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Briga M, Goult E, Brett TS, Rohani P, Domenech de Cellès M. Maternal pertussis immunization and the blunting of routine vaccine effectiveness: a meta-analysis and modeling study. Nat Commun 2024; 15:921. [PMID: 38297003 PMCID: PMC10830464 DOI: 10.1038/s41467-024-44943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38-1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization's short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.
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Affiliation(s)
- Michael Briga
- Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany.
| | - Elizabeth Goult
- Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Tobias S Brett
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
- Center of Ecology of Infectious Diseases, University of Georgia, Athens, GA, 30602, USA
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de St. Maurice A, Martin‐Blais R, Halasa N. Preparing for the 2020-2021 influenza season. Pediatr Transplant 2021; 25:e14025. [PMID: 33904211 PMCID: PMC8237025 DOI: 10.1111/petr.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has altered health seeking behaviors and has increased attention to non-pharmaceutical interventions that reduce the risk of transmission of respiratory viruses including SARS-CoV-2 and influenza. While the potential impact of the COVID-19 pandemic on influenza is not fully known, in the Southern hemisphere influenza infection rates appear to be very low. Influenza vaccine efficacy for 2019-2020 season was comparable to prior season and influenza vaccine recommendations for pediatric immunizations remain similar to prior years. Influenza treatments continue to include neuraminidase inhibitors as well as baloxavir for treatment and in some instances prophylaxis.
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Affiliation(s)
- Annabelle de St. Maurice
- Division of Pediatric Infectious DiseasesDepartment of PediatricsUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Rachel Martin‐Blais
- Division of Pediatric Infectious DiseasesDepartment of PediatricsUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Natasha Halasa
- Division of Pediatric Infectious DiseasesDepartment of PediatricsVanderbilt University Medical CenterLos AngelesCAUSA
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Mazagatos C, Godoy P, Muñoz Almagro C, Pozo F, Larrauri A. Effectiveness of influenza vaccination during pregnancy to prevent severe infection in children under 6 months of age, Spain, 2017-2019. Vaccine 2020; 38:8405-8410. [PMID: 32741669 DOI: 10.1016/j.vaccine.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/14/2020] [Accepted: 07/09/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Influenza vaccination is recommended to pregnant women in Spain to reduce the risk of influenza-related complications. Influenza related hospitalizations pose a significant disease burden in children every year. Although children below 6 months are too young to be vaccinated, they can receive protection against influenza through vaccination of their mothers during pregnancy. We estimated the effectiveness of maternal influenza vaccination to prevent influenza hospitalizations in infants under 6 months of age. METHODS This is a retrospective pilot study, using data from the Severe Hospitalized Confirmed Influenza Cases (SHCIC) surveillance system in seasons 2017/18 and 2018/19 in Spain. Maternal vaccination status during pregnancy was collected for cases in children 6 months and younger hospitalized with confirmed influenza infection. Influenza vaccine effectiveness was estimated using the screening method, by comparing the proportion of children with vaccinated mothers during pregnancy (proportion of cases vaccinated, PCV), with the vaccination coverage among pregnant women in Spain (proportion of population vaccinated, PPV). RESULTS For all the study period, the PCV was 17% and the PPV was 35%. Influenza vaccination in mothers during pregnancy prevented influenza confirmed hospitalizations in infants aged 6 months and younger with a 61% (95%CI: 27-79%) effectiveness. CONCLUSIONS In line with evidence from other countries, influenza vaccination during pregnancy protects infants up to 6 months of age from influenza hospitalizations in Spain. These results support current recommendations of influenza vaccination in pregnant women, and more studies are needed in Spain to confirm the double protection of maternal vaccination in mothers and infants.
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Affiliation(s)
- Clara Mazagatos
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Pere Godoy
- Servicio de Vigilancia y Salud, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Carmen Muñoz Almagro
- Dirección General de Salud Pública, Aragón, Spain; Servicio de Vigilancia Epidemiológica, Dirección General de Salud Pública, Consejería de Sanidad, Asturias, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Francisco Pozo
- Servicio de Epidemiología, Dirección General de Salud Pública y Participación, Baleares, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - A Larrauri
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain.
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Domínguez A, Soldevila N, Toledo D, Godoy P, Espejo E, Fernandez MA, Mayoral JM, Castilla J, Egurrola M, Tamames S, Astray J, Morales-Suárez-Varela M. The effectiveness of influenza vaccination in preventing hospitalisations of elderly individuals in two influenza seasons: a multicentre case-control study, Spain, 2013/14 and 2014/15. ACTA ACUST UNITED AC 2018; 22. [PMID: 28857047 PMCID: PMC5753443 DOI: 10.2807/1560-7917.es.2017.22.34.30602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/10/2017] [Indexed: 11/20/2022]
Abstract
Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case–control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22–47). VE was 51% (95% CI: 15–71) in patients without high-risk medical conditions and 30% (95% CI: 14–44) in patients with them. VE was 39% (95% CI: 20–53) in patients aged 65–79 years and 34% (95% CI: 11–51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals.
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Affiliation(s)
- Angela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Núria Soldevila
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Diana Toledo
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pere Godoy
- Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Lleida, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | | | | | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain
| | | | - Sonia Tamames
- Dirección General de Salud Pública, Investigación, Desarrollo e Innovación, Junta de Castilla y León, León, Spain
| | | | - María Morales-Suárez-Varela
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain
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- The members of the Working Group are listed at the end of the article
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Estimation of seasonal influenza vaccine effectiveness using data collected in primary care in France: comparison of the test-negative design and the screening method. Clin Microbiol Infect 2017; 24:431.e5-431.e12. [PMID: 28899840 DOI: 10.1016/j.cmi.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/09/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We discussed which method between the test-negative design (TND) and the screening method (SM) could provide more robust real-time and end-of-season vaccine effectiveness (VE) estimates using data collected from routine influenza surveillance in primary care. METHODS We used data collected during two influenza seasons, 2014-15 and 2015-16. Using the SM, we estimated end-of-season VE in preventing medically attended influenza-like illness and laboratory-confirmed influenza among the population at risk. Using the TND, we estimated end-of-season VE in preventing influenza among both the general and the at-risk population. We estimated real-time VE using both methods. RESULTS For the SM, the overall adjusted end-of-season VE was 24% (95% confidence interval (CI), 16 to 32) and 12% (95% CI, -16 to 33) during season 2014-15, and 53% (95% CI, 44 to 60) and 47% (95% CI, 23 to 64) during season 2015-16, in preventing influenza-like illness and laboratory-confirmed influenza, respectively. For the TND, the overall adjusted end-of-season VE was -17% (95% CI, -79 to 24) and -38% (95% CI, -199 to 13) in 2014-15, and 10% (95% CI, -31 to 39) and 18% (95% CI, -33 to 50) in 2015-16, among the general and at-risk population, respectively. Real-time VE estimates obtained through the TND showed more variability across each season and lower precision than those estimated with the SM. CONCLUSIONS Although the worldwide use of the TND allows for comparison of overall VE estimates among countries, the SM performs better in providing robust real-time VE estimates among the population at risk.
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Souty C, Vilcu AM, Capai L, van der Werf S, Valette M, Blanchon T, Lina B, Behillil S, Hanslik T, Falchi A. Early estimates of 2016/17 seasonal influenza vaccine effectiveness in primary care in France. J Clin Virol 2017; 95:1-4. [PMID: 28818690 DOI: 10.1016/j.jcv.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/24/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The ongoing 2016/17 influenza epidemic in France is characterized by the circulation of A(H3N2) viruses, known to cause more severe illness among at risk populations. OBJECTIVES The purpose of our study was to provide early influenza vaccine effectiveness (IVE) estimates for the ongoing influenza epidemic in France and compare these estimates over the six post-pandemic IVE. STUDY DESIGN We used clinical and virological data collected in primary care by the French Sentinelles network. IVE in preventing influenza infection was estimated by the test-negative design method. The screening method was used to estimate IVE in preventing medically-attended influenza-like illness among target groups (<65year with chronic diseases and ≥65 years) since 2010/11 influenza epidemic. RESULTS Early IVE estimates in primary care against influenza A(H3N2) were 48% (95% confidence interval (CI): 22-66) overall and 39% (95% CI: -17 to 69) among elderly (aged 65 and older). In comparison to the last six epidemics, 2016/17 early IVE in preventing influenza-like illness among target groups showed VE estimates higher to those reported during the 2011/12 and 2014/15 epidemics. CONCLUSIONS The moderate 2016/17 IVE estimates were higher than those estimated during influenza A(H3N2) epidemics with vaccine mismatch.
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Affiliation(s)
- Cécile Souty
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.
| | - Ana-Maria Vilcu
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Lisandru Capai
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France; EA7310, Université de Corse, Inserm, France
| | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, UMR 3569 CNRS, Université Paris Diderot SPC, Institut Pasteur, Paris, France; CNR des Virus influenzae, Institut Pasteur, Paris, France
| | - Martine Valette
- Laboratoire de Virologie, CNR des virus influenza, Institut des Agents Infectieux, Groupement Hospitalier Nord des HCL, Lyon, France; Laboratoire Virpath, CIRI Inserm U1111, CNRS 5308, ENS, UCBL, Faculté de Médecine LYON Est, Université de Lyon, Lyon, France
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Bruno Lina
- Laboratoire de Virologie, CNR des virus influenza, Institut des Agents Infectieux, Groupement Hospitalier Nord des HCL, Lyon, France; Laboratoire Virpath, CIRI Inserm U1111, CNRS 5308, ENS, UCBL, Faculté de Médecine LYON Est, Université de Lyon, Lyon, France
| | - Sylvie Behillil
- Unité de Génétique Moléculaire des Virus à ARN, UMR 3569 CNRS, Université Paris Diderot SPC, Institut Pasteur, Paris, France; CNR des Virus influenzae, Institut Pasteur, Paris, France
| | - Thomas Hanslik
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France; AP-HP, Hôpital Ambroise Paré, service de médecine interne, Boulogne-Billancourt, France; UFR des Sciences de la Santé Simone-Veil,Université Versailles Saint Quentin en Yvelines, Versailles, France
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Argante L, Tizzoni M, Medini D. Fast and accurate dynamic estimation of field effectiveness of meningococcal vaccines. BMC Med 2016; 14:98. [PMID: 27363534 PMCID: PMC4929770 DOI: 10.1186/s12916-016-0642-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/10/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Estimating the effectiveness of meningococcal vaccines with high accuracy and precision can be challenging due to the low incidence of the invasive disease, which ranges between 0.5 and 1 cases per 100,000 in Europe and North America. Vaccine effectiveness (VE) is usually estimated with a screening method that combines in one formula the proportion of meningococcal disease cases that have been vaccinated and the proportion of vaccinated in the overall population. Due to the small number of cases, initial point estimates are affected by large uncertainties and several years may be required to estimate VE with a small confidence interval. METHODS We used a Monte Carlo maximum likelihood (MCML) approach to estimate the effectiveness of meningococcal vaccines, based on stochastic simulations of a dynamic model for meningococcal transmission and vaccination. We calibrated the model to describe two immunization campaigns: the campaign against MenC in England and the Bexsero campaign that started in the UK in September 2015. First, the MCML method provided estimates for both the direct and indirect effects of the MenC vaccine that were validated against results published in the literature. Then, we assessed the performance of the MCML method in terms of time gain with respect to the screening method under different assumptions of VE for Bexsero. RESULTS MCML estimates of VE for the MenC immunization campaign are in good agreement with results based on the screening method and carriage studies, yet characterized by smaller confidence intervals and obtained using only incidence data collected within 2 years of scheduled vaccination. Also, we show that the MCML method could provide a fast and accurate estimate of the effectiveness of Bexsero, with a time gain, with respect to the screening method, that could range from 2 to 15 years, depending on the value of VE measured from field data. CONCLUSIONS Results indicate that inference methods based on dynamic computational models can be successfully used to quantify in near real time the effectiveness of immunization campaigns against Neisseria meningitidis. Such an approach could represent an important tool to complement and support traditional observational studies, in the initial phase of a campaign.
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Affiliation(s)
- Lorenzo Argante
- Department of Physics and INFN, University of Turin, via Giuria 1, Turin, 10125, Italy.
- ISI Foundation, via Alassio 11/C, Turin, 10126, Italy.
- GSK Vaccines, Siena, Italy.
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Souty C, Blanchon T, Bonmarin I, Lévy-Bruhl D, Behillil S, Enouf V, Valette M, Bouscambert M, Turbelin C, Capai L, Roussel V, Hanslik T, Falchi A. Early estimates of 2014/15 seasonal influenza vaccine effectiveness in preventing influenza-like illness in general practice using the screening method in France. Hum Vaccin Immunother 2016; 11:1621-5. [PMID: 26061896 DOI: 10.1080/21645515.2015.1046661] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The ongoing influenza epidemic is characterized by intense activity with most influenza infections due to the A (H3N2) viruses. Using the screening method, mid-season vaccine effectiveness (VE) in preventing influenza-like illness in primary care was estimated to 32% (95% CI; 23 to 40) among risk groups and was 11% (95% CI; -4 to 23) among the elderly (≥ 65 y). The VE in ≥ 65 y was the lowest estimate regarding the 4 previous seasonal influenza epidemics.
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Affiliation(s)
- Cécile Souty
- a INSERM, UMR_S 1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique ; Paris , France
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Remschmidt C, Rieck T, Bödeker B, Wichmann O. Application of the screening method to monitor influenza vaccine effectiveness among the elderly in Germany. BMC Infect Dis 2015; 15:137. [PMID: 25887460 PMCID: PMC4371628 DOI: 10.1186/s12879-015-0882-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 03/12/2015] [Indexed: 11/11/2022] Open
Abstract
Background Elderly people are at increased risk for severe influenza illness and constitute therefore a major target-group for seasonal influenza vaccination in most industrialized countries. The aim of this study was to estimate influenza vaccine effectiveness (VE) among individuals aged 60+ years over three seasons and to assess if the screening method is a suitable tool to monitor influenza VE in this particular target-group in Germany. Methods We identified laboratory-confirmed influenza cases aged 60+ years through the national communicable disease reporting system for seasons 2010/11, 2011/12 and 2012/13. Vaccination coverage (VC) data were retrieved from a database of health insurance claims representing ~85% of the total German population. We applied the screening method to calculate influenza subtype-specific VE and compared our results with VE estimates from other observational studies in Europe. Results In total, 7,156 laboratory-confirmed influenza cases were included. VE against all influenza types ranged between 49% (95% confidence interval [CI]: 39–56) in 2011/12 and 80% (95% CI: 76-83%) in 2010/11. In 2010/11 subtype-specific VE against influenza A(H1N1)pdm and B was 76% and 84%, respectively. In the following seasons, VE against influenza A(H1N1)pdm, A(H3N2) and B was 87%, -9% , 74% (2011/12), and 74%, 39%, 73% (2012/13). VE was higher among hospitalized compared to non-hospitalized influenza A cases. Seventeen observational studies from Europe reporting subtype-specific VE among the elderly were identified for the respective seasons (all applying the test-negative design) and showed comparable subtype-specific VE estimates. Conclusions According to our study, influenza vaccination provided moderate protection against laboratory-confirmed influenza A(H1N1)pdm and B in individuals aged 60+ but no or only little protection against A(H3N2). Higher VE among hospitalized cases might indicate higher protection against severe influenza disease. Based on the available data, the screening method allowed us to assess subtype-specific VE in hospitalized and non-hospitalized elderly persons. Since controlling for several important confounders was not possible, the applied method only provided crude VE estimates. However, given the precise VC-data and the large number of cases, the screening method provided results being in line with VE estimates from other observational studies in Europe that applied a different study design. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0882-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Thorsten Rieck
- Immunization Unit, Robert Koch Institute, Berlin, Germany. .,Charité - University Medicine Berlin, Berlin, Germany.
| | - Birte Bödeker
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
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