1
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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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2
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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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3
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Waterer G. Vaccination in patients with
COPD
:
COVID
has raised the bar. Respirology 2022; 27:799-800. [PMID: 35852029 PMCID: PMC9350271 DOI: 10.1111/resp.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Grant Waterer
- School of Medicine University of Western Australia, Royal Perth Hospital Perth Western Australia Australia
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4
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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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5
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Meier GC, Watkins J, McEwan P, Pockett RD. Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009. PLoS One 2020; 15:e0236472. [PMID: 32760071 PMCID: PMC7410242 DOI: 10.1371/journal.pone.0236472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown that influenza is associated with a substantial healthcare burden in the United Kingdom (UK), but more studies are needed to evaluate the resource use and direct medical costs of influenza in primary care and secondary care. Methods A retrospective observational database study in the UK to describe the primary care and directly-associated secondary care resource use, and direct medical costs of acute respiratory illness (ARI), according to age, and risk status (NCT Number: 01521416). Patients with influenza, ARI or influenza-related respiratory infections during 9 consecutive pre-pandemic influenza peak seasons were identified by READ codes in the linked Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) dataset. The study period was from 21st January 2001 to 31st March 2009. Results A total of 156,193 patients had ≥1 general practitioner (GP) episode of ARI, and a total of 82,204 patients received ≥1 GP prescription, at a mean of 2.5 (standard deviation [SD]: 3.0) prescriptions per patient. The total cost of GP consultations and prescriptions equated to £462,827 per year per 100,000 patients. The yearly cost of prescribed medication for ARI was £319,732, at an estimated cost of £11,596,350 per year extrapolated to the UK, with 40% attributable to antibiotics. The mean cost of hospital admissions equated to a yearly cost of £981,808 per 100,000 patients. The total mean direct medical cost of ARI over 9 influenza seasons was £21,343,445 (SD: £10,441,364), at £136.65 (SD: £66.85) per case. Conclusions Extrapolating to the UK population, for pre-pandemic influenza seasons from 2001 to 2009, the direct medical cost of ARI equated to £86 million each year. More studies are needed to assess the costs of influenza disease to help guide public health decision-making for seasonal influenza in the UK.
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Affiliation(s)
| | - John Watkins
- Public Health Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Phil McEwan
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom
| | - Rhys D. Pockett
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
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6
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Blyth CC, Macartney KK, McRae J, Clark JE, Marshall HS, Buttery J, Francis JR, Kotsimbos T, Kelly PM, Cheng AC. Influenza Epidemiology, Vaccine Coverage and Vaccine Effectiveness in Children Admitted to Sentinel Australian Hospitals in 2017: Results from the PAEDS-FluCAN Collaboration. Clin Infect Dis 2020; 68:940-948. [PMID: 30137244 DOI: 10.1093/cid/ciy597] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/25/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2017, Australia experienced record influenza notifications. Two surveillance programs combined to summarize the epidemiology of hospitalized influenza in children and report on vaccine effectiveness (VE) in the context of a limited nationally funded vaccination program. METHODS Subjects were prospectively recruited (April-October 2017). Case patients were children aged ≤16 years admitted to 11 hospitals with an acute respiratory illness and laboratory-confirmed influenza. Controls were hospitalized with acute respiratory illness and tested negative for influenza. VE estimates were calculated using the test-negative design. RESULTS A total of 1268 children were hospitalized with influenza: 31.5% were <2 years old, 8.3% were indigenous, and 45.1% had comorbid conditions predisposing to severe influenza. Influenza B was detected in 34.1% with influenza A/H1N1 and A/H3N2 detected in 47.2% and 52.8% of subtyped influenza A specimens. The median length of stay was 3 days (interquartile range, 1-5), 14.5% were admitted to the intensive care unit, and 15.9% received oseltamivir. Four in-hospital deaths occurred (0.3%): one was considered influenza associated. Only 17.1% of test-negative-controls were vaccinated. The VE of inactivated quadrivalent influenza vaccine for preventing hospitalized influenza was estimated at 30.3% (95% confidence interval, 2.6%-50.2%). CONCLUSIONS Significant influenza-associated morbidity was observed in 2017 in Australia. Most hospitalized children had no comorbid conditions. Vaccine coverage and antiviral use was inadequate. Influenza vaccine was protective in 2017, yet VE was lower than previous seasons. Multiple Australian states have introduced funded preschool vaccination programs in 2018. Additional efforts to promote vaccination and monitor effectiveness are required.
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Affiliation(s)
- Christopher C Blyth
- School of Medicine, University of Western Australia, Perth.,Department of Infectious Disease, Perth Children's Hospital, Perth.,PathWest Laboratory Medicine, QEII Medical Centre, Perth.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, New South Wales.,Department of Infectious Diseases and Microbiology, Children's Hospital Westmead, New South Wales.,School of Paediatrics and Child Health, University of Sydney, New South Wales
| | - Jocelynne McRae
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, New South Wales.,School of Paediatrics and Child Health, University of Sydney, New South Wales
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, Brisbane, Queensland
| | - Helen S Marshall
- Women's and Children's Health Network, Robinson Research Institute and Adelaide Medical School, The University of Adelaide, South Australia
| | - Jim Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Monash Health, Melbourne, Victoria.,Monash Centre of Health Care Research and Implementation, Departments of Paediatrics, Monash University, Melbourne, Victoria
| | - Joshua R Francis
- Royal Darwin Hospital and Menzies School of Health, Northern Territory, Melbourne, Victoria
| | - Tom Kotsimbos
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Monash University, Melbourne, Victoria
| | - Paul M Kelly
- ACT Government Health Directorate, Australian National University Medical School, Canberra, Australian Capital Territory, Melbourne, Victoria
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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7
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Blyth CC, Cheng AC, Crawford NW, Clark JE, Buttery JP, Marshall HS, Francis JR, McRae J, Kotsimbos T, Kelly PM, Macartney KK. The impact of new universal child influenza programs in Australia: Vaccine coverage, effectiveness and disease epidemiology in hospitalised children in 2018. Vaccine 2020; 38:2779-2787. [PMID: 32107062 DOI: 10.1016/j.vaccine.2020.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND New jurisdictionally-based vaccination programs were established providing free quadrivalent influenza vaccine (QIV) for preschool Australian children in 2018. This was in addition to the National Immunisation Program (NIP) funded QIV for Indigenous children and children with comorbid medical conditions. We assessed the impact of this policy change on influenza disease burden and vaccine coverage, as well as report on 2018 vaccine effectiveness in a hospital-based surveillance system. METHODS Subjects were recruited prospectively from twelve PAEDS-FluCAN sentinel hospital sites (April until October 2018). Children aged ≤16 years hospitalised with an acute respiratory illness (ARI) and laboratory-confirmed influenza were considered cases. Hospitalised children with ARI who tested negative for influenza were considered controls. VE estimates were calculated from the adjusted odds ratio of vaccination in cases and controls. RESULTS A total of 458 children were hospitalised with influenza: 31.7% were <2 years, 5.0% were Indigenous, and 40.6% had medical comorbidities predisposing to severe influenza. Influenza A was detected in 90.6% of children (A/H1N1: 38.0%; A/H3N2: 3.1%; A/unsubtyped 48.6%). The median length of stay was 2 days (IQR: 1,3) and 8.1% were admitted to ICU. Oseltamivir use was infrequent (16.6%). Two in-hospital deaths occurred (0.45%). 12.0% of influenza cases were vaccinated compared with 36.0% of test-negative controls. Vaccine effectiveness of QIV for preventing influenza hospitalisation was estimated at 78.8% (95%CI: 66.9; 86.4). CONCLUSIONS Compared with 2017 (n = 1268 cases), a significant reduction in severe influenza was observed in Australian children, possibly contributed to by improved vaccine coverage and high vaccine effectiveness. Despite introduction of jurisdictionally-funded preschool programs and NIP-funded vaccine for children with risk factors for severe disease, improved coverage is required to ensure adequate protection against paediatric influenza morbidity and mortality.
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Affiliation(s)
- Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, WA, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Jim P Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia; Monash Centre of Health Care Research and Implementation, Departments of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Helen S Marshall
- Women's and Children's Health Network, Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Joshua R Francis
- Royal Darwin Hospital and Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jocelynne McRae
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, NSW, Australia; School of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Tom Kotsimbos
- Department of Allergy, Immunology and Respiratory Medicine Alfred Health, Monash University, Victoria, Australia
| | - Paul M Kelly
- ACT Government Health Directorate, Australian National University Medical School, Australian Capital Territory, Australia
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, NSW, Australia; School of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia; Department of Infectious Diseases and Microbiology, Children's Hospital Westmead, Westmead, Sydney, NSW, Australia
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8
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Chua H, Feng S, Lewnard JA, Sullivan SG, Blyth CC, Lipsitch M, Cowling BJ. The Use of Test-negative Controls to Monitor Vaccine Effectiveness: A Systematic Review of Methodology. Epidemiology 2020; 31:43-64. [PMID: 31609860 PMCID: PMC6888869 DOI: 10.1097/ede.0000000000001116] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The test-negative design is an increasingly popular approach for estimating vaccine effectiveness (VE) due to its efficiency. This review aims to examine published test-negative design studies of VE and to explore similarities and differences in methodological choices for different diseases and vaccines. METHODS We conducted a systematic search on PubMed, Web of Science, and Medline, for studies reporting the effectiveness of any vaccines using a test-negative design. We screened titles and abstracts and reviewed full texts to identify relevant articles. We created a standardized form for each included article to extract information on the pathogen of interest, vaccine(s) being evaluated, study setting, clinical case definition, choices of cases and controls, and statistical approaches used to estimate VE. RESULTS We identified a total of 348 articles, including studies on VE against influenza virus (n = 253), rotavirus (n = 48), pneumococcus (n = 24), and nine other pathogens. Clinical case definitions used to enroll patients were similar by pathogens of interest but the sets of symptoms that defined them varied substantially. Controls could be those testing negative for the pathogen of interest, those testing positive for nonvaccine type of the pathogen of interest, or a subset of those testing positive for alternative pathogens. Most studies controlled for age, calendar time, and comorbidities. CONCLUSIONS Our review highlights similarities and differences in the application of the test-negative design that deserve further examination. If vaccination reduces disease severity in breakthrough infections, particular care must be taken in interpreting vaccine effectiveness estimates from test-negative design studies.
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Affiliation(s)
- Huiying Chua
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Benjamin J Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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9
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Quach THT, Mallis NA, Cordero JF. Influenza Vaccine Efficacy and Effectiveness in Pregnant Women: Systematic Review and Meta-analysis. Matern Child Health J 2019; 24:229-240. [DOI: 10.1007/s10995-019-02844-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Barratt J, Mishra V, Acton M. Latin American Adult Immunisation Advocacy Summit: Overcoming regional barriers to adult vaccination. Aging Clin Exp Res 2019; 31:339-344. [PMID: 30859460 DOI: 10.1007/s40520-019-01156-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/17/2019] [Indexed: 12/19/2022]
Abstract
Older adults in Latin America are at an increased risk of hospitalisation, ill health, catastrophic disability and death due to vaccine-preventable diseases such as influenza, herpes zoster, and pneumonia. The Latin American Adult Immunisation Advocacy Summit, held in Mexico City, gathered 40 experts in health, ageing and immunisation from 12 Latin American countries to explore good practices of adult vaccination, key country and regional barriers, and strategies to overcome these barriers. The Summit comprised of introductory lectures, plenary panels and breakout sessions with the overarching goal of improving adult vaccination uptake rates throughout the region. Several key messages and recommendations arose from the Summit. Delegates agreed upon the need for a paradigm shift in thinking towards a life course perspective on vaccination to sustain good health throughout life and promote well-being, dignity and functional capacity in older age. Delegates revealed the need for national financial commitment to fixed and irrevocable funding for universal vaccination and the urgent requirement for robust scientific, epidemiologic research in Latin American communities on the cost benefits of such coverage. The recommendations were strengthened through a common understanding of the unique multisectoral and multidisciplinary collaborations essential to influence and help shape public policy.
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Affiliation(s)
- Jane Barratt
- International Federation on Ageing, 1 Bridgepoint Drive, Suite G. 238, Toronto, ON, M4M 2B4, Canada
| | - Vyvyan Mishra
- Freelance Medical Writer and Editor, Melbourne, Australia
| | - Megan Acton
- International Federation on Ageing, 1 Bridgepoint Drive, Suite G. 238, Toronto, ON, M4M 2B4, Canada.
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11
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Cheng AC, Macartney KK, Waterer GW, Kotsimbos T, Kelly PM, Blyth CC. Reply to Skowronski and Chambers. Clin Infect Dis 2019; 65:355. [PMID: 28431103 DOI: 10.1093/cid/cix376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance.,Children's Hospital at Westmead, Syndey, New South Wales
| | - Grant W Waterer
- Royal Perth Hospital.,University of Western Australia (UWA), Perth, Western Australia
| | - Tom Kotsimbos
- Department of Allergy, Immunology, and Respiratory Medicine, Alfred Health, Melbourne
| | - Paul M Kelly
- ACT Health Directorate.,Australian National University Medical School, Canberra
| | - Christopher C Blyth
- School of Paediatrics and Child Health, UWA, Perth.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, UWA.,Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Australia
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12
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Cheng AC, Macartney KK, Waterer GW, Kotsimbos T, Kelly PM, Blyth CC. Repeated Vaccination Does Not Appear to Impact Upon Influenza Vaccine Effectiveness Against Hospitalization With Confirmed Influenza. Clin Infect Dis 2018; 64:1564-1572. [PMID: 28329167 DOI: 10.1093/cid/cix209] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background. Annual influenza vaccine is recommended for those at greatest risk of severe influenza infection. Recent reports of a negative impact of serial influenza vaccination on vaccine effectiveness (VE) raises concerns about the recommendation for annual influenza vaccines, particularly in persons at greatest risk. Methods. The Influenza Complications Alert Network (FluCAN) is an Australian hospital-based sentinel surveillance program. In this observational study, cases were defined as subjects aged >9 years admitted with influenza confirmed by polymerase chain reaction. Controls were subjects with acute respiratory illness testing negative for influenza. Propensity scores were used to adjust for the likelihood of being vaccinated. VE was calculated as 1 - adjusted odds ratio of vaccination in cases compared with test-negative controls. Results. Over 2010-2015, 6223 cases and 6505 controls were hospitalized with confirmed influenza and influenza test-negative acute respiratory illness, respectively. Following stratification by quintile of propensity score, site, and year, VE was estimated to be 43% (95% confidence interval [CI], 37%-49%) overall. VE was estimated to be 51% (95% CI, 45%-57%) in those vaccinated in both the current and previous season, compared with 33% (95% CI, 17%-47%) vaccinated in the current season only and 35% (95% CI, 21%-46%) in the previous season only. Similar results were observed for influenza A/H1N1, influenza A/H3N2, and influenza B strains. Conclusions. Vaccination in both the current and previous seasons was associated with a higher VE against hospitalization with influenza than vaccination in either single season. These findings reinforce current recommendations for annual influenza vaccination, particularly those at greatest risk of influenza disease.
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Affiliation(s)
- Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health and.,School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance and.,Children's Hospital at Westmead
| | - Grant W Waterer
- Royal Perth Hospital and.,University of Western Australia, Perth
| | - Tom Kotsimbos
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne
| | - Paul M Kelly
- Australian Capital Territory Health Directorate and.,Australian National University Medical School, Canberra
| | - Christopher C Blyth
- School of Paediatrics and Child Health, and Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth.,Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, and.,Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Australia
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13
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Foppa IM, Ferdinands JM, Chaves SS, Haber MJ, Reynolds SB, Flannery B, Fry AM. The case test-negative design for studies of the effectiveness of influenza vaccine in inpatient settings. Int J Epidemiol 2018; 45:2052-2059. [PMID: 26979985 PMCID: PMC5025336 DOI: 10.1093/ije/dyw022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 01/11/2023] Open
Abstract
Background: The test-negative design (TND) to evaluate influenza vaccine effectiveness is based on patients seeking care for acute respiratory infection, with those who test positive for influenza as cases and the test-negatives serving as controls. This design has not been validated for the inpatient setting where selection bias might be different from an outpatient setting. Methods: We derived mathematical expressions for vaccine effectiveness (VE) against laboratory-confirmed influenza hospitalizations and used numerical simulations to verify theoretical results exploring expected biases under various scenarios. We explored meaningful interpretations of VE estimates from inpatient TND studies. Results: VE estimates from inpatient TND studies capture the vaccine-mediated protection of the source population against laboratory-confirmed influenza hospitalizations. If vaccination does not modify disease severity, these estimates are equivalent to VE against influenza virus infection. If chronic cardiopulmonary individuals are enrolled because of non-infectious exacerbation, biased VE estimates (too high) will result. If chronic cardiopulmonary disease status is adjusted for accurately, the VE estimates will be unbiased. If chronic cardiopulmonary illness cannot be adequately be characterized, excluding these individuals may provide unbiased VE estimates. Conclusions: The inpatient TND offers logistic advantages and can provide valid estimates of influenza VE. If highly vaccinated patients with respiratory exacerbation of chronic cardiopulmonary conditions are eligible for study inclusion, biased VE estimates will result unless this group is well characterized and the analysis can adequately adjust for it. Otherwise, such groups of subjects should be excluded from the analysis.
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Affiliation(s)
- Ivo M Foppa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael J Haber
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sue B Reynolds
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Andrew MK, Shinde V, Hatchette T, Ambrose A, Boivin G, Bowie W, Chit A, Dos Santos G, ElSherif M, Green K, Haguinet F, Halperin SA, Ibarguchi B, Johnstone J, Katz K, Langley JM, LeBlanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney J, McGeer A, Nichols MK, Powis J, Richardson D, Semret M, Stiver G, Trottier S, Valiquette L, Webster D, Ye L, McNeil SA. Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada. BMC Infect Dis 2017; 17:805. [PMID: 29284435 PMCID: PMC5747268 DOI: 10.1186/s12879-017-2905-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Serious Outcomes Surveillance (SOS) Network was established to monitor seasonal influenza complications among hospitalized Canadian adults and to assess the effectiveness of influenza vaccination against severe outcomes. Here we report age- and strain-specific vaccine effectiveness (VE) in preventing severe outcomes during a season characterized by mixed outbreaks of four different influenza strains. METHODS This prospective, multicentre, test-negative case-control study evaluated the VE of trivalent influenza vaccine (TIV) in the prevention of laboratory-confirmed influenza-hospitalization in adults aged ≥16 years (all adults) and adults aged 16-64 years (younger adults). The SOS Network identified hospitalized patients with diagnoses potentially attributable to influenza during the 2011/12 influenza season. Swabs collected at admission were tested by reverse transcriptase polymerase chain reaction (RT PCR) or viral culture to discriminate influenza cases (positive) from controls (negative). VE was calculated as 1-odds ratio (OR) of vaccination in cases versus controls × 100. RESULTS Overall, in all adults, the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 41.8% (95% Confidence Interval [CI]: 26.0, 54.3), and 42.8% (95% CI: 23.8, 57.0), respectively. In younger adults (16-64 years), the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 35.8% (95% CI: 4.5, 56.8) and 33.2% (95% CI: -6.7, 58.2), respectively. In the all adults group, adjusted VE against influenza A/H1N1 was 72.5% (95% CI: 30.5, 89.1), against A/H3N2 was 86.1% (95% CI: 40.1, 96.8), against B/Victoria was 40.5% (95% CI: -28.9, 72.6), and against B/Yamagata was 32.3% (95% CI: -8.3, 57.7). The adjusted estimate of early season VE (from November 1 to March 11) was 54.4% (95% CI: 29.7-70.4), which was higher than late season (from March 11 to May 25) VE estimate (VE: 29.7%, 95% CI: -5.3, 53.1). CONCLUSIONS These results suggest that TIV was highly effective against A viruses and moderately effective against B viruses during a mild season characterised by co-circulation of four influenza strains in Canada. Findings underscore the need to provide VE assessment by subtype/lineage as well as the timing of vaccination (early season vs late season) to accurately evaluate vaccine performance and thus guide public health decision-making. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01517191. Registration was retrospective and the date of registration was January 17, 2012.
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Affiliation(s)
- Melissa K. Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Vivek Shinde
- GSK, King of Prussia, Current affiliation: Novavax Vaccines, Washington, DC, USA
| | - Todd Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, 2705 Boulevard Laurier, RC-709, Québec, Québec G1V 4G2 Canada
| | - William Bowie
- University of British Columbia, 452D, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5 Canada
| | - Ayman Chit
- Leslie Dan Faculty of Pharmacy, University of Toronto, Current affiliation: Sanofi Pasteur, Swiftwater, Pennsylvania USA
| | - Gael Dos Santos
- Business & Decision Life Sciences, Bruxelles, Belgium, on behalf of GSK (Wavre, Belgium), Current affiliation: GSK, Wavre, Belgium
| | - May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Karen Green
- Mount Sinai Hospital, 600 University Ave, Room 210, Toronto, Ontario M5G 1X5 Canada
| | | | - Scott A. Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Barbara Ibarguchi
- GSK, Mississauga, Ontario, Canada, Current affiliation: Bayer Inc, Mississauga, Ontario Canada
| | - Jennie Johnstone
- McMaster University, Michael G. DeGroote Centre for Learning, 1200 Main Street West, Room 3208, Hamilton, Ontario L8S 4K1 Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, Toronto, Ontario M2K 1E1 Canada
| | - Joanne M. Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Mark Loeb
- McMaster University, Michael G. DeGroote Centre for Learning, 1200 Main Street West, Room 3208, Hamilton, Ontario L8S 4K1 Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Anne McCarthy
- The Ottawa Hospital, Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9 Canada
| | - Janet McElhaney
- Health Sciences North Research Institute, 41 Ramsey Lake Rd, Sudbury, Ontario P3E 5J1 Canada
| | - Allison McGeer
- Mount Sinai Hospital, 600 University Ave, Room 210, Toronto, Ontario M5G 1X5 Canada
| | - Michaela K. Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Jeff Powis
- Michael Garron Hospital, 825 Coxwell Ave, Toronto, Ontario M4C 3E7 Canada
| | - David Richardson
- William Osler Health System, Department of Infectious Diseases and Medical Microbiology, 2100 Bovaird Dr East, Brampton, Ontario L6R 3J7 Canada
| | - Makeda Semret
- McGill University, McGill University Health Centre, Glen Site, 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Canada
| | - Grant Stiver
- University of British Columbia, 452D, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5 Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, 2705 Boulevard Laurier, RC-709, Québec, Québec G1V 4G2 Canada
| | - Louis Valiquette
- Université de Sherbrooke, 3001 12th Ave North, Sherbrooke, Quebec J1H 5N4 Canada
| | - Duncan Webster
- Saint John Regional Hospital, Dalhousie University, 400 University Ave, Saint John, New Brunswick E2L 4L2 Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - Shelly A. McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
| | - on behalf of the Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Serious Outcomes Surveillance Network and the Toronto Invasive Bacterial Diseases Network (TIBDN)
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada
- GSK, King of Prussia, Current affiliation: Novavax Vaccines, Washington, DC, USA
- Centre Hospitalier Universitaire de Québec, 2705 Boulevard Laurier, RC-709, Québec, Québec G1V 4G2 Canada
- University of British Columbia, 452D, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Current affiliation: Sanofi Pasteur, Swiftwater, Pennsylvania USA
- Business & Decision Life Sciences, Bruxelles, Belgium, on behalf of GSK (Wavre, Belgium), Current affiliation: GSK, Wavre, Belgium
- Mount Sinai Hospital, 600 University Ave, Room 210, Toronto, Ontario M5G 1X5 Canada
- GSK, Wavre, Belgium
- GSK, Mississauga, Ontario, Canada, Current affiliation: Bayer Inc, Mississauga, Ontario Canada
- McMaster University, Michael G. DeGroote Centre for Learning, 1200 Main Street West, Room 3208, Hamilton, Ontario L8S 4K1 Canada
- North York General Hospital, 4001 Leslie St, Toronto, Ontario M2K 1E1 Canada
- The Ottawa Hospital, Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9 Canada
- Health Sciences North Research Institute, 41 Ramsey Lake Rd, Sudbury, Ontario P3E 5J1 Canada
- Michael Garron Hospital, 825 Coxwell Ave, Toronto, Ontario M4C 3E7 Canada
- William Osler Health System, Department of Infectious Diseases and Medical Microbiology, 2100 Bovaird Dr East, Brampton, Ontario L6R 3J7 Canada
- McGill University, McGill University Health Centre, Glen Site, 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Canada
- Université de Sherbrooke, 3001 12th Ave North, Sherbrooke, Quebec J1H 5N4 Canada
- Saint John Regional Hospital, Dalhousie University, 400 University Ave, Saint John, New Brunswick E2L 4L2 Canada
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Rondy M, El Omeiri N, Thompson MG, Levêque A, Moren A, Sullivan SG. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. J Infect 2017; 75:381-394. [PMID: 28935236 PMCID: PMC5912669 DOI: 10.1016/j.jinf.2017.09.010] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults. METHODS We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18-64 and 65 years and above) using random-effects models. RESULTS We identified 3411 publications and 30 met our inclusion criteria. Between 2010-11 and 2014-15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18-64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59),37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI:-3;30) when A(H3N2) variant viruses predominated. CONCLUSIONS Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant.
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Affiliation(s)
- Marc Rondy
- Epiconcept, Paris, France; Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux F-33000, France.
| | - Nathalie El Omeiri
- Université Libre de Bruxelles, School of Public Health, Brussels, Belgium
| | - Mark G Thompson
- US Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, USA
| | - Alain Levêque
- Université Libre de Bruxelles, School of Public Health, Brussels, Belgium
| | | | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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16
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Andrew MK, Shinde V, Ye L, Hatchette T, Haguinet F, Dos Santos G, McElhaney JE, Ambrose A, Boivin G, Bowie W, Chit A, ElSherif M, Green K, Halperin S, Ibarguchi B, Johnstone J, Katz K, Langley J, Leblanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McGeer A, Powis J, Richardson D, Semret M, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. The Importance of Frailty in the Assessment of Influenza Vaccine Effectiveness Against Influenza-Related Hospitalization in Elderly People. J Infect Dis 2017; 216:405-414. [PMID: 28931244 PMCID: PMC5853583 DOI: 10.1093/infdis/jix282] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Influenza is an important cause of morbidity and mortality among older adults. Even so, effectiveness of influenza vaccine for older adults has been reported to be lower than for younger adults, and the impact of frailty on vaccine effectiveness (VE) and outcomes is uncertain. We aimed to study VE against influenza hospitalization in older adults, focusing on the impact of frailty. Methods We report VE of trivalent influenza vaccine (TIV) in people ≥65 years of age hospitalized during the 2011-2012 influenza season using a multicenter, prospective, test-negative case-control design. A validated frailty index (FI) was used to measure frailty. Results Three hundred twenty cases and 564 controls (mean age, 80.6 and 78.7 years, respectively) were enrolled. Cases had higher baseline frailty than controls (P = .006). In the fully adjusted model, VE against influenza hospitalization was 58.0% (95% confidence interval [CI], 34.2%-73.2%). The contribution of frailty was important; adjusting for frailty alone yielded a VE estimate of 58.7% (95% CI, 36.2%-73.2%). VE was 77.6% among nonfrail older adults and declined as frailty increased. Conclusions Despite commonly held views that VE is poor in older adults, we found that TIV provided good protection against influenza hospitalization in older adults who were not frail, though VE diminished as frailty increased. Clinical Trials Registration NCT01517191.
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Affiliation(s)
- Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | - Vivek Shinde
- GlaxoSmithKline (GSK), King of Prussia, Pennsylvania; and
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | - Todd Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | | | | | | | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec City, and
| | | | - Ayman Chit
- Sanofi Pasteur, Swiftwater, Pennsylvania
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | - May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | | | - Scott Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | | | | | | | - Joanne Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | - Jason Leblanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | | | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
| | | | | | | | | | | | - Grant Stiver
- University of British Columbia, Vancouver, Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Quebec City, and
| | | | | | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax
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17
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Hintergrundpapier der STIKO: Evaluation der bestehenden Influenzaimpfempfehlung für Indikationsgruppen und für Senioren (Standardimpfung ab 60 Jahren). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1606-1622. [PMID: 27815578 DOI: 10.1007/s00103-016-2467-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Havers F, Sokolow L, Shay DK, Farley MM, Monroe M, Meek J, Daily Kirley P, Bennett NM, Morin C, Aragon D, Thomas A, Schaffner W, Zansky SM, Baumbach J, Ferdinands J, Fry AM. Case-Control Study of Vaccine Effectiveness in Preventing Laboratory-Confirmed Influenza Hospitalizations in Older Adults, United States, 2010-2011. Clin Infect Dis 2016; 63:1304-1311. [PMID: 27486114 DOI: 10.1093/cid/ciw512] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults are at increased risk of influenza-associated complications, including hospitalization, but influenza vaccine effectiveness (VE) data are limited for this population. We conducted a case-control study to estimate VE to prevent laboratory-confirmed influenza hospitalizations among adults aged ≥50 years in 11 US Emerging Infections Program hospitalization surveillance sites. METHODS Cases were influenza infections (confirmed by reverse-transcription polymerase chain reaction) in adults aged ≥50 years hospitalized during the 2010-2011 influenza season, identified through Emerging Infections Program surveillance. Community controls, identified through home telephone lists, were matched by age group (±5 years), county, and month of hospitalization for case patients. Vaccination status was determined by self-report (with location and date) or medical records. Conditional logistic regression models were used to calculate adjusted VE (aVE) estimates (100 × [1 - adjusted odds ratio]), adjusting for sex, race, socioeconomic factors, smoking, chronic medical conditions, recent hospitalization for a respiratory condition, and functional status. RESULTS Among case patients, 205 of 368 (55%) were vaccinated, compared with 489 of 773 controls (63%). Case patients were more likely to be of nonwhite race and more likely to have ≥2 chronic health conditions, a recent hospitalization for a respiratory condition, an income <$35 000, and a lower functional status score (P < .01 for all). The aVE was 56.8% (95% confidence interval, 34.1%-71.7%) and was similar across age groups, including adults ≥75 years (aVE, 57.3%; 15.9%-78.4%). CONCLUSIONS During 2010-2011, influenza vaccination was associated with a significant reduction in the risk of laboratory-confirmed influenza hospitalization among adults aged ≥50 years, regardless of age group.
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Affiliation(s)
- Fiona Havers
- Influenza Division, Centers for Disease Control and Prevention
| | - Leslie Sokolow
- Influenza Division, Centers for Disease Control and Prevention.,Battelle Memorial Institute
| | - David K Shay
- Influenza Division, Centers for Disease Control and Prevention
| | - Monica M Farley
- Emory University School of Medicine.,VA Medical Center, Atlanta, Georgia
| | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | | | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, New York
| | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | | | | | | | | | - Jill Ferdinands
- Influenza Division, Centers for Disease Control and Prevention
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention
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19
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Blyth CC, Macartney KK, Hewagama S, Senenayake S, Friedman ND, Simpson G, Upham J, Kotsimbos T, Kelly P, Cheng AC. Influenza epidemiology, vaccine coverage and vaccine effectiveness in children admitted to sentinel Australian hospitals in 2014: the Influenza Complications Alert Network (FluCAN). Euro Surveill 2016; 21:30301. [DOI: 10.2807/1560-7917.es.2016.21.30.30301] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/06/2015] [Indexed: 11/20/2022] Open
Abstract
The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance programme operating in all states and territories in Australia. We summarise the epidemiology of children hospitalised with laboratory-confirmed influenza in 2014 and reports on the effectiveness of inactivated trivalent inactivated vaccine (TIV) in children. In this observational study, cases were defined as children admitted with acute respiratory illness (ARI) with influenza confirmed by PCR. Controls were hospitalised children with ARI testing negative for influenza. Vaccine effectiveness (VE) was estimated as 1 minus the odds ratio of vaccination in influenza positive cases compared with test-negative controls using conditional logistic regression models. From April until October 2014, 402 children were admitted with PCR-confirmed influenza. Of these, 28% were aged < 1 year, 16% were Indigenous, and 39% had underlying conditions predisposing to severe influenza. Influenza A was detected in 90% of cases of influenza; influenza A(H1N1)pdm09 was the most frequent subtype (109/141 of subtyped cases) followed by A(H3N2) (32/141). Only 15% of children with influenza received antiviral therapy. The adjusted VE of one or more doses of TIV for preventing hospitalised influenza was estimated at 55.5% (95% confidence intervals (CI): 11.6–77.6%). Effectiveness against influenza A(H1N1)pdm09 was high (91.6% , 95% CI: 36.0–98.9%) yet appeared poor against H3N2. In summary, the 2014 southern hemisphere TIV was moderately effective against severe influenza in children. Significant VE was observed against influenza A(H1N1)pdm09.
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Affiliation(s)
- Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Kristine K Macartney
- Children’s Hospital Westmead, University of Sydney, Sydney, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, Australia
| | - Saliya Hewagama
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sanjaya Senenayake
- The Canberra Hospital, Garran, Australian Capital Territory, Australia
- Australian National University Medical School, Acton, Australian Capital Territory, Australia
| | | | | | - John Upham
- Princess Alexandra Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Tom Kotsimbos
- Alfred Health; Monash University, Melbourne, Victoria, Australia
| | - Paul Kelly
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
- Australian National University Medical School, Acton, Australian Capital Territory, Australia
| | - Allen C Cheng
- Alfred Health; Monash University, Melbourne, Victoria, Australia
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Kelly HA, Lane C, Cheng AC. Influenza vaccine effectiveness in general practice and in hospital patients in Victoria, 2011-2013. Med J Aust 2016; 204:76. [PMID: 26821109 DOI: 10.5694/mja15.01017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare influenza vaccine effectiveness in the general practice and hospital settings. DESIGN Analysis of annual case test-negative studies. SETTING Victorian sentinel hospitals and general practices, 2011-2013. PARTICIPANTS Patients presenting to general practitioners, or those admitted to hospital with an influenza-like illness who were tested for influenza using a polymerase chain reaction assay. Cases were patients with a positive test result for influenza; non-cases (controls) had a negative test result. MAIN OUTCOME MEASURES Vaccine effectiveness against laboratory-confirmed influenza. RESULTS Hospitalised patients were on average older and reported a higher proportion of comorbidities than general practice patients. The pooled estimate of influenza vaccine effectiveness against laboratory-confirmed infection for the 3 years was 50% (95% CI, 26%-66%) for general practice patients and 39% (95% CI, 28%-47%) for patients admitted to hospital. CONCLUSIONS Influenza vaccines appeared to be similarly modestly effective in the general practice and hospital settings. Influenza vaccination appears to prevent hospital admission by preventing symptomatic infection rather than by attenuating the severity of illness.
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Affiliation(s)
- Heath A Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
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Norowitz YM, Kohlhoff S, Smith-Norowitz TA. Relationship of influenza virus infection to associated infections in children who present with influenza-like symptoms. BMC Infect Dis 2016; 16:304. [PMID: 27317396 PMCID: PMC4912778 DOI: 10.1186/s12879-016-1642-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Influenza virus is a major health care burden and is associated with significant morbidity and mortality. Data on morbidity and complications (pneumonia, otitis media) related to influenza virus infection in primary care settings are limited with reports mainly obtained from hospital settings. We assessed the prevalence of complications from viral/bacterial infections in influenza- positive compared with influenza- negative children presenting with influenza-like illness (ILI) in a primary care setting. Methods This retrospective, practice-based chart review studied complications from viral/bacterial infections in 255 children and adolescents (females/males, 1-21 years) who presented with ILI. We also compared the prevalence of complications by influenza vaccination status between influenza positive (N = 32/121) and influenza negative (N = 50/134) cases (2013-2015). Comparisons for categorical variables were made using chi-squared tests. Results The prevalence of complications was similar in influenza positive (18/121) and influenza negative (22/134) patients (P = NS). Patients presenting with ILI, who were vaccinated, were less likely to test positive for influenza compared with patients who were not vaccinated (P = 0.064). However, prevalence of infections was similar in both groups based on vaccination status. We did not find any effect of type of health insurance on influenza status (P > 0.05) Conclusion Common respiratory complications of seasonal influenza did not differ in influenza positive compared with influenza negative patients. Vaccination with influenza vaccine may result in decreased duration or severity of symptoms, and remains an important public health intervention. In primary care settings, determination of influenza status may be an important tool for clinicians to predict the likelihood of complications.
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Affiliation(s)
- Yitzchok M Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA
| | - Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
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Puig-Barberà J, Natividad-Sancho A, Trushakova S, Sominina A, Pisareva M, Ciblak MA, Badur S, Yu H, Cowling BJ, El Guerche-Séblain C, Mira-Iglesias A, Kisteneva L, Stolyarov K, Yurtcu K, Feng L, López-Labrador X, Burtseva E. Epidemiology of Hospital Admissions with Influenza during the 2013/2014 Northern Hemisphere Influenza Season: Results from the Global Influenza Hospital Surveillance Network. PLoS One 2016; 11:e0154970. [PMID: 27196667 PMCID: PMC4873033 DOI: 10.1371/journal.pone.0154970] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 04/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Global Influenza Hospital Surveillance Network was established in 2012 to obtain valid epidemiologic data on hospital admissions with influenza-like illness. Here we describe the epidemiology of admissions with influenza within the Northern Hemisphere sites during the 2013/2014 influenza season, identify risk factors for severe outcomes and complications, and assess the impact of different influenza viruses on clinically relevant outcomes in at-risk populations. METHODS Eligible consecutive admissions were screened for inclusion at 19 hospitals in Russia, Turkey, China, and Spain using a prospective, active surveillance approach. Patients that fulfilled a common case definition were enrolled and epidemiological data were collected. Risk factors for hospitalization with laboratory-confirmed influenza were identified by multivariable logistic regression. FINDINGS 5303 of 9507 consecutive admissions were included in the analysis. Of these, 1086 were influenza positive (534 A(H3N2), 362 A(H1N1), 130 B/Yamagata lineage, 3 B/Victoria lineage, 40 untyped A, and 18 untyped B). The risk of hospitalization with influenza (adjusted odds ratio [95% confidence interval]) was elevated for patients with cardiovascular disease (1.63 [1.33-2.02]), asthma (2.25 [1.67-3.03]), immunosuppression (2.25 [1.23-4.11]), renal disease (2.11 [1.48-3.01]), liver disease (1.94 [1.18-3.19], autoimmune disease (2.97 [1.58-5.59]), and pregnancy (3.84 [2.48-5.94]). Patients without comorbidities accounted for 60% of admissions with influenza. The need for intensive care or in-hospital death was not significantly different between patients with or without influenza. Influenza vaccination was associated with a lower risk of confirmed influenza (adjusted odds ratio = 0.61 [0.48-0.77]). CONCLUSIONS Influenza infection was detected among hospital admissions with and without known risk factors. Pregnancy and underlying comorbidity increased the risk of detecting influenza virus in patients hospitalized with influenza-like illness. Our results support influenza vaccination as a measure for reducing the risk of influenza-associated hospital admission.
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Affiliation(s)
- Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- * E-mail:
| | - Angels Natividad-Sancho
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Svetlana Trushakova
- D.I. Ivanovsky Institute of Virology FSBI “N.F. Gamaleya FRCEM” Ministry of Health of Russian Federation, Moscow, Russian Federation
| | - Anna Sominina
- Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Maria Pisareva
- Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Meral A. Ciblak
- National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selim Badur
- National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Benjamin J. Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Lidiya Kisteneva
- D.I. Ivanovsky Institute of Virology FSBI “N.F. Gamaleya FRCEM” Ministry of Health of Russian Federation, Moscow, Russian Federation
| | - Kirill Stolyarov
- Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Kubra Yurtcu
- National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xavier López-Labrador
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Centro de Investigación Biomédica en Epidemiología y Salud Publica (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Burtseva
- D.I. Ivanovsky Institute of Virology FSBI “N.F. Gamaleya FRCEM” Ministry of Health of Russian Federation, Moscow, Russian Federation
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Chiu SS, Feng S, Chan KH, Lo JYC, Chan ELY, So LY, Cowling BJ, Peiris JSM. Hospital-based vaccine effectiveness against influenza B lineages, Hong Kong, 2009-14. Vaccine 2016; 34:2164-9. [PMID: 27013437 DOI: 10.1016/j.vaccine.2016.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND We estimated vaccine effectiveness (VE) against pediatric influenza B hospitalizations in Hong Kong year round between November 2001 and October 2014. METHODS We conducted a test-negative year-round study, enrolling children 6 months to 17 years of age admitted to two hospitals in Hong Kong with a febrile acute respiratory infection. Children were tested for influenza A and B. Conditional logistic regression was used to estimate overall and lineage-specific vaccine effectiveness comparing influenza vaccination history of the trivalent influenza vaccine (TIV) among patients testing positive for influenza B versus negative for influenza A and B, adjusting for age and sex and matching by calendar week of recruitment. RESULTS Of the 6013 children included in the analysis, 262 tested positive for influenza B. Vaccination coverage was low: 6.5% in the influenza B positive children when compared with 8.8% in children who tested negative for both influenza A and B (p=0.248). Overall, VE was 47.6% (95% CI: 10.0, 69.4%) against influenza B hospitalization despite variable co-circulation of both lineages in all years. VE for Victoria-like virus calculated from 3 years when the vaccine was lineage-matched was 59.1% (95% CI: 6.2, 82.2%). Lineage-matched VE for Yamagata-like virus was -8.8% (95% CI: -215.4, 62.5%) in a clade mismatch season. With wide confidence intervals, we were unable to demonstrate cross-lineage protection: VE against the mismatched B/Yamagata-like virus was 9.5% (95% CI: -240.4, 76.0%) in 2011/12 and against mismatched B/Victoria-like virus in 2013/14 was 42.7% (95% CI: -368.6, 93.0%). CONCLUSIONS TIV conferred an overall VE of 47.6% (95% CI: 10.0, 69.4%) against influenza B hospitalization in children despite variable co-circulation of both lineages in all years. Lineage-matched VE for Yamagata-like virus was poor and may be related to clade mismatch. Cross-lineage protection was not observed.
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Affiliation(s)
- Susan S Chiu
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Hung Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Janice Y C Lo
- Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, China
| | - Eunice L Y Chan
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lok-Yee So
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China; Centre of Influenza Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Feng S, Cowling BJ, Sullivan SG. Influenza vaccine effectiveness by test-negative design - Comparison of inpatient and outpatient settings. Vaccine 2016; 34:1672-9. [PMID: 26920469 DOI: 10.1016/j.vaccine.2016.02.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/30/2016] [Accepted: 02/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Observational studies of influenza vaccine effectiveness (VE) are increasingly using the test-negative design. Studies are typically based in outpatient or inpatient settings, but these two approaches are rarely compared directly. The aim of our study was to assess whether influenza VE estimates differ between inpatient and outpatient settings. METHODS We searched the literature from Medline, PubMed and Web of Science using a combination of keywords to identify published studies of influenza VE using the test-negative design. Studies assessing any type of influenza vaccine among any population in any setting were considered, while interim studies or re-analyses were excluded. Retrieved articles were reviewed, screened and categorized based on study setting, location and influenza season. We searched for parallel studies in inpatient and outpatient settings that were done in the same influenza season, in the same location, and in the same or similar age groups. For each of the pairs identified, we estimated the difference in VE estimates between settings, and we tested whether the average difference was significant using a paired t-test. RESULTS In total 25 pairs of estimates were identified that permitted comparisons between VE estimates in inpatient and outpatient study settings. Within pairs, the prevalence of influenza was generally higher among patients enrolled in the outpatient studies, while influenza vaccination coverage among the test-negative control groups was generally higher in the inpatient studies. There was no heterogeneity in the paired differences in VE, and the pooled difference in VE between inpatient and outpatient studies was -2% (95% confidence interval: -12%, 10%). CONCLUSIONS We found no differences in VE estimates between inpatient and outpatient settings by studies using the test-negative design. Further research involving direct comparisons of VE estimates from the two settings in the same populations and years would be valuable.
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Affiliation(s)
- 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, Hong Kong, 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, China.
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia; Fielding School of Public Health, University of California, Los Angeles, USA
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McAnerney JM, Walaza S, Cohen AL, Tempia S, Buys A, Venter M, Blumberg L, Duque J, Cohen C. Effectiveness and knowledge, attitudes and practices of seasonal influenza vaccine in primary healthcare settings in South Africa, 2010-2013. Influenza Other Respir Viruses 2016; 9:143-50. [PMID: 25677874 PMCID: PMC4415698 DOI: 10.1111/irv.12305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives Influenza vaccine effectiveness (VE) and coverage data for sub-Saharan Africa are scarce. Using a test-negative case–control design, we estimated influenza VE annually among individuals with influenza-like illness presenting to an outpatient sentinel surveillance programme in South Africa from 2010 to 2013. A knowledge, attitudes and practices (KAP) influenza vaccine survey of programme clinicians was conducted in 2013. Sample In total, 9420 patients were enrolled in surveillance of whom 5344 (56.7%) were included in the VE analysis: 2678 (50.1%) were classified as controls (influenza test-negative) and 2666 (49.9%) as cases (influenza test-positive). Results Mean annual influenza vaccine coverage among controls was 4.5% for the four years. Annual VE estimates adjusted for age, underlying medical conditions and seasonality for 2010-2013 were 54.2% (95% confidence interval (CI): 2.4–78.6%), 57.1% (95% CI: 15.5–78.2%), 38.4% (95% CI: −71.7–78.1%) and 87.2% (95% CI: 67.2–95.0%), respectively. The KAP survey showed that >90% of clinicians were familiar with the indications for and the benefits of influenza vaccination. Conclusions Our study showed that the vaccine was significantly protective in 2010, 2011 and 2013, but not in 2012 when the circulating A(H3N2) strain showed genetic drift. Vaccine coverage was low despite good clinician knowledge of vaccination indications. Further studies are needed to investigate the reason for the low uptake of influenza vaccine.
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Affiliation(s)
- Johanna M McAnerney
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Services (NHLS), Johannesburg, South Africa
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Abstract
The increasing availability of nucleic acid amplification tests since the 1980s has revolutionised our understanding of the pathogenesis, epidemiology, clinical and laboratory aspects of known and novel viral respiratory pathogens. High-throughput, multiplex polymerase chain reaction is the most commonly used qualitative detection method, but utilisation of newer techniques such as next-generation sequencing will become more common following significant cost reductions. Rapid and readily accessible isothermal amplification platforms have also allowed molecular diagnostics to be used in a ‘point-of-care’ format. This review focuses on the current applications and limitations of molecular diagnosis for respiratory viruses.
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Blyth CC, Cheng AC, Finucane C, Jacoby P, Effler PV, Smith DW, Kelly H, Macartney KK, Richmond PC. The effectiveness of influenza vaccination in preventing hospitalisation in children in Western Australia. Vaccine 2015; 33:7239-7244. [PMID: 26549359 DOI: 10.1016/j.vaccine.2015.10.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/11/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is increasing evidence demonstrating influenza vaccine effectiveness (VE) in the prevention of influenza in children, including the very young. Data demonstrating the effectiveness against severe disease, including hospitalisation, are limited. We aimed to determine the VE of the southern hemisphere trivalent inactivated influenza vaccine (TIV) in preventing laboratory-confirmed influenza-associated hospitalisation in children. PATIENTS AND METHODS Laboratory records were used to identify children with confirmed influenza hospitalised (i.e., cases) during a 5 year period (2008, 2010-2013) at the only tertiary paediatric facility in Western Australia. Cases and time, age and ward matched controls were retrospectively reviewed to determine risk factors, vaccination status and outcome. Adjusted odds ratios and VE estimates were derived using conditional logistic regression models. RESULTS Three hundred and eighty five cases were identified (Influenza A, 64.9%; Influenza B, 35.1%). Influenza-like illness and pneumonia were the most frequent presentation (74.5% and 23.9%, respectively). The median length of stay was 2 days (Interquartile range 1-4 days). Twenty children (5.2%) required admission to the intensive care unit. Vaccine uptake in cases and controls was low (4.9% and 8.5%, respectively). Three hundred and six case-control pairs were included in the VE analysis, of which 19 pairs were informative with discrepant vaccination status. VE (fully vaccinated vs. unvaccinated) was estimated to be 62.3% (95% CI: -6.6%, 86.7%). CONCLUSION In this study, the point estimate for the effectiveness of TIV in preventing influenza-associated hospitalisation in children was similar to that reported for emergency or outpatient attended, laboratory-confirmed influenza, yet confidence intervals were wide. Vaccine uptake remains low. Studies, enroling larger numbers of children, ideally with higher vaccine uptake, are needed to provide additional evidence on TIV protection against influenza hospitalisation in children.
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Affiliation(s)
- Christopher C Blyth
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Carolyn Finucane
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Peter Jacoby
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Paul V Effler
- Communicable Disease Control Directorate, WA Department of Health, Perth, Australia
| | - David W Smith
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia; Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine WA, Perth, Australia
| | - Heath Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia; Australian National University, Canberra, Australia
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, Australia; Children's Hospital Westmead, University of Sydney, Sydney, Australia
| | - Peter C Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Australia
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Puig-Barberà J, Tormos A, Trushakova S, Sominina A, Pisareva M, Ciblak MA, Badur S, Yu H, Cowling BJ, Burtseva E. The Global Influenza Hospital Surveillance Network (GIHSN): a new platform to describe the epidemiology of severe influenza. Influenza Other Respir Viruses 2015; 9:277-286. [PMID: 26198771 PMCID: PMC4605407 DOI: 10.1111/irv.12335] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Influenza is a global public health problem. However, severe influenza only recently has been addressed in routine surveillance. OBJECTIVES The Global Influenza Hospital Surveillance Network (GIHSN) was established to study the epidemiology of severe influenza in consecutive seasons in different countries. Our objective is to describe the GIHSN approach and methods. METHODS The GIHSN uses prospective active surveillance to identify consecutive influenza admissions in permanent residents of well-defined geographic areas in sites around the world. A core common protocol is followed. After consent, data are collected on patient characteristics and clinical outcomes, respiratory swabs are obtained, and the presence of influenza virus and subtype or lineage is ascertained by polymerase chain reaction. Data are collated and analyzed at the GIHSN coordination center. RESULTS The GIHSN has run its activities for two consecutive influenza seasons, 2012-2013 and 2013-2014, and hospitals in Brazil, China, France, Russian Federation, Turkey, and Spain have been involved in one or both seasons. Consistency on the application of the protocol and heterogeneity for the first season have been addressed in two previous publications. During both seasons, 19 677 eligible admissions were recorded; 11 843 (60%) were included and tested, and 2713 (23%) were positive for influenza: 991 (37%) A(H1N1); 807 (30%) A(H3N2); 583 (21%) B/Yamagata; 56 (2%) B/Victoria and 151 (6%) influenza A; and 125 (5%) influenza B were not characterized. CONCLUSIONS The GIHSN is a platform that provides information on severe influenza worldwide, applying a common core protocol and a consistent case definition.
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Affiliation(s)
- Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)Valencia, Spain
| | - Anita Tormos
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)Valencia, Spain
| | | | - Anna Sominina
- Research Institute of InfluenzaSt. Petersburg, Russian Federation
| | - Maria Pisareva
- Research Institute of InfluenzaSt. Petersburg, Russian Federation
| | - Meral A Ciblak
- National Influenza Reference Laboratory Capa-IstanbulIstanbul, Turkey
| | - Selim Badur
- National Influenza Reference Laboratory Capa-IstanbulIstanbul, Turkey
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionBeijing, China
| | - Benjamin J Cowling
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong KongHong Kong, China
| | - Elena Burtseva
- D.I. Ivanovsky Institute of VirologyMoscow, Russian Federation
| | - on behalf of the GIHSN Group*
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)Valencia, Spain
- D.I. Ivanovsky Institute of VirologyMoscow, Russian Federation
- Research Institute of InfluenzaSt. Petersburg, Russian Federation
- National Influenza Reference Laboratory Capa-IstanbulIstanbul, Turkey
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionBeijing, China
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong KongHong Kong, China
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Cheng AC, Kotsimbos T, Kelly PM. Influenza vaccine effectiveness against hospitalisation with influenza in adults in Australia in 2014. Vaccine 2015; 33:7352-7356. [PMID: 26529066 DOI: 10.1016/j.vaccine.2015.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/25/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022]
Abstract
We provide estimates of the influenza vaccine protection against hospitalisation with laboratory-confirmed influenza in the 2014 Australian season where the A/H1N1/pdm09 strain predominated. This was performed using a case-test negative study design as part of a national sentinel surveillance system in Australia. Vaccine effectiveness was estimated as (1-OR)×100% where the odds ratio of vaccination in cases vs test negative participants was estimated from a conditional logistic regression. Between April and November, 1692 adult patients were admitted with laboratory-confirmed influenza. Vaccine effectiveness was estimated from 1283 patients with influenza and 1116 test negative patients where vaccination status was ascertained. Vaccination was associated with a reduction in the risk of hospitalisation with influenza of 51.5% (95% CI: 41.6%, 59.7%) in all patients, and a reduction of 50.7% (95% CI: 40.1%, 59.3%) in the target population for vaccination. We estimate that the influenza vaccine was moderately protective against hospitalisation with laboratory-confirmed influenza during the 2014 influenza season in Australia.
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Affiliation(s)
- Allen C Cheng
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia.
| | - Tom Kotsimbos
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health and Monash University, Melbourne, VIC, Australia
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El Omeiri N, Azziz-Baumgartner E, Clará W, Guzmán-Saborío G, Elas M, Mejía H, Molina IB, De Molto Y, Mirza S, Widdowson MA, Ropero-Álvarez AM. Pilot to evaluate the feasibility of measuring seasonal influenza vaccine effectiveness using surveillance platforms in Central-America, 2012. BMC Public Health 2015; 15:673. [PMID: 26184659 PMCID: PMC4504410 DOI: 10.1186/s12889-015-2001-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
Background Since 2004, the uptake of seasonal influenza vaccines in Latin America and the Caribbean has markedly increased. However, vaccine effectiveness (VE) is not routinely measured in the region. We assessed the feasibility of using routine surveillance data collected by sentinel hospitals to estimate influenza VE during 2012 against laboratory-confirmed influenza hospitalizations in Costa-Rica, El Salvador, Honduras and Panama. We explored the completeness of variables needed for VE estimation. Methods We conducted the pilot case–control study at 23 severe acute respiratory infections (SARI) surveillance hospitals. Participant inclusion criteria included children 6 months–11 years and adults ≥60 years targeted for vaccination and hospitalized for SARI during January–December 2012. We abstracted information needed to estimate target group specific VE (i.e., date of illness onset and specimen collection, preexisting medical conditions, 2012 and 2011 vaccination status and date, and pneumococcal vaccination status for children and adults) from SARI case-reports and for children ≤9 years, inquired about the number of annual vaccine doses given. A case was defined as an influenza virus positive by RT-PCR in a person with SARI, while controls were RT-PCR negative. We recruited 3 controls per case from the same age group and month of onset of symptoms. Results We identified 1,186 SARI case-patients (342 influenza cases; 849 influenza-negative controls), of which 994 (84 %) had all the information on key variables sought. In 893 (75 %) SARI case-patients, the vaccination status field was missing in the SARI case-report forms and had to be completed using national vaccination registers (36 %), vaccination cards (30 %), or other sources (34 %). After applying exclusion criteria for VE analyses, 541 (46 %) SARI case-patients with variables necessary for the group-specific VE analyses were selected (87 cases, 236 controls among children; 64 cases, 154 controls among older adults) and were insufficient to provide precise regional estimates (39 % for children and 25 % for adults of minimum sample size needed). Conclusions Sentinel surveillance networks in middle income countries, such as some Latin American and Caribbean countries, could provide a simple and timely platform to estimate regional influenza VE annually provided SARI forms collect all necessary information. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2001-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie El Omeiri
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET)/The Taskforce for Global Health, Inc., ᅟ, ᅟ. .,Pan American Health Organization, Ancón, Avenida Gorgas, Edificio 261, Panama City, Panama.
| | | | - Wilfrido Clará
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
| | - Guiselle Guzmán-Saborío
- Costa-Rican Social Security Fund (Caja Costarricense de Seguro Social), San José, Costa-Rica.
| | - Miguel Elas
- Ministry of Health, San Salvador, El Salvador.
| | | | | | | | - Sara Mirza
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
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Impact of Vaccination on Hospitalized Adults With Influenza A, 2012–2013. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Kelly HA. Safety and effectiveness of influenza vaccines. Med J Aust 2015; 201:560-1. [PMID: 25390245 DOI: 10.5694/mja14.01281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/07/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Heath A Kelly
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, VIC, Australia.
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Lytras T, Kossyvakis A, Melidou A, Exindari M, Gioula G, Pogka V, Malisiovas N, Mentis A. Influenza vaccine effectiveness against laboratory confirmed influenza in Greece during the 2013–2014 season: A test-negative study. Vaccine 2015; 33:367-73. [DOI: 10.1016/j.vaccine.2014.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/24/2014] [Accepted: 11/06/2014] [Indexed: 11/25/2022]
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Darvishian M, Bijlsma MJ, Hak E, van den Heuvel ER. Effectiveness of seasonal influenza vaccine in community-dwelling elderly people: a meta-analysis of test-negative design case-control studies. THE LANCET. INFECTIOUS DISEASES 2014; 14:1228-39. [PMID: 25455990 DOI: 10.1016/s1473-3099(14)70960-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The application of test-negative design case-control studies to assess the effectiveness of influenza vaccine has increased substantially in the past few years. The validity of these studies is predicated on the assumption that confounding bias by risk factors is limited by design. We aimed to assess the effectiveness of influenza vaccine in a high-risk group of elderly people. METHODS We searched the Cochrane library, Medline, and Embase up to July 13, 2014, for test-negative design case-control studies that assessed the effectiveness of seasonal influenza vaccine against laboratory confirmed influenza in community-dwelling people aged 60 years or older. We used generalised linear mixed models, adapted for test-negative design case-control studies, to estimate vaccine effectiveness according to vaccine match and epidemic conditions. FINDINGS 35 test-negative design case-control studies with 53 datasets met inclusion criteria. Seasonal influenza vaccine was not significantly effective during local virus activity, irrespective of vaccine match or mismatch to the circulating viruses. Vaccination was significantly effective against laboratory confirmed influenza during sporadic activity (odds ratio [OR] 0·69, 95% CI 0·48-0·99) only when the vaccine matched. Additionally, vaccination was significantly effective during regional (match: OR 0·42, 95% CI 0·30-0·60; mismatch: OR 0·57, 95% CI 0·41-0·79) and widespread (match: 0·54, 0·46-0·62; mismatch: OR 0·72, 95% CI 0·60-0·85) outbreaks. INTERPRETATION Our findings show that in elderly people, irrespective of vaccine match, seasonal influenza vaccination is effective against laboratory confirmed influenza during epidemic seasons. Efforts should be renewed worldwide to further increase uptake of the influenza vaccine in the elderly population. FUNDING None.
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Affiliation(s)
- Maryam Darvishian
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Maarten J Bijlsma
- Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Eelko Hak
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Edwin R van den Heuvel
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, Netherlands.
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Cowling BJ, Chan KH, Feng S, Chan ELY, Lo JYC, Peiris JSM, Chiu SS. The effectiveness of influenza vaccination in preventing hospitalizations in children in Hong Kong, 2009-2013. Vaccine 2014; 32:5278-84. [PMID: 25092636 PMCID: PMC4165553 DOI: 10.1016/j.vaccine.2014.07.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/11/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
Background Influenza vaccination is widely recommended every year to protect individuals against influenza virus infection and illness. There are few published estimates of influenza vaccine effectiveness against hospitalization in children or from subtropical regions. Methods We conducted a test-negative year-round study between October 2009 and September 2013, recruiting children 6 months to 17 years of age admitted to two hospitals in Hong Kong with a febrile acute respiratory infection. Cases were tested for influenza A and B and conditional logistic regression was used to estimate vaccine effectiveness comparing influenza vaccination history of the trivalent influenza vaccine (TIV) among patients testing positive versus negative for influenza, adjusting for age and sex and matching by calendar week of recruitment. Results Overall vaccine effectiveness against hospitalization with laboratory-confirmed influenza A and B was estimated to be 61.7% (95% CI: 43.0%, 74.2%). The estimated vaccine effectiveness against A(H3N2) was 36.6% (95% CI: −25.5%, 67.9%) compared to 71.5% (95% CI: 39.4%, 86.6%) for A(H1N1)pdm09 and 68.8% (95% CI: 41.6%, 83.3%) for B. Conclusions Vaccine effectiveness against hospitalization in children varied from year to year, but was moderate to high overall even in an area with influenza activity throughout the year.
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Affiliation(s)
- Benjamin J Cowling
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Hung Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eunice L Y Chan
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Janice Y C Lo
- Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - J S Malik Peiris
- Division of Public Health Laboratory Sciences, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China; Centre for Influenza Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Susan S Chiu
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Puig-Barberà J, Natividad-Sancho A, Launay O, Burtseva E, Ciblak MA, Tormos A, Buigues-Vila A, Martínez-Úbeda S, Sominina A. 2012-2013 Seasonal influenza vaccine effectiveness against influenza hospitalizations: results from the global influenza hospital surveillance network. PLoS One 2014; 9:e100497. [PMID: 24945510 PMCID: PMC4063939 DOI: 10.1371/journal.pone.0100497] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/24/2014] [Indexed: 01/14/2023] Open
Abstract
Background The effectiveness of currently licensed vaccines against influenza has not been clearly established, especially among individuals at increased risk for complications from influenza. We used a test-negative approach to estimate influenza vaccine effectiveness (IVE) against hospitalization with laboratory-confirmed influenza based on data collected from the Global Influenza Hospital Surveillance Network (GIHSN). Methods and Findings This was a multi-center, prospective, active surveillance, hospital-based epidemiological study during the 2012–2013 influenza season. Data were collected from hospitals participating in the GIHSN, including five in Spain, five in France, and four in the Russian Federation. Influenza was confirmed by reverse transcription-polymerase chain reaction. IVE against hospitalization for laboratory-confirmed influenza was estimated for adult patients targeted for vaccination and who were swabbed within 7 days of symptom onset. The overall adjusted IVE was 33% (95% confidence interval [CI], 11% to 49%). Point estimates of IVE were 23% (95% CI, −26% to 53%) for influenza A(H1N1)pdm09, 30% (95% CI, −37% to 64%) for influenza A(H3N2), and 43% (95% CI, 17% to 60%) for influenza B/Yamagata. IVE estimates were similar in subjects <65 and ≥65 years of age (35% [95% CI, −15% to 63%] vs.31% [95% CI, 4% to 51%]). Heterogeneity in site-specific IVE estimates was high (I2 = 63.4%) for A(H1N1)pdm09 in patients ≥65 years of age. IVE estimates for influenza B/Yamagata were homogenous (I2 = 0.0%). Conclusions These results, which were based on data collected from the GIHSN during the 2012–2013 influenza season, showed that influenza vaccines provided low to moderate protection against hospital admission with laboratory-confirmed influenza in adults targeted for influenza vaccination. In this population, IVE estimates against A(H1N1)pdm09 were sensitive to age group and study site. Influenza vaccination was moderately effective in preventing admissions with influenza B/Yamagata for all sites and age groups.
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Affiliation(s)
- Joan Puig-Barberà
- Foundation for the Promotion of Health and Biomedical Research in the Valencia Region FISABIO – Public Health, Valencia, Spain
- * E-mail:
| | - Angels Natividad-Sancho
- Foundation for the Promotion of Health and Biomedical Research in the Valencia Region FISABIO – Public Health, Valencia, Spain
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, Inserm, CIC 1417 and the French Vaccine Research Network (REIVAC), Paris, France
| | - Elena Burtseva
- D.I. Ivanovsky Institute of Virology, Moscow, Russian Federation
| | - Meral A. Ciblak
- National Influenza Reference Laboratory Cappa-Istanbul, Istanbul, Turkey
| | - Anita Tormos
- Foundation for the Promotion of Health and Biomedical Research in the Valencia Region FISABIO – Public Health, Valencia, Spain
| | - Amparo Buigues-Vila
- Foundation for the Promotion of Health and Biomedical Research in the Valencia Region FISABIO – Public Health, Valencia, Spain
| | - Sergio Martínez-Úbeda
- Foundation for the Promotion of Health and Biomedical Research in the Valencia Region FISABIO – Public Health, Valencia, Spain
| | - Anna Sominina
- Research Institute of Influenza, St. Petersburg, Russian Federation
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McNeil SA, Shinde V, Andrew M, Hatchette TF, LeBlanc J, Ambrose A, Boivin G, Bowie WR, Diaz-Mitoma F, ElSherif M, Green K, Haguinet F, Halperin S, Ibarguchi B, Katz K, Langley JM, Lagacé-Wiens P, Light B, Loeb M, McElhaney JE, MacKinnon-Cameron D, McCarthy AE, Poirier M, Powis J, Richardson D, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, Ye L, McGeer A. Interim estimates of 2013/14 influenza clinical severity and vaccine effectiveness in the prevention of laboratory-confirmed influenza-related hospitalisation, Canada, February 2014. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.9.20729] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - V Shinde
- GlaxoSmithKline Biologicals, Wavre, Belgium
| | - M Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - T F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - W R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - F Diaz-Mitoma
- Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada
| | - M ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K Green
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - F Haguinet
- GlaxoSmithKline Biologicals, Wavre, Belgium
| | - S Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B Ibarguchi
- GlaxoSmithKline, Mississauga, Ontario, Canada
| | - K Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - JM Langley
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - B Light
- St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - M Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - J E McElhaney
- Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - M Poirier
- Centre de santé et de service sociaux de Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| | - J Powis
- Toronto East General Hospital, Toronto, Ontario, Canada
| | - D Richardson
- William Osler Health Centre, Brampton, Ontario, Canada
| | - M Semret
- McGill University, Montreal, Quebec, Canada
| | - S Smith
- University of Alberta, Edmonton, Alberta, Canada
| | - D Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - G Stiver
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - L Valiquette
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - D Webster
- Horizon Health, Saint John, New Brunswick, Canada
| | - L Ye
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
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McLean HQ, Meece JK, Belongia EA. Influenza vaccination and risk of hospitalization among adults with laboratory confirmed influenza illness. Vaccine 2014; 32:453-7. [DOI: 10.1016/j.vaccine.2013.11.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/12/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
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