durability of effectiveness of three doses over time, particularly against emerging variants. Funding Public Health Agency of Canada
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Affiliation(s)
- Jessica Widdifield
- Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto ON, Canada
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, Canada
| | | | - Lihi Eder
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Eric I Benchimol
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Carol Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - J Antonio Aviña-Zubieta
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Diane Lacaille
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | | | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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17
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El-Heneidy A, Grimwood K, Lambert SB, Sarna M, Ware RS. Association between vaccination status, symptom identification and healthcare use: Implications for test negative design observational studies. Vaccine 2022; 40:1918-1923. [PMID: 35216842 DOI: 10.1016/j.vaccine.2022.02.049] [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: 08/27/2021] [Revised: 12/10/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
AIM To test the internal validity of the test-negative design (TND) by investigating associations between maternal influenza vaccination, and new virus detection episodes (VDEs), acute respiratory illness, and healthcare visits in their children. METHODS Eighty-five children from a birth cohort provided daily symptoms, weekly nasal swabs, and healthcare use data until age 2-years. Effect estimates are summarised as incidence rate ratios (IRR). RESULTS There was no association between maternal vaccination and VDEs in children (IRR = 1.1; 95 %CI = 0.9-1.2). Influenza-vaccinated mothers were more likely than unvaccinated mothers to both report, and seek healthcare for, acute lower respiratory illness in their children, IRR = 2.4; 95 %CI = 1.2-4.8 and IRR = 2.2; 95 %CI = 1.1-4.3, respectively. CONCLUSION A key assumption of the TND, that healthcare seeking behaviour for conditions of the same severity is not associated with vaccine receipt, did not hold. Further studies of the performance of the TND in different populations are required to confirm its validity.
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Affiliation(s)
- Asmaa El-Heneidy
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia.
| | - Keith Grimwood
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia; Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Gold Coast, QLD 4215, Australia.
| | - Stephen B Lambert
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA 6009, Australia.
| | - Robert S Ware
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia.
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18
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Pearson CAB, Edmunds WJ, Hladish TJ, Eggo RM. Potential test-negative design study bias in outbreak settings: application to Ebola vaccination in Democratic Republic of Congo. Int J Epidemiol 2022; 51:265-278. [PMID: 34458913 PMCID: PMC8855996 DOI: 10.1093/ije/dyab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Infectious disease outbreaks present unique challenges to study designs for vaccine evaluation. Test-negative design (TND) studies have previously been used to estimate vaccine effectiveness and have been proposed for Ebola virus disease (EVD) vaccines. However, there are key differences in how cases and controls are recruited during outbreaks and pandemics of novel pathogens, whcih have implications for the reliability of effectiveness estimates using this design. METHODS We use a modelling approach to quantify TND bias for a prophylactic vaccine under varying study and epidemiological scenarios. Our model accounts for heterogeneity in vaccine distribution and for two potential routes to testing and recruitment into the study: self-reporting and contact-tracing. We derive conventional and hybrid TND estimators for this model and suggest ways to translate public health response data into the parameters of the model. RESULTS Using a conventional TND study, our model finds biases in vaccine effectiveness estimates. Bias arises due to differential recruitment from self-reporting and contact-tracing, and due to clustering of vaccination. We estimate the degree of bias when recruitment route is not available, and propose a study design to eliminate the bias if recruitment route is recorded. CONCLUSIONS Hybrid TND studies can resolve the design bias with conventional TND studies applied to outbreak and pandemic response testing data, if those efforts collect individuals' routes to testing. Without route to testing, other epidemiological data will be required to estimate the magnitude of potential bias in a conventional TND study. Since these studies may need to be conducted retrospectively, public health responses should obtain these data, and generic protocols for outbreak and pandemic response studies should emphasize the need to record routes to testing.
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Affiliation(s)
- Carl A B Pearson
- Department of Infectious Disease Epidemiology & Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - W John Edmunds
- Department of Infectious Disease Epidemiology & Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Thomas J Hladish
- Department of Biology & Emerging Pathogens Institute, University of Florida, Gainesville, United States
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology & Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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19
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Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020818. [PMID: 35055642 PMCID: PMC8775496 DOI: 10.3390/ijerph19020818] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/23/2021] [Accepted: 11/27/2021] [Indexed: 02/06/2023]
Abstract
Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effectiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influenza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; applied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, publication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed using a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017–2018 influenza season. The arVE was 3% (−2% to 7%) in the 2018–2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.
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20
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Ciocănea-Teodorescu I, Nason M, Sjölander A, Gabriel EE. Adjustment for Disease Severity in the Test-Negative Study Design. Am J Epidemiol 2021; 190:1882-1889. [PMID: 33728441 DOI: 10.1093/aje/kwab066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/14/2022] Open
Abstract
The test-negative study design is often used to estimate vaccine effectiveness in influenza studies, but it has also been proposed in the context of other infectious diseases, such as cholera, dengue, or Ebola. It was introduced as a variation of the case-control design, in an attempt to reduce confounding bias due to health-care-seeking behavior, and has quickly gained popularity because of its logistic advantages. However, examination of the directed acyclic graphs that describe the test-negative design reveals that without strong assumptions, the estimated odds ratio derived under this sampling mechanism is not collapsible over the selection variable, such that the results obtained for the sampled individuals cannot be generalized to the whole population. In this paper, we show that adjustment for severity of disease can reduce this bias and, under certain assumptions, makes it possible to unbiasedly estimate a causal odds ratio. We support our findings with extensive simulations and discuss them in the context of recently published cholera test-negative studies of the effectiveness of cholera vaccines.
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21
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Crowcroft NS, Schwartz KL, Savage RD, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Deeks SL, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Simmonds K, Righolt CH, Bell C, Mahmud SM, Kwong JC. A Call for Caution in Use of Pertussis Vaccine Effectiveness Studies to Estimate Waning Immunity: A Canadian Immunization Research Network Study. Clin Infect Dis 2021; 73:83-90. [PMID: 32384142 DOI: 10.1093/cid/ciaa518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vaccine effectiveness (VE) studies provide essential evidence on waning vaccine-derived immunity, a major threat to pertussis control. We evaluated how study design affects estimates by comparing 2 case-control studies conducted in Ontario, Canada. METHODS We compared results from a test-negative design (TND) with a frequency-matched design (FMD) case-control study using pertussis cases from 2005-2015. In the first study, we identified test-negative controls from the public health laboratory that diagnosed cases and, in the second, randomly selected controls from patients attending the same physicians that reported cases, frequency matched on age and year. We compared characteristics of cases and controls using standardized differences. RESULTS In both designs, VE estimates for the early years postimmunization were consistent with clinical trials (TND, 84%; FMD, 89% at 1-3 years postvaccination) but diverged as time since last vaccination increased (TND, 41%; FMD, 74% by 8 years postvaccination). Overall, we observed lower VE and faster waning in the TND than the FMD. In the TND but not FMD, controls differed from cases in important confounders, being younger, having more comorbidities, and higher healthcare use. Differences between the controls of each design were greater than differences between cases. TND controls were more likely to be unvaccinated or incompletely vaccinated than FMD controls (P < .001). CONCLUSIONS The FMD adjusted better for healthcare-seeking behavior than the TND. Duration of protection from pertussis vaccines is unclear because estimates vary by study design. Caution should be exercised by experts, researchers, and decision makers when evaluating evidence on optimal timing of boosters.
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Affiliation(s)
- Natasha S Crowcroft
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,St Joseph's Health Centre, Toronto, Ontario, Canada
| | - Rachel D Savage
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Ye Li
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Shelly Bolotin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Frances B Jamieson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Service, Edmonton, Alberta, Canada.,Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, Alberta, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberley Simmonds
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher Bell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Gujar N, Tambe M, Parande M, Salunke N, Jagdale G, Anderson SG, Dharmadhikari A, Lakhkar A, Kulkarni PS. A case control study to assess effectiveness of measles containing vaccines in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children. Hum Vaccin Immunother 2021; 17:3316-3321. [PMID: 34128766 PMCID: PMC8220437 DOI: 10.1080/21645515.2021.1930471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Currently, most licensed vaccines against SARS-CoV-2 infection are approved for adults and not for children. We conducted a test negative case-control study to assess the effectiveness of Measles Containing Vaccines (MCVs) against SARS-CoV-2 infection in Pune, India, in children who were ≥1 year and <18 years of age and were tested for SARS-CoV-2 infection by Reverse transcription polymerase chain reaction (RT-PCR). The enrolled participants included 274 SARS-CoV-2 positive cases (216 vaccinated and 58 unvaccinated) along with 274 SARS-CoV-2 negative controls (265 vaccinated and 9 unvaccinated). Of the 274 cases, 180 (65.7%) were asymptomatic while 94 (34.3%) were symptomatic, all with mild severity. The number of participants with symptomatic SARS-CoV-2 infection was significantly lower in the vaccinated group compared to the unvaccinated group (p < .0001). The unadjusted overall Vaccine Effectiveness (VE) in the vaccinated group compared to unvaccinated group was 87.4% (OR = 0.126, 95% CI of VE: 73.9-93.9) while the adjusted overall VE after adjusting for age and sex was 87.5% (OR = 0.125, 95% CI of VE: 74.2-94.0). MCVs reduced incidence of laboratory confirmed SARS-CoV-2 infection in children. Number of symptomatic cases were also lower in the vaccinated group compared to the unvaccinated group. Results of our study have provided strong preliminary evidence that MCVs have a good effectiveness against SARS-CoV-2 infection in the pediatric population, which needs to be confirmed further through prospective randomized clinical trials.
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Affiliation(s)
| | - Muralidhar Tambe
- Department of Community Medicine, B J Government Medical College, Pune, India
| | - Malangori Parande
- Department of Community Medicine, B J Government Medical College, Pune, India
| | - Nandkumar Salunke
- Department of Community Medicine, B J Government Medical College, Pune, India
| | - Ganesh Jagdale
- Department of Community Medicine, B J Government Medical College, Pune, India
| | - Sarah G Anderson
- Department of Biostatistics, Emmes Services Pvt Ltd, Bangalore, India
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23
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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.
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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
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24
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Feldstein LR, Self WH, Ferdinands JM, Randolph AG, Aboodi M, Baughman AH, Brown SM, Exline MC, Files DC, Gibbs K, Ginde AA, Gong MN, Grijalva CG, Halasa N, Khan A, Lindsell CJ, Newhams M, Peltan ID, Prekker ME, Rice TW, Shapiro NI, Steingrub J, Talbot HK, Halloran ME, Patel M. Incorporating Real-time Influenza Detection Into the Test-negative Design for Estimating Influenza Vaccine Effectiveness: The Real-time Test-negative Design (rtTND). Clin Infect Dis 2021; 72:1669-1675. [PMID: 32974644 DOI: 10.1093/cid/ciaa1453] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/17/2023] Open
Abstract
With rapid and accurate molecular influenza testing now widely available in clinical settings, influenza vaccine effectiveness (VE) studies can prospectively select participants for enrollment based on real-time results rather than enrolling all eligible patients regardless of influenza status, as in the traditional test-negative design (TND). Thus, we explore advantages and disadvantages of modifying the TND for estimating VE by using real-time, clinically available viral testing results paired with acute respiratory infection eligibility criteria for identifying influenza cases and test-negative controls prior to enrollment. This modification, which we have called the real-time test-negative design (rtTND), has the potential to improve influenza VE studies by optimizing the case-to-test-negative control ratio, more accurately classifying influenza status, improving study efficiency, reducing study cost, and increasing study power to adequately estimate VE. Important considerations for limiting biases in the rtTND include the need for comprehensive clinical influenza testing at study sites and accurate influenza tests.
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Affiliation(s)
- Leora R Feldstein
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Departments of Anesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Aboodi
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Samuel M Brown
- Division of Pulmonary/Critical Care, Department of Medicine, Intermountain Medical Center and University of Utah, Murray, Utah, USA
| | - Matthew C Exline
- The Ohio State University, College of Nursing, Columbus, Ohio, USA
| | - D Clark Files
- Pulmonary Critical Care Allergy and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kevin Gibbs
- Pulmonary Critical Care Allergy and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michelle N Gong
- Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Department of Epidemiology and Population Health, Montefiore Healthcare System, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Akram Khan
- Department of Pulmonary and Critical Care, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Margaret Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Departments of Anesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ithan D Peltan
- Division of Pulmonary/Critical Care, Department of Medicine, Intermountain Medical Center and University of Utah, Murray, Utah, USA
| | - Matthew E Prekker
- Department of Medicine, Division of Pulmonary and Critical Care and Department of Emergency Medicine, Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jay Steingrub
- Division of Critical Care Pulmonary Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M Elizabeth Halloran
- Department of Biostatistics, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Manish Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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25
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Exposure misclassification bias in the estimation of vaccine effectiveness. PLoS One 2021; 16:e0251622. [PMID: 33984065 PMCID: PMC8118540 DOI: 10.1371/journal.pone.0251622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
In epidemiology, a typical measure of interest is the risk of disease conditional upon exposure. A common source of bias in the estimation of risks and risk ratios is misclassification. Exposure misclassification affects the measurement of exposure, i.e. the variable one conditions on. This article explains how to assess biases under non-differential exposure misclassification when estimating vaccine effectiveness, i.e. the vaccine-induced relative reduction in the risk of disease. The problem can be described in terms of three binary variables: the unobserved true exposure status, the observed but potentially misclassified exposure status, and the observed true disease status. The bias due to exposure misclassification is quantified by the difference between the naïve estimand defined as one minus the risk ratio comparing individuals observed as vaccinated with individuals observed as unvaccinated, and the vaccine effectiveness defined as one minus the risk ratio comparing truly vaccinated with truly unvaccinated. The magnitude of the bias depends on five factors: the risks of disease in the truly vaccinated and the truly unvaccinated, the sensitivity and specificity of exposure measurement, and vaccination coverage. Non-differential exposure misclassification bias is always negative. In practice, if the sensitivity and specificity are known or estimable from external sources, the true risks and the vaccination coverage can be estimated from the observed data and, thus, the estimation of vaccine effectiveness based on the observed risks can be corrected for exposure misclassification. When analysing risks under misclassification, careful consideration of conditional probabilities is crucial.
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26
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Shinjoh M, Sugaya N, Yamaguchi Y, Ookawara I, Nakata Y, Narabayashi A, Furuichi M, Yoshida N, Kamei A, Kuramochi Y, Shibata A, Shimoyamada M, Nakazaki H, Maejima N, Yuasa E, Araki E, Maeda N, Ohnishi T, Nishida M, Taguchi N, Yoshida M, Tsunematsu K, Shibata M, Hirano Y, Sekiguchi S, Kawakami C, Mitamura K, Takahashi T. Influenza vaccine effectiveness against influenza A in children based on the results of various rapid influenza tests in the 2018/19 season. PLoS One 2021; 16:e0249005. [PMID: 33770132 PMCID: PMC7997015 DOI: 10.1371/journal.pone.0249005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
During influenza epidemics, Japanese clinicians routinely conduct rapid influenza diagnostic tests (RIDTs) in patients with influenza-like illness, and patients with positive test results are treated with anti-influenza drugs within 48 h after the onset of illness. We assessed the vaccine effectiveness (VE) of inactivated influenza vaccine (IIV) in children (6 months-15 years old, N = 4243), using a test-negative case-control design based on the results of RIDTs in the 2018/19 season. The VE against influenza A(H1N1)pdm and A(H3N2) was analyzed separately using an RIDT kit specifically for detecting A(H1N1)pdm09. The adjusted VE against combined influenza A (H1N1pdm and H3N2) and against A(H1N1)pdm09 was 39% (95% confidence interval [CI], 30%-46%) and 74% (95% CI, 39%-89%), respectively. By contrast, the VE against non-A(H1N1)pdm09 influenza A (presumed to be H3N2) was very low at 7%. The adjusted VE for preventing hospitalization was 56% (95% CI, 16%-77%) against influenza A. The VE against A(H1N1)pdm09 was consistently high in our studies. By contrast, the VE against A(H3N2) was low not only in adults but also in children in the 2018/19 season.
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Affiliation(s)
- Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, Kanagawa, Japan
- * E-mail:
| | - Yoshio Yamaguchi
- Institute of Clinical Research & Department of Infection and Allergy, National Hospital Organization Tochigi Hospital, Tochigi, Japan
| | - Ichiro Ookawara
- Department of Pediatrics, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yuji Nakata
- Department of Pediatrics, Nippon Koukan Hospital, Kanagawa, Japan
| | | | - Munehiro Furuichi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoko Yoshida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Akinobu Kamei
- Department Pediatrics, Yokohama Municipal Citizen’s Hospital, Kanagawa, Japan
| | - Yuu Kuramochi
- Department of Pediatrics, Subaru Health Insurance Society Ota Memorial Hospital, Gunma, Japan
| | - Akimichi Shibata
- Department of Pediatrics, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | | | - Hisataka Nakazaki
- Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Naohiko Maejima
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Erika Yuasa
- Department of Pediatrics, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Eriko Araki
- Department of Pediatrics, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takuma Ohnishi
- Department of Pediatrics, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Mitsuhiro Nishida
- Department of Pediatrics, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | | | - Makoto Yoshida
- Department of Pediatrics, Sano Kosei General Hospital, Tochigi, Japan
| | | | - Meiwa Shibata
- Department of Pediatrics, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yasuhiro Hirano
- Department of Pediatrics, Hiratsuka City Hospital, Kanagawa, Japan
| | | | | | - Keiko Mitamura
- Department of Pediatrics, Eiju General Hospital, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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27
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Baum U, Kulathinal S, Auranen K. Mitigation of biases in estimating hazard ratios under non-sensitive and non-specific observation of outcomes-applications to influenza vaccine effectiveness. Emerg Themes Epidemiol 2021; 18:1. [PMID: 33446220 PMCID: PMC7807790 DOI: 10.1186/s12982-020-00091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Non-sensitive and non-specific observation of outcomes in time-to-event data affects event counts as well as the risk sets, thus, biasing the estimation of hazard ratios. We investigate how imperfect observation of incident events affects the estimation of vaccine effectiveness based on hazard ratios. Methods Imperfect time-to-event data contain two classes of events: a portion of the true events of interest; and false-positive events mistakenly recorded as events of interest. We develop an estimation method utilising a weighted partial likelihood and probabilistic deletion of false-positive events and assuming the sensitivity and the false-positive rate are known. The performance of the method is evaluated using simulated and Finnish register data. Results The novel method enables unbiased semiparametric estimation of hazard ratios from imperfect time-to-event data. False-positive rates that are small can be approximated to be zero without inducing bias. The method is robust to misspecification of the sensitivity as long as the ratio of the sensitivity in the vaccinated and the unvaccinated is specified correctly and the cumulative risk of the true event is small. Conclusions The weighted partial likelihood can be used to adjust for outcome measurement errors in the estimation of hazard ratios and effectiveness but requires specifying the sensitivity and the false-positive rate. In absence of exact information about these parameters, the method works as a tool for assessing the potential magnitude of bias given a range of likely parameter values.
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Affiliation(s)
- Ulrike Baum
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland.
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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28
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Abstract
The test-negative design (TND) has become a standard approach for vaccine effectiveness (VE) studies. However, previous studies suggested that it may be more vulnerable than other designs to misclassification of disease outcome caused by imperfect diagnostic tests. This could be a particular limitation in VE studies where simple tests (e.g. rapid influenza diagnostic tests) are used for logistical convenience. To address this issue, we derived a mathematical representation of the TND with imperfect tests, then developed a bias correction framework for possible misclassification. TND studies usually include multiple covariates other than vaccine history to adjust for potential confounders; our methods can also address multivariate analyses and be easily coupled with existing estimation tools. We validated the performance of these methods using simulations of common scenarios for vaccine efficacy and were able to obtain unbiased estimates in a variety of parameter settings.
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29
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Berild JD, Winje BA, Vestrheim DF, Slotved HC, Valentiner-Branth P, Roth A, Storsäter J. A Systematic Review of Studies Published between 2016 and 2019 on the Effectiveness and Efficacy of Pneumococcal Vaccination on Pneumonia and Invasive Pneumococcal Disease in an Elderly Population. Pathogens 2020; 9:pathogens9040259. [PMID: 32260132 PMCID: PMC7238108 DOI: 10.3390/pathogens9040259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
Adult vaccination is high on the agenda in many countries. Two different vaccines are available for the prevention of pneumococcal disease in adults: a 23-valent polysaccharide vaccine (PPV23), and a 13-valent conjugated vaccine (PCV13). The objective of this review is to update the evidence base for vaccine efficacy and effectiveness of PPV23 and PCV13 against invasive pneumococcal disease and pneumonia among an unselected elderly population. We systematically searched for clinical trials and observational studies published between January 1 2016 and April 17 2019 in Pubmed, Embase, Cinahl, Web of Science, Epistemonikos and Cochrane databases. Risk of bias was assessed using Cochrane Risk of Bias tool for and the Newcastle–Ottawa Scale. Results were stratified by vaccine type and outcome. We identified nine studies on PCV13 and six on PPV23. No new randomized clinical trials were identified. Due to different outcomes, it was not possible to do a meta-analysis. New high-quality observational studies indicate protective vaccine effectiveness for both vaccines against vaccine type pneumonia. Our estimates for the protective vaccine efficacy and effectiveness (VE) of PPV23 on pneumonia and pneumococcal pneumonia overlap with results from previously published reviews. Some of the results indicate that the effectiveness of the PPV23 is best in younger age groups, and that it decreases over time.
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Affiliation(s)
- Jacob Dag Berild
- Department of Vaccine Preventable Diseases, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (B.A.W.); (D.F.V.)
- Correspondence:
| | - Brita Askeland Winje
- Department of Vaccine Preventable Diseases, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (B.A.W.); (D.F.V.)
| | - Didrik Frimann Vestrheim
- Department of Vaccine Preventable Diseases, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (B.A.W.); (D.F.V.)
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, 2300 Copenhagen, Denmark;
| | - Palle Valentiner-Branth
- Infectious Disease Epidemiology & Prevention, Statens Serum Institute, 2300 Copenhagen, Denmark;
| | - Adam Roth
- Unit for Vaccination Programmes, Public Health Agency of Sweden, 171 82 Solna, Sweden; (A.R.); (J.S.)
| | - Jann Storsäter
- Unit for Vaccination Programmes, Public Health Agency of Sweden, 171 82 Solna, Sweden; (A.R.); (J.S.)
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Li Y, Zhou Y, Cheng Y, Wu P, Zhou C, Cui P, Song C, Liang L, Wang F, Qiu Q, Guo C, Zeng M, Long L, Cowling BJ, Yu H. Effectiveness of EV-A71 vaccination in prevention of paediatric hand, foot, and mouth disease associated with EV-A71 virus infection requiring hospitalisation in Henan, China, 2017-18: a test-negative case-control study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:697-704. [PMID: 31375313 PMCID: PMC8713082 DOI: 10.1016/s2352-4642(19)30185-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inactivated monovalent enterovirus A71 (EV-A71) vaccines are now available in China to reduce the substantial public health burden of hand, foot, and mouth disease. However, post-licensure monitoring of vaccine effectiveness is important. We did an observational test-negative study of EV-A71 vaccine effectiveness. METHODS Children with hand, foot, and mouth disease who were admitted to Henan Children's Hospital (Zhengzhou, China) within 7 days of illness onset were invited to participate in this test-negative case-control study. Participant vaccination history with EV-A71, including the number of doses received and the date of each dose of vaccination, was elicited from parents or legal guardians of participants with a standardised questionnaire. Children must have received two doses before hospitalisation to be counted as fully vaccinated. Patients who had received a single dose before hospitalisation were classified as partly vaccinated. Children who had received no EV-A71 vaccine before hospitalisation were classified as unvaccinated. Throat swabs and stool samples collected from patients were tested by RT-PCR to identify EV-A71 and other enteroviruses. The primary outcome of the study was paediatric hand, foot, and mouth disease associated with EV-A71 requiring hospitalisation. We estimated vaccine effectiveness with conditional logistic regression models adjusted for potential confounders. FINDINGS Between Feb 15, 2017, and Feb 15, 2018, we enrolled 1803 children aged 6-71 months with hand, foot, and mouth disease. 234 (13%) children tested positive for EV-A71, 1529 (85%) tested positive for other enteroviruses-528 (29%) were positive for Coxsackievirus (CV)-A6 and 342 (19%) were positive for CV-A16-and 29 (2%) tested negative for all enteroviruses. 11 (1%) children with neither throat swab nor stool testing results were excluded from further analyses. Overall vaccine effectiveness was estimated to be 85·4% (95% CI 53·2 to 95·4) for fully vaccinated children and 63·1% (13·1 to 84·3) for partly vaccinated children. The vaccine effectiveness for full vaccination was estimated to be 91·1% (35·1 to 98·8) among non-severe cases compared with 73·3% (-32·6 to 94·6) in severe cases. The vaccine effectiveness for partial vaccination was 77·9% (4·3 to 94·9) in children aged 24-71 months and 40·8% (-71·1 to 79·5) in children aged 6-23 months. We found no significant association between full or partial vaccination and CV-A6 or CV-A16-related hand, foot, and mouth disease. INTERPRETATION EV-A71 vaccination was effective in preventing non-severe hand, foot, and mouth disease associated with EV-A71 virus infection in children aged 6-71 months, and we found evidence that one dose of vaccination provided partial protection for children aged 24-71 months. Introduction of multivalent vaccines could further reduce the burden of hand, foot, and mouth disease. FUNDING The National Science Fund for Distinguished Young Scholars.
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Affiliation(s)
- Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yibing Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chongchen Zhou
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Peng Cui
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Chunlan Song
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Lu Liang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fang Wang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Chun Guo
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Mengyao Zeng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; NHC Key Lab of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Medical School, Fudan University, Shanghai, China
| | - Lu Long
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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Blanchette PS, Chung H, Pritchard KI, Earle CC, Campitelli MA, Buchan SA, Schwartz KL, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Simor A, Smieja M, Zahariadis G, Campigotto A, Kwong JC. Influenza Vaccine Effectiveness Among Patients With Cancer: A Population-Based Study Using Health Administrative and Laboratory Testing Data From Ontario, Canada. J Clin Oncol 2019; 37:2795-2804. [PMID: 31465264 DOI: 10.1200/jco.19.00354] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
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Affiliation(s)
- Phillip S Blanchette
- University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,ICES London and Toronto, Ontario, Canada
| | | | | | - Craig C Earle
- ICES London and Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Katz
- University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Ontario, Canada
| | - James D McNally
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | | | - Aaron Campigotto
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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Velez ID, Santacruz E, Kutcher SC, Duque SL, Uribe A, Barajas J, Gonzalez S, Patino AC, Zuluaga L, Martínez L, Muñoz E, Mejia MC, Arbelaez MP, Pulido H, Jewell NP, Dufault SM, O'Neill SL, Simmons CP, Anders KL, Tanamas SK. The impact of city-wide deployment of Wolbachia-carrying mosquitoes on arboviral disease incidence in Medellín and Bello, Colombia: study protocol for an interrupted time-series analysis and a test-negative design study. F1000Res 2019; 8:1327. [PMID: 34900237 PMCID: PMC8637243 DOI: 10.12688/f1000research.19858.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 08/23/2023] Open
Abstract
Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia-exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018.
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Affiliation(s)
- Ivan D. Velez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Eduardo Santacruz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Simon C. Kutcher
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra L. Duque
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Alexander Uribe
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Jovany Barajas
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Sandra Gonzalez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | - Lina Zuluaga
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Luis Martínez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Estefanía Muñoz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | | | | | - Nicholas P. Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Scott L. O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Cameron P. Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Katherine L. Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Stephanie K. Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
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34
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Velez ID, Santacruz E, Kutcher SC, Duque SL, Uribe A, Barajas J, Gonzalez S, Patino AC, Zuluaga L, Martínez L, Muñoz E, Mejia MC, Arbelaez MP, Pulido H, Jewell NP, Dufault SM, O'Neill SL, Simmons CP, Anders KL, Tanamas SK. The impact of city-wide deployment of Wolbachia-carrying mosquitoes on arboviral disease incidence in Medellín and Bello, Colombia: study protocol for an interrupted time-series analysis and a test-negative design study. F1000Res 2019; 8:1327. [PMID: 34900237 PMCID: PMC8637243 DOI: 10.12688/f1000research.19858.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia-exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018.
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Affiliation(s)
- Ivan D. Velez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Eduardo Santacruz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Simon C. Kutcher
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra L. Duque
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Alexander Uribe
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Jovany Barajas
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Sandra Gonzalez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | - Lina Zuluaga
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Luis Martínez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Estefanía Muñoz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | | | | | - Nicholas P. Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Scott L. O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Cameron P. Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Katherine L. Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Stephanie K. Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
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Shibata N, Kimura S, Hoshino T, Urushihara H. Influenza vaccination effectiveness for people aged under 65 years in Japan, 2013/2014 season: application of a doubly robust method to a large-scale, real-world dataset. BMC Infect Dis 2019; 19:586. [PMID: 31277580 PMCID: PMC6612174 DOI: 10.1186/s12879-019-4186-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Influenza vaccination is recognized as a primary public health intervention which prevents the illness of patients and relieves the societal burdens of influenza for medical community as well as the economy. To date, no effectiveness study of influenza vaccination has been conducted including a large population with a wide age span, in Japan. Here, we evaluated the clinical effectiveness of influenza vaccination in a large Japanese population. METHODS We conducted a cohort study using a large-scale claims database for employee health care insurance plans. Vaccination status was identified using plan records for influenza vaccination subsidies. We excluded people aged 65 years or more because of the unavailability of vaccination records. Effectiveness of vaccination in preventing influenza and its complication was evaluated with doubly robust methods using inversed probability treatment weighting to adjust health conscious behaviours and other confounders. RESULTS During the 2013/2014 influenza season, 369,425 subjects with age range from 1 to 64 years were eligible. Vaccination rate was 39.5% and an estimated odds ratio (OR) for influenza onset was 0.775 after doubly robust adjustment. Age-stratified ORs were significantly reduced in all age groups; lowest in subjects aged 1 to 4 years (0.600) and highest in those aged 13 to 19 (0.938). ORs for all the influenza complication outcomes were also statistically significant (0.403-0.709). CONCLUSIONS We confirmed the clinical effectiveness of influenza vaccination in people aged 1 to 64 years. Influenza vaccination significantly prevented influenza onset and was more effective in reducing secondary risks of influenza complications.
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Affiliation(s)
- Natsumi Shibata
- Department of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Shinya Kimura
- Japan Medical Data Center Co., Ltd, Sumitomo Shibadaimon Building 12F, 2-5-5 Shibadaimon, Minato-ku, Tokyo, 105-0012, Japan
| | - Takahiro Hoshino
- Department of Economics, Faculty of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
| | - Hisashi Urushihara
- Department of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
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36
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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.
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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
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37
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Crowcroft NS, Schwartz KL, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Simmonds K, Mahmud SM, Kwong JC. Pertussis vaccine effectiveness in a frequency matched population-based case-control Canadian Immunization Research Network study in Ontario, Canada 2009–2015. Vaccine 2019; 37:2617-2623. [DOI: 10.1016/j.vaccine.2019.02.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 11/25/2022]
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38
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Chon I, Saito R, Hibino A, Yagami R, Dapat C, Odagiri T, Kondo H, Sato I, Kimura S, Kawashima T, Kodo N, Masaki H, Asoh N, Tsuchihashi Y, Zaraket H, Shobugawa Y. Effectiveness of the quadrivalent inactivated influenza vaccine in Japan during the 2015-2016 season: A test-negative case-control study comparing the results by real time PCR, virus isolation. Vaccine X 2019; 1:100011. [PMID: 31384733 PMCID: PMC6668230 DOI: 10.1016/j.jvacx.2019.100011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We estimated influenza vaccine effectiveness (VE) in 2015-2016 season against medically attended, laboratory-confirmed influenza, when quadrivalent inactivated vaccine (IIV4) was first introduced in Japan, using test-negative case-control design. Influenza A(H1N1)pdm09 cocirculated with B/Yamagata and B/Victoria during the study period in Japan. METHOD We based our case definition on two laboratory tests, real-time reverse transcription polymerase chain reaction (RT PCR), and virus isolation and compared VEs based on these tests. In addition, VE was evaluated by rapid diagnostic test (RDT). Nasopharyngeal swabs were collected from outpatients who visited clinics with influenza-like illness (ILIs) in Hokkaido, Niigata, Gunma and Nagasaki prefectures. RESULTS Among 713 children and adults enrolled in this study, 578 were influenza positive by RT PCR including, 392 influenza A and 186 influenza B, while 135 were tested negative controls. The adjusted VE by RT PCR for all ages against any influenza was low protection of 36.0% (95% confidence interval [CI], 3.1% to 58.6%), for influenza A was 30.0% (95% CI: -10.0% to 55.5%), and influenza B was moderate 50.2% (95% CI: 13.3% to 71.4%). Adjusted VE for virus isolation for A(H1N1)pdm09 was 37.1% (95% CI: 1.7% to 59.7%), Yamagata lineage 51.3% (95% CI: 6.4% to 74.7%) and Victoria lineage 21.3% (95% CI: -50.0% to 58.9%). VE was highest and protective in 0-5 years old group against any influenza and influenza A and B/Yamagata, but the protective effect was not observed for other age groups and B/Victoria. RDT demonstrated concordant results with RT PCR and virus isolation. Sequencing of hemagglutinin gene showed that all A(H1N1)pdm09 belong to clade 6B including 31 strains (88.6%), which belong to clade 6B.1 possessing S162N mutations that may alter antigenicity and affect VE for A(H1N1)pdm09. CONCLUSIONS IIV4 influenza vaccine during 2015-2016 was effective against A(H1N1)pdm09 and the two lineages of type B. Younger children was more protected than older children and adults by vaccination.
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Affiliation(s)
- Irina Chon
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Reiko Saito
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akinobu Hibino
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ren Yagami
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Clyde Dapat
- Department of Virology, Tohoku University Graduate School of Medicine
| | - Takashi Odagiri
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroki Kondo
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Isamu Sato
- Yoiko-no-Syounika Sato Pediatric Clinic, Niigata, Japan
| | - Shinji Kimura
- Center for Medical Education, Sapporo Medical University, Sapporo, Japan
| | | | | | | | | | | | - Hassan Zaraket
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department Pathology, Immunology, and Microbiology, Faculty of Medicine American University of Beirut, Beirut, Lebanon
- Center for Infectious Disease Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yugo Shobugawa
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Ainslie KEC, Haber M, Orenstein WA. Bias of influenza vaccine effectiveness estimates from test-negative studies conducted during an influenza pandemic. Vaccine 2019; 37:1987-1993. [PMID: 30833155 DOI: 10.1016/j.vaccine.2019.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
Abstract
Test-negative (TN) studies have become the most widely used study design for the estimation of influenza vaccine effectiveness (VE) and are easily incorporated into existing influenza surveillance networks. We seek to determine the bias of TN-based VE estimates during a pandemic using a dynamic probability model. The model is used to evaluate and compare the bias of VE estimates under various sources of bias when vaccination occurs after the beginning of an outbreak, such as during a pandemic. The model includes two covariates (health status and health awareness), which may affect the probabilities of vaccination, developing influenza and non-influenza acute respiratory illness (ARI), and seeking medical care. Specifically, we evaluate the bias of VE estimates when (1) vaccination affects the probability of developing a non-influenza ARI; (2) vaccination affects the probability of seeking medical care; (3) a covariate (e.g. health status) is related to both the probabilities of vaccination and developing an ARI; and (4) a covariate (e.g. health awareness) is related to both the probabilities of vaccination and of seeking medical care. We considered two outcomes against which the vaccine is supposed to protect: symptomatic influenza and medically-attended influenza. When vaccination begins during an outbreak, we found that the effect of delayed onset of vaccination is unpredictable. VE estimates from TN studies were biased regardless of the source of bias present. However, if the core assumption of the TN design is satisfied, that is, if vaccination does not affect the probability of non-influenza ARI, then TN-based VE estimates against medically-attended influenza will only suffer from small (<0.05) to moderate bias (≥0.05 and <0.10). These results suggest that if sources of bias listed above are ruled out, TN studies are a valid study design for the estimation of VE during a pandemic.
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Affiliation(s)
- Kylie E C Ainslie
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA; 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
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 1462 Clifton Rd., Atlanta, GA 30322, USA
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Ainslie KEC, Shi M, Haber M, Orenstein WA. A Dynamic Model for Evaluation of the Bias of Influenza Vaccine Effectiveness Estimates From Observational Studies. Am J Epidemiol 2019; 188:451-460. [PMID: 30329006 DOI: 10.1093/aje/kwy240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/12/2018] [Indexed: 11/12/2022] Open
Abstract
Given that influenza vaccination is now widely recommended in the United States, observational studies based on patients with acute respiratory illness (ARI) remain as the only option to estimate influenza vaccine effectiveness (VE). We developed a dynamic probability model to evaluate bias of VE estimates from passive surveillance cohort, test-negative, and traditional case-control studies. The model includes 2 covariates (health status and health awareness) that might affect the probabilities of vaccination, developing ARI, and seeking medical care. Our results suggest that test-negative studies produce unbiased estimates of VE against medically attended influenza when: 1) Vaccination does not affect the probability of noninfluenza ARI; and 2) health status has the same effect on the probability of influenza and noninfluenza ARIs. The same estimate might be severely biased (i.e., estimated VE - true VE ≥ 0.20) for estimating VE against symptomatic influenza if the vaccine affects the probability of seeking care against influenza ARI. VE estimates from test-negative studies might also be severely biased for both outcomes of interest when vaccination affects the probability of noninfluenza ARI, but estimates from passive surveillance cohort studies are unbiased in this case. Finally, VE estimates from traditional case-control studies suffer from bias regardless of the source of bias.
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Affiliation(s)
- Kylie E C Ainslie
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Meng Shi
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael Haber
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Ramsay LC, Buchan SA, Stirling RG, Cowling BJ, Feng S, Kwong JC, Warshawsky BF. The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis. BMC Med 2019; 17:9. [PMID: 30626399 PMCID: PMC6327561 DOI: 10.1186/s12916-018-1239-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Conflicting results regarding the impact of repeated vaccination on influenza vaccine effectiveness (VE) may cause confusion regarding the benefits of receiving the current season's vaccine. METHODS We systematically searched MEDLINE, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature from database inception to August 17, 2016, for observational studies published in English that reported VE against laboratory-confirmed influenza for the following four vaccination groups: current season only, prior season only, both seasons, and neither season. We pooled differences in VE (∆VE) between vaccination groups by influenza season and type/subtype using a random-effects model. The study protocol is registered with PROSPERO (registration number: CRD42016037241). RESULTS We identified 3435 unique articles, reviewed the full text of 634, and included 20 for meta-analysis. Compared to prior season vaccination only, vaccination in both seasons was associated with greater protection against influenza H1N1 (∆VE = 25%; 95% CI 14%, 35%) and B (∆VE = 18%; 95% CI 3%, 33%), but not H3N2 (∆VE = 7%; 95% CI - 7%, 21%). Compared to no vaccination for either season, individuals who received the current season's vaccine had greater protection against H1N1 (∆VE = 62%; 95% CI 51%, 70%), H3N2 (∆VE = 45%; 95% CI 35%, 53%), and B (∆VE = 64%; 95% CI 57%, 71%). We observed no differences in VE between vaccination in both seasons and the current season only for H1N1 (∆VE = 3%; 95% CI - 8%, 13%), but less protection against influenza H3N2 (∆VE = - 20%; 95% CI - 36%, - 4%), and B (∆VE = - 11%; 95% CI - 20%, - 2%). CONCLUSIONS Our results support current season vaccination regardless of prior season vaccination because VE for vaccination in the current season only is higher compared to no vaccination in either season for all types/subtypes, and for H1N1 and influenza B, vaccination in both seasons provides better VE than vaccination in the prior season only. Although VE was lower against H3N2 and B for individuals vaccinated in both seasons compared to those vaccinated in the current season only, it should be noted that past vaccination history cannot be altered and this comparison disregards susceptibility to influenza during the prior season among those vaccinated in the current season only. In addition, our results for H3N2 were particularly influenced by the 2014-2015 influenza season and the impact of repeated vaccination for all types/subtypes may vary from season to season. It is important that future VE studies include vaccination history over multiple seasons to evaluate repeated vaccination in more detail.
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Affiliation(s)
- Lauren C. Ramsay
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
| | - Sarah A. Buchan
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
| | - Robert G. Stirling
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
- Public Health Agency of Canada, 130 Colonnade Road, Ottawa, Ontario K1A 0K9 Canada
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jeffrey C. Kwong
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
- Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, Ontario M4N 3M5 Canada
- Department of Family & Community Medicine, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7 Canada
- University Health Network, 399 Bathurst St, Toronto, Ontario M5T 2S8 Canada
| | - Bryna F. Warshawsky
- Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario M5G 1V2 Canada
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, Ontario N6A 3K7 Canada
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Crowcroft NS, Klein NP. A framework for research on vaccine effectiveness. Vaccine 2018; 36:7286-7293. [DOI: 10.1016/j.vaccine.2018.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 01/20/2023]
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Matthews I, Lu X, Dawson H, Bricout H, O'Hanlon H, Yu E, Nozad B. Assessing the effectiveness of zoster vaccine live: A retrospective cohort study using primary care data in the United Kingdom. Vaccine 2018; 36:7105-7111. [PMID: 30195489 DOI: 10.1016/j.vaccine.2018.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/25/2018] [Accepted: 08/16/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Herpes zoster (shingles) is a common viral disease increasing in risk and severity with age. Post-herpetic neuralgia (PHN), a complication of shingles, causes severe pain impacting quality of life (QoL). Zoster Vaccine Live (ZVL), a licensed vaccine for the prevention of shingles in the United Kingdom (UK), is part of the national immunisation programme (NIP) for adults aged 70-79. Public Health England (PHE) reports show shingles vaccine coverage varies, but is typically 50-60% across eligible cohorts. MATERIALS/METHODS This retrospective, matched cohort study was conducted using The Health Improvement Network (THIN) UK primary care database. Individuals aged 70-79 were classified based on their vaccination status between September 2013 and May 2016. Risk and incidence rates for shingles were calculated for both groups over the duration of the study (mean 1.2 years). Vaccine effectiveness (VE) was calculated using the equation 1-relative risk (RR) for shingles and PHN. RESULTS Within the total cohort (n = 295,135), 70,867 (24%) were vaccinated and 224,268 (76%) were unvaccinated. 2435 (0.83%) patients developed shingles: 241 (0.34%) among the vaccinated and 2194 (0.98%) among the unvaccinated. The VE for preventing shingles was 65.3% (95% CI: 60.3-69.6%). The incidence rate in the vaccinated group was 2.95 (95% CI: 2.59-3.34) vs 8.02 (95% CI: 7.68-8.36) per 1000 person years in the unvaccinated group. Risk of PHN was 0.02% and 0.06% in the respective vaccinated and unvaccinated groups. The VE for preventing PHN was 72% (95% CI: 50.0-83.9%). PHN incidence rates were 0.16 (95% CI: 0.08-0.27) and 0.53 (95% CI: 0.44-0.62) per 1000 person years in the vaccinated and unvaccinated groups, respectively. CONCLUSIONS ZVL reduced the risk of shingles among an elderly population. Given the negative impact of shingles and PHN on QoL, the benefits of vaccination are clear. Improving uptake in the UK is needed in this population.
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Anders KL, Cutcher Z, Kleinschmidt I, Donnelly CA, Ferguson NM, Indriani C, Ryan PA, O’Neill SL, Jewell NP, Simmons CP. Cluster-Randomized Test-Negative Design Trials: A Novel and Efficient Method to Assess the Efficacy of Community-Level Dengue Interventions. Am J Epidemiol 2018; 187:2021-2028. [PMID: 29741576 DOI: 10.1093/aje/kwy099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/27/2018] [Indexed: 12/31/2022] Open
Abstract
Cluster-randomized controlled trials are the gold standard for assessing efficacy of community-level interventions, such as vector-control strategies against dengue. We describe a novel cluster-randomized trial methodology with a test-negative design (CR-TND), which offers advantages over traditional approaches. This method uses outcome-based sampling of patients presenting with a syndrome consistent with the disease of interest, who are subsequently classified as test-positive cases or test-negative controls on the basis of diagnostic testing. We used simulations of a cluster trial to demonstrate validity of efficacy estimates under the test-negative approach. We demonstrated that, provided study arms are balanced for both test-negative and test-positive illness at baseline and that other test-negative design assumptions are met, the efficacy estimates closely match true efficacy. Analytical considerations for an odds ratio-based effect estimate arising from clustered data and potential approaches to analysis are also discussed briefly. We concluded that application of the test-negative design to certain cluster-randomized trials could increase their efficiency and ease of implementation.
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Affiliation(s)
- Katherine L Anders
- Institute of Vector-Borne Disease, Monash University, Melbourne, Australia
| | - Zoe Cutcher
- Institute of Vector-Borne Disease, Monash University, Melbourne, Australia
| | - Immo Kleinschmidt
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christl A Donnelly
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Neil M Ferguson
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Citra Indriani
- Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Peter A Ryan
- Institute of Vector-Borne Disease, Monash University, Melbourne, Australia
| | - Scott L O’Neill
- Institute of Vector-Borne Disease, Monash University, Melbourne, Australia
| | - Nicholas P Jewell
- Department of Statistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Cameron P Simmons
- Institute of Vector-Borne Disease, Monash University, Melbourne, Australia
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Haber M, Lopman BA, Tate JE, Shi M, Parashar UD. A comparison of the test-negative and traditional case-control study designs with respect to the bias of estimates of rotavirus vaccine effectiveness. Vaccine 2018; 36:5071-5076. [PMID: 29980389 DOI: 10.1016/j.vaccine.2018.06.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/15/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
Estimation of the effectiveness of rotavirus vaccines via the test-negative control study design has gained popularity over the past few years. In this study design, children with severe diarrhea who test positive for rotavirus infection are considered as cases, while children who test negative serve as controls. We use a simple probability model to evaluate and compare the test-negative control and the traditional case-control designs with respect to the bias of resulting estimates of rotavirus vaccine effectiveness (VE). Comparisons are performed under two scenarios, corresponding to studies performed in high-income and low-income countries. We consider two potential sources of bias: (a) misclassification bias resulting from imperfect sensitivity and specificity of the test used to diagnose rotavirus infection, and (b) selection bias associated with possible effect of rotavirus vaccination on the probability of contracting severe non-rotavirus diarrhea. Our results suggest that both sources of bias may produce VE estimates with substantial bias. Particularly, lack of perfect specificity is associated with severe negative bias. For example, if the specificity of the diagnostic test is 90% then VE estimates from both types of case-control studies may under-estimate the true VE by more than 20%. If the vaccine protects children against non-rotavirus diarrhea then VE estimates from test-negative control studies may be close to zero even though the true VE is 50%. However, the sensitivity and specificity of the enzyme immunoassay test currently used to diagnose rotavirus infections are both over 99%, and there is no solid evidence that the existing rotavirus vaccines affect the rates of non-rotavirus diarrhea. We therefore conclude that the test-negative control study design is a convenient and reliable alternative for estimation of rotavirus VE.
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Affiliation(s)
- Michael Haber
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
| | - Benjamin A Lopman
- Department of Epidemiology, Emory University, Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Meng Shi
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
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Kimiya T, Shinjoh M, Anzo M, Takahashi H, Sekiguchi S, Sugaya N, Takahashi T. Effectiveness of inactivated quadrivalent influenza vaccine in the 2015/2016 season as assessed in both a test-negative case-control study design and a traditional case-control study design. Eur J Pediatr 2018; 177:1009-1017. [PMID: 29680993 DOI: 10.1007/s00431-018-3145-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/09/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED Both traditional case-control studies (TCCSs) and test-negative case-control studies (TNCCSs) are commonly used to assess influenza vaccine effectiveness (VE). To compensate for the fact that observational studies are susceptible to bias, we combined both methods to assess VE in one geographical area during the 2015/2016 season, when influenza A (H1N1)pdm was dominant. Our TNCCS covered 331 children aged 6 months to 15 years who visited our hospital with fever, including 182 with influenza, and our TCCS covered 812 pediatric outpatients aged 6 months to 15 years, including 214 with influenza. Influenza infection and vaccination history were reviewed, and VE was calculated as (1 - odds ratio) × 100. In the TNCCS, VE against influenza A was 68% (95% CI 47-81) overall, and 70% (48-83) for those given two doses; against influenza B, VE was 37% (- 12-64) overall and 49% (2-74) for two doses. In the TCCS, VE against influenza A was 44% (15-63) overall and 44% (13-64) for two doses, and VE against influenza B was 24% (- 19-52) overall and 41% (3-64) for two doses. CONCLUSION Both studies confirmed significant VE against influenza A, significant two-dose VE against influenza B, and better two-dose VE than one-dose VE. What is Known: • Influenza vaccine effectiveness (VE) varies from year to year. • Observational studies are conventionally used for VE assessment. However, they are inherently susceptible to bias and confounding. What is New: • This is the first report of influenza VE assessment using more than one observational study and performed in a specific area during the same season. • VE estimates obtained in our traditional case-control study were lower than those in our test-negative case-control study, but both studies found significant VE against influenza.
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Affiliation(s)
- Takahisa Kimiya
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo, 170-8476, Japan.
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Makoto Anzo
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo, 170-8476, Japan
| | - Hiroki Takahashi
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo, 170-8476, Japan
| | - Shinichiro Sekiguchi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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De Smedt T, Merrall E, Macina D, Perez-Vilar S, Andrews N, Bollaerts K. Bias due to differential and non-differential disease- and exposure misclassification in studies of vaccine effectiveness. PLoS One 2018; 13:e0199180. [PMID: 29906276 PMCID: PMC6003693 DOI: 10.1371/journal.pone.0199180] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies of vaccine effectiveness (VE) rely on accurate identification of vaccination and cases of vaccine-preventable disease. In practice, diagnostic tests, clinical case definitions and vaccination records often present inaccuracies, leading to biased VE estimates. Previous studies investigated the impact of non-differential disease misclassification on VE estimation. METHODS We explored, through simulation, the impact of non-differential and differential disease- and exposure misclassification when estimating VE using cohort, case-control, test-negative case-control and case-cohort designs. The impact of misclassification on the estimated VE is demonstrated for VE studies on childhood seasonal influenza and pertussis vaccination. We additionally developed a web-application graphically presenting bias for user-selected parameters. RESULTS Depending on the scenario, the misclassification parameters had differing impacts. Decreased exposure specificity had greatest impact for influenza VE estimation when vaccination coverage was low. Decreased exposure sensitivity had greatest impact for pertussis VE estimation for which high vaccination coverage is typically achieved. The impact of the exposure misclassification parameters was found to be more noticeable than that of the disease misclassification parameters. When misclassification is limited, all study designs perform equally. In case of substantial (differential) disease misclassification, the test-negative design performs worse. CONCLUSIONS Misclassification can lead to significant bias in VE estimates and its impact strongly depends on the scenario. We developed a web-application for assessing the potential (joint) impact of possibly differential disease- and exposure misclassification that can be modified by users to their own study scenario. Our results and the simulation tool may be used to guide better design, conduct and interpretation of future VE studies.
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Affiliation(s)
- Tom De Smedt
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | - Silvia Perez-Vilar
- FISABIO-Public Health, Valencia, Spain
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London, United Kingdom
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- * E-mail:
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Anders KL, Indriani C, Ahmad RA, Tantowijoyo W, Arguni E, Andari B, Jewell NP, Rances E, O'Neill SL, Simmons CP, Utarini A. The AWED trial (Applying Wolbachia to Eliminate Dengue) to assess the efficacy of Wolbachia-infected mosquito deployments to reduce dengue incidence in Yogyakarta, Indonesia: study protocol for a cluster randomised controlled trial. Trials 2018; 19:302. [PMID: 29855331 PMCID: PMC5984439 DOI: 10.1186/s13063-018-2670-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika and chikungunya, present an increasing public health challenge in tropical regions. Current vector control strategies have failed to curb disease transmission, but continue to be employed despite the absence of robust evidence for their effectiveness or optimal implementation. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with Wolbachia bacterium, with a significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Modelling predicts this will translate to local elimination of dengue in most epidemiological settings. This study protocol describes the first trial to measure the efficacy of Wolbachia in reducing dengue virus transmission in the field. Methods/design The study is a parallel, two-arm, non-blinded cluster randomised controlled trial conducted in a single site in Yogyakarta, Indonesia. The aim is to determine whether large-scale deployment of Wolbachia-infected Ae. aegypti mosquitoes leads to a measurable reduction in dengue incidence in treated versus untreated areas. The primary endpoint is symptomatic, virologically confirmed dengue virus infection of any severity. The 26 km2 study area was subdivided into 24 contiguous clusters, allocated randomly 1:1 to receive Wolbachia deployments or no intervention. We use a novel epidemiological study design, the cluster-randomised test-negative design trial, in which dengue cases and arbovirus-negative controls are sampled concurrently from among febrile patients presenting to a network of primary care clinics, with case or control status classified retrospectively based on the results of laboratory diagnostic testing. Efficacy is estimated from the odds ratio of Wolbachia exposure distribution (probability of living in a Wolbachia-treated area) among virologically confirmed dengue cases compared to test-negative controls. A secondary per-protocol analysis allows for individual Wolbachia exposure levels to be assessed to account for movements outside the cluster and the heterogeneity in local Wolbachia prevalence among treated clusters. Discussion The findings from this study will provide the first experimental evidence for the efficacy of Wolbachia in reducing dengue incidence. Together with observational evidence that is accumulating from pragmatic deployments of Wolbachia in other field sites, this will provide valuable data to estimate the effectiveness of this novel approach to arbovirus control, inform future cost-effectiveness estimates, and guide plans for large-scale deployments in other endemic settings. Trial registration ClinicalTrials.gov, identifier: NCT03055585. Registered on 14 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2670-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine L Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, Australia.
| | - Citra Indriani
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Eliminate Dengue Project, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riris Andono Ahmad
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Eliminate Dengue Project, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Warsito Tantowijoyo
- Eliminate Dengue Project, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eggi Arguni
- Eliminate Dengue Project, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Pediatrics, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bekti Andari
- Eliminate Dengue Project, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Edwige Rances
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Scott L O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Cameron P Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Adi Utarini
- Eliminate Dengue Project, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Health Policy and Management, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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49
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Suzuki M, Katsurada N, Le MN, Kaneko N, Yaegashi M, Hosokawa N, Otsuka Y, Aoshima M, Yoshida LM, Morimoto K. Effectiveness of inactivated influenza vaccine against laboratory-confirmed influenza pneumonia among adults aged ≥65 years in Japan. Vaccine 2018; 36:2960-2967. [PMID: 29685596 PMCID: PMC7126450 DOI: 10.1016/j.vaccine.2018.04.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The effectiveness of inactivated influenza vaccine (IIV) against laboratory-confirmed influenza pneumonia in older adults remains to be established. METHODS Pneumonia patients aged ≥65 years who visited a study hospital in Chiba, Japan, were prospectively enrolled from February 2012 to January 2014. Sputum samples were collected from participants and tested for influenza virus by polymerase chain reaction assays. Influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza pneumonia was estimated by a test-negative design. RESULTS Among a total of 814 pneumonia patients, 42 (5.2%) tested positive for influenza: 40 were positive for influenza A virus, and two were positive for influenza B virus. The IVE against laboratory-confirmed influenza pneumonia was 58.3% (95% confidence interval, 28.8-75.6%). The IVE against influenza pneumonia hospital admission, severe pneumonia, and death was 60.2% (95% CI, 22.8-79.4%), 65.5% (95% CI, 44.3-78.7%), and 71% (95% CI, -62.9% to 94.8%), respectively. In the subgroup analyses, the IVE against influenza pneumonia was higher for patients with immunosuppressive conditions (85.9%; 95% CI, 67.4-93.9%) than for those without (48.7%; 95% CI, 2.7-73%) but did not differ by patients' statin use status. CONCLUSION IIV effectively reduces the risk of laboratory-confirmed influenza pneumonia in older adults.
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Affiliation(s)
- Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Adult Pneumonia Study Group-Japan, Japan.
| | - Naoko Katsurada
- Adult Pneumonia Study Group-Japan, Japan; Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan; Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Minh Nhat Le
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Norihiro Kaneko
- Adult Pneumonia Study Group-Japan, Japan; Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Makito Yaegashi
- Adult Pneumonia Study Group-Japan, Japan; Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Naoto Hosokawa
- Adult Pneumonia Study Group-Japan, Japan; Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan
| | - Yoshihito Otsuka
- Adult Pneumonia Study Group-Japan, Japan; Department of Laboratory Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Masahiro Aoshima
- Adult Pneumonia Study Group-Japan, Japan; Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Lay Myint Yoshida
- Adult Pneumonia Study Group-Japan, Japan; Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Adult Pneumonia Study Group-Japan, Japan
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50
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Basic principles of test-negative design in evaluating influenza vaccine effectiveness. Vaccine 2018; 35:4796-4800. [PMID: 28818471 DOI: 10.1016/j.vaccine.2017.07.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 04/20/2017] [Accepted: 05/31/2017] [Indexed: 11/20/2022]
Abstract
Based on the unique characteristics of influenza, the concept of "monitoring" influenza vaccine effectiveness (VE) across the seasons using the same observational study design has been developed. In recent years, there has been a growing number of influenza VE reports using the test-negative design, which can minimize both misclassification of diseases and confounding by health care-seeking behavior. Although the test-negative designs offer considerable advantages, there are some concerns that widespread use of the test-negative design without knowledge of the basic principles of epidemiology could produce invalid findings. In this article, we briefly review the basic concepts of the test-negative design with respect to classic study design such as cohort studies or case-control studies. We also mention selection bias, which may be of concern in some countries where rapid diagnostic testing is frequently used in routine clinical practices, as in Japan.
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