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Ng C, Ye L, Noorduyn SG, Hux M, Thommes E, Goeree R, Ambrose A, Andrew MK, Hatchette T, Boivin G, Bowie W, ElSherif M, Green K, Johnstone J, Katz K, Leblanc J, Loeb M, MacKinnon‐Cameron D, McCarthy A, McElhaney J, McGeer A, Poirier A, Powis J, Richardson D, Sharma R, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. Resource utilization and cost of influenza requiring hospitalization in Canadian adults: A study from the serious outcomes surveillance network of the Canadian Immunization Research Network. Influenza Other Respir Viruses 2018; 12:232-240. [PMID: 29125689 PMCID: PMC5820421 DOI: 10.1111/irv.12521] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Consideration of cost determinants is crucial to inform delivery of public vaccination programs. OBJECTIVES To estimate the average total cost of laboratory-confirmed influenza requiring hospitalization in Canadians prior to, during, and 30 days following discharge. To analyze effects of patient/disease characteristics, treatment, and regional differences in costs. METHODS Study utilized previously recorded clinical characteristics, resource use, and outcomes of laboratory-confirmed influenza patients admitted to hospitals in the Serious Outcomes Surveillance (SOS), Canadian Immunization Research Network (CIRN), from 2010/11 to 2012/13. Unit costs including hospital overheads were linked to inpatient/outpatient resource utilization before and after admissions. RESULTS Dataset included 2943 adult admissions to 17 SOS Network hospitals and 24 Toronto Invasive Bacterial Disease Network hospitals. Mean age was 69.5 years. Average hospital stay was 10.8 days (95% CI: 10.3, 11.3), general ward stays were 9.4 days (95% CI: 9.0, 9.8), and ICU stays were 9.8 days (95% CI: 8.6, 11.1) for the 14% of patients admitted to the ICU. Average cost per case was $14 612 CAD (95% CI: $13 852, $15 372) including $133 (95% CI: $116, $150) for medical care prior to admission, $14 031 (95% CI: $13 295, $14 768) during initial hospital stay, $447 (95% CI: $271, $624) post-discharge, including readmission within 30 days. CONCLUSION The cost of laboratory-confirmed influenza was higher than previous estimates, driven mostly by length of stay and analyzing only laboratory-confirmed influenza cases. The true per-patient cost of influenza-related hospitalization has been underestimated, and prevention programs should be evaluated in this context.
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Affiliation(s)
| | - Lingyun Ye
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | | | | | | | - Ardith Ambrose
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Melissa K. Andrew
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Todd Hatchette
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Guy Boivin
- Centre Hospitalier Universitaire de QuébecQuébecQCCanada
| | | | - May ElSherif
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | | | - Kevin Katz
- North York General HospitalTorontoONCanada
| | - Jason Leblanc
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | - Donna MacKinnon‐Cameron
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Anne McCarthy
- The Ottawa HospitalOttawa Hospital Civic CampusOttawaONCanada
| | | | | | - Andre Poirier
- Centre de santé et de service sociaux de Trois‐RivièresTrois RivièresQCCanada
| | | | - David Richardson
- Department of Infectious Diseases and Medical MicrobiologyWilliam Osler Health SystemBramptonONCanada
| | | | - Makeda Semret
- McGill University Health CentreMcGill UniversityMontrealQCCanada
| | | | | | | | | | | | | | - Shelly A. McNeil
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
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3
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Bettinger JA, Rouleau I, Gariépy MC, Bowie WR, Valiquette L, Vanderkooi OG, Kellner JD, Coleman BL, McNeil SA, McCarthy A, De Serres G. Successful methodology for large-scale surveillance of severe events following influenza vaccination in Canada, 2011 and 2012. Euro Surveill 2015; 20:21189. [DOI: 10.2807/1560-7917.es2015.20.29.21189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - I Rouleau
- Centre de Recherche du CHU de Québec, Laval University, Canada
| | - M C Gariépy
- Centre de Recherche du CHU de Québec, Laval University, Canada
| | - W R Bowie
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Valiquette
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - O G Vanderkooi
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - J D Kellner
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - B L Coleman
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - A McCarthy
- Ottawa Hospital, Ottawa, Ontario, Canada
| | - G De Serres
- Centre de Recherche du CHU de Québec, Laval University, Canada
- Institut National de Santé Publique du Quebec, Quebec City, Quebec, Canada
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Abstract
Objective This report summarizes influenza activity in Canada during the 2012-13 influenza season (August 26, 2012-August 24, 2013) from data obtained through the FluWatch surveillance program. Methods FluWatch collected information from six primary indicators of influenza activity that describe the epidemiologic and virologic behaviour of influenza in Canada: sentinel laboratory-based influenza detections; strain characterization and antiviral resistance for circulating influenza viruses; primary care consultation rates of influenza-like illness; regional influenza activity levels; influenza-associated severe outcomes; and pharmacy surveillance. Results The influenza season peaked nationally between late December 2012 and early January 2013 with influenza A(H3N2) identified as the predominant circulating influenza strain until early March, when influenza B became the predominant circulating strain. The cumulative reported hospitalization rates for all age groups were 25.0 per 100,000. Influenza A most greatly affected adults ≥65 years of age and influenza B most greatly affected children ≤19 years of age. Conclusion The influenza season was moderately severe. When compared to the previous two seasons, which were considered relatively mild, there was a significant increase in laboratory detections for influenza, as well as hospitalizations associated with influenza in 2012-13.
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Herman M, Smieja M, Carruthers S, Loeb M. Oseltamivir use amongst hospitalized patients infected with influenza. Influenza Other Respir Viruses 2014; 8:547-8. [PMID: 24996027 PMCID: PMC4181818 DOI: 10.1111/irv.12260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Michael Herman
- Department of Medicine, McMaster UniversityHamilton, ON, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster UniversityHamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster UniversityHamilton, ON, Canada
- Institute for Infectious Diseases Research, McMaster UniversityHamilton, ON, Canada
| | - Susan Carruthers
- Department of Pathology and Molecular Medicine, McMaster UniversityHamilton, ON, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster UniversityHamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster UniversityHamilton, ON, Canada
- Institute for Infectious Diseases Research, McMaster UniversityHamilton, ON, Canada
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6
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Skowronski DM, Janjua NZ, De Serres G, Sabaiduc S, Eshaghi A, Dickinson JA, Fonseca K, Winter AL, Gubbay JB, Krajden M, Petric M, Charest H, Bastien N, Kwindt TL, Mahmud SM, Van Caeseele P, Li Y. Low 2012-13 influenza vaccine effectiveness associated with mutation in the egg-adapted H3N2 vaccine strain not antigenic drift in circulating viruses. PLoS One 2014; 9:e92153. [PMID: 24667168 PMCID: PMC3965421 DOI: 10.1371/journal.pone.0092153] [Citation(s) in RCA: 317] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/17/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is generally interpreted in the context of vaccine match/mismatch to circulating strains with evolutionary drift in the latter invoked to explain reduced protection. During the 2012-13 season, however, detailed genotypic and phenotypic characterization shows that low VE was instead related to mutations in the egg-adapted H3N2 vaccine strain rather than antigenic drift in circulating viruses. METHODS/FINDINGS Component-specific VE against medically-attended, PCR-confirmed influenza was estimated in Canada by test-negative case-control design. Influenza A viruses were characterized genotypically by amino acid (AA) sequencing of established haemagglutinin (HA) antigenic sites and phenotypically through haemagglutination inhibition (HI) assay. H3N2 viruses were characterized in relation to the WHO-recommended, cell-passaged vaccine prototype (A/Victoria/361/2011) as well as the egg-adapted strain as per actually used in vaccine production. Among the total of 1501 participants, influenza virus was detected in 652 (43%). Nearly two-thirds of viruses typed/subtyped were A(H3N2) (394/626; 63%); the remainder were A(H1N1)pdm09 (79/626; 13%), B/Yamagata (98/626; 16%) or B/Victoria (54/626; 9%). Suboptimal VE of 50% (95%CI: 33-63%) overall was driven by predominant H3N2 activity for which VE was 41% (95%CI: 17-59%). All H3N2 field isolates were HI-characterized as well-matched to the WHO-recommended A/Victoria/361/2011 prototype whereas all but one were antigenically distinct from the egg-adapted strain as per actually used in vaccine production. The egg-adapted strain was itself antigenically distinct from the WHO-recommended prototype, and bore three AA mutations at antigenic sites B [H156Q, G186V] and D [S219Y]. Conversely, circulating viruses were identical to the WHO-recommended prototype at these positions with other genetic variation that did not affect antigenicity. VE was 59% (95%CI:16-80%) against A(H1N1)pdm09, 67% (95%CI: 30-85%) against B/Yamagata (vaccine-lineage) and 75% (95%CI: 29-91%) against B/Victoria (non-vaccine-lineage) viruses. CONCLUSIONS These findings underscore the need to monitor vaccine viruses as well as circulating strains to explain vaccine performance. Evolutionary drift in circulating viruses cannot be regulated, but influential mutations introduced as part of egg-based vaccine production may be amenable to improvements.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Canada
- Case-Control Studies
- Child
- Child, Preschool
- DNA, Viral/genetics
- Female
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Humans
- Immunization
- Infant
- Infant, Newborn
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/genetics
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Middle Aged
- Molecular Sequence Data
- Mutation/genetics
- Protein Conformation
- Seasons
- Young Adult
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Affiliation(s)
- Danuta M. Skowronski
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Department of Biological and Occupational Risks, Institut National de Santé Publique du Québec, Québec (Québec), Canada
- Department of Social and Preventive Medicine, Laval University, Québec (Québec), Canada
| | - Suzana Sabaiduc
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Alireza Eshaghi
- Department of Molecular Research, Public Health Ontario, Toronto, Ontario, Canada
| | - James A. Dickinson
- Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Department of Virology, Provincial Laboratory of Public Health, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Luise Winter
- Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Jonathan B. Gubbay
- Department of Microbiology, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mel Krajden
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Martin Petric
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hugues Charest
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Département De Microbiologie, Infectiologie et Immunologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Bastien
- Influenza and Respiratory Virus Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Trijntje L. Kwindt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Salaheddin M. Mahmud
- Community Health Sciences and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yan Li
- Influenza and Respiratory Virus Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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7
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Wong VWY, Fong DYT, Tarrant M. Brief education to increase uptake of influenza vaccine among pregnant women: a study protocol for a randomized controlled trial. BMC Pregnancy Childbirth 2014; 14:19. [PMID: 24423245 PMCID: PMC3898030 DOI: 10.1186/1471-2393-14-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Pregnant women are the highest priority group for annual influenza vaccination. Studies have shown unacceptably low uptake of both seasonal and pandemic A/H1N1 influenza vaccination among pregnant women. This paper will describe the study protocol and methodology of a randomised controlled trial designed to assess the effectiveness of a brief educational intervention in improving the uptake of seasonal influenza vaccine among pregnant women in Hong Kong. Methods A randomised controlled trial will be conducted with pregnant women in at least the second trimester of pregnancy from four publicly funded hospital antenatal clinics in Hong Kong. Participants will be randomly assigned to either one of the two treatment groups: standard care (control) or standard care plus brief education (intervention). Pregnant women in the standard care group will receive the usual antenatal care with an educational pamphlet developed by the Hong Kong Centre for Health Protection and those in the intervention group will be provided with usual care plus a brief ten-minute education intervention. Content of the education session will cover four core components recommended in the research literature. The primary study outcome will be the proportion of participants who have received influenza vaccine during their pregnancy. A total of 184 pregnant women (92 per group) will be required to give an 80% power to detect a treatment effect of 15%. Discussion Most intervention studies aimed at improving influenza vaccination rates in pregnant women have targeted obstetric-care providers and the results of the two patient-oriented RCT interventions are conflicting. The high priority for vaccination given to pregnant women and the low influenza vaccination rate among pregnant women worldwide strongly indicates a need for interventions to improve uptake. Trial registration This trial is registered with the Clinical Trials Registry at www.clinicaltrials.gov(NCT01772901).
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Affiliation(s)
| | | | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China.
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