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Russell CA, Fouchier RAM, Ghaswalla P, Park Y, Vicic N, Ananworanich J, Nachbagauer R, Rudin D. Seasonal influenza vaccine performance and the potential benefits of mRNA vaccines. Hum Vaccin Immunother 2024; 20:2336357. [PMID: 38619079 PMCID: PMC11020595 DOI: 10.1080/21645515.2024.2336357] [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: 11/13/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
Influenza remains a public health threat, partly due to suboptimal effectiveness of vaccines. One factor impacting vaccine effectiveness is strain mismatch, occurring when vaccines no longer match circulating strains due to antigenic drift or the incorporation of inadvertent (eg, egg-adaptive) mutations during vaccine manufacturing. In this review, we summarize the evidence for antigenic drift of circulating viruses and/or egg-adaptive mutations occurring in vaccine strains during the 2011-2020 influenza seasons. Evidence suggests that antigenic drift led to vaccine mismatch during four seasons and that egg-adaptive mutations caused vaccine mismatch during six seasons. These findings highlight the need for alternative vaccine development platforms. Recently, vaccines based on mRNA technology have demonstrated efficacy against SARS-CoV-2 and respiratory syncytial virus and are under clinical evaluation for seasonal influenza. We discuss the potential for mRNA vaccines to address strain mismatch, as well as new multi-component strategies using the mRNA platform to improve vaccine effectiveness.
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Affiliation(s)
- Colin A. Russell
- Department of Medical Microbiology & Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron A. M. Fouchier
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
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Anoma S, Bhattarakosol P, Kowitdamrong E. Characteristics and evolution of hemagglutinin and neuraminidase genes of Influenza A(H3N2) viruses in Thailand during 2015 to 2018. PeerJ 2024; 12:e17523. [PMID: 38846750 PMCID: PMC11155671 DOI: 10.7717/peerj.17523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
Background Influenza A(H3N2) virus evolves continuously. Its hemagglutinin (HA) and neuraminidase (NA) genes have high genetic variation due to the antigenic drift. This study aimed to investigate the characteristics and evolution of HA and NA genes of the influenza A(H3N2) virus in Thailand. Methods Influenza A positive respiratory samples from 2015 to 2018 were subtyped by multiplex real-time RT-PCR. Full-length HA and NA genes from the positive samples of influenza A(H3N2) were amplified and sequenced. Phylogenetic analysis with the maximum likelihood method was used to investigate the evolution of the virus compared with the WHO-recommended influenza vaccine strain. Homology modeling and N-glycosylation site prediction were also performed. Results Out of 443 samples, 147 (33.18%) were A(H1N1)pdm09 and 296 (66.82%) were A(H3N2). The A(H3N2) viruses circulating in 2015 were clade 3C.2a whereas sub-clade 3C.2a1 and 3C.2a2 dominated in 2016-2017 and 2018, respectively. Amino acid substitutions were found in all antigenic sites A, B, C, D, and E of HA but the majority of the substitutions were located at antigenic sites A and B. The S245N and N329S substitutions in the NA gene affect the N-glycosylation. None of the mutations associated with resistance to NA inhibitors were observed. Mean evolutionary rates of the HA and NA genes were 3.47 × 10 -3 and 2.98 × 10-3 substitutions per site per year. Conclusion The influenza A(H3N2) virus is very genetically diverse and is always evolving to evade host defenses. The HA and NA gene features including the evolutionary rate of the influenza A(H3N2) viruses that were circulating in Thailand between 2015 and 2018 are described. This information is useful for monitoring the genetic characteristics and evolution in HA and NA genes of influenza A(H3N2) virus in Thailand which is crucial for predicting the influenza vaccine strains resulting in high vaccine effectiveness.
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Affiliation(s)
- Sasiprapa Anoma
- Interdisciplinary Program in Medical Microbiology, Graduated School, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Applied Medical Virology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Parvapan Bhattarakosol
- Center of Excellence in Applied Medical Virology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Virology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ekasit Kowitdamrong
- Center of Excellence in Applied Medical Virology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Virology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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3
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Akhtar Z, Götberg M, Erlinge D, Christiansen EH, Oldroyd KG, Motovska Z, Erglis A, Hlinomaz O, Jakobsen L, Engstrøm T, Jensen LO, Fallesen CO, Jensen SE, Angerås O, Calais F, Kåregren A, Lauermann J, Mokhtari A, Nilsson J, Persson J, Islam AKMM, Rahman A, Malik F, Choudhury S, Collier T, Pocock SJ, Pernow J, MacIntyre CR, Fröbert O. Optimal timing of influenza vaccination among patients with acute myocardial infarction - Findings from the IAMI trial. Vaccine 2023; 41:7159-7165. [PMID: 37925315 DOI: 10.1016/j.vaccine.2023.10.028] [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: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Influenza vaccination reduces the risk of adverse cardiovascular events.The IAMI trial randomly assigned 2571 patients with acute myocardial infarction (AMI) to receive influenza vaccine or saline placebo during their index hospital admission. It was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. In this post-hoc exploratory sub-study, we compare the trial outcomes in patients receiving early season vaccination (n = 1188) and late season vaccination (n = 1344).The primary endpoint wasthe composite of all-cause death, myocardial infarction (MI), or stent thrombosis at 12 months. Thecumulative incidence of the primary and key secondary endpoints by randomized treatment and early or late vaccination was estimated using the Kaplan-Meier method. In the early vaccinated group, the primary composite endpoint occurred in 36 participants (6.0%) assigned to influenza vaccine and 49 (8.4%) assigned to placebo (HR 0.69; 95% CI 0.45 to 1.07), compared to 31 participants (4.7%) assigned to influenza vaccine and 42 (6.2%) assigned to placebo (HR 0.74; 95% CI 0.47 to 1.18) in the late vaccinated group (P = 0.848 for interaction on HR scale at 1 year). We observed similar estimates for the key secondary endpoints of all-cause death and CV death. There was no statistically significant difference in vaccine effectiveness against adverse cardiovascular events by timing of vaccination. The effect of vaccination on all-cause death at one year was more pronounced in the group receiving early vaccination (HR 0.50; 95% CI, 0.29 to 0.86) compared late vaccination group (HR 0.75; 35% CI, 0.40 to 1.40) but there was no statistically significant difference between these groups (Interaction P = 0.335). In conclusion,there is insufficient evidence from the trial to establish whether there is a difference in efficacy between early and late vaccinationbut regardless of vaccination timing we strongly recommend influenza vaccination in all patients with cardiovascular diseases.
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Affiliation(s)
- Zubair Akhtar
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia; Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Keith G Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne University Hospital and Masaryk University, Brno, Czech Republic
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Engstrøm
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Oskar Angerås
- Sahlgrenska University Hospital, Gothenburg, Sweden and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Gothenburg, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | | | - Jörg Lauermann
- Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
| | - Arash Mokhtari
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Nilsson
- Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Abu K M M Islam
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Afzalur Rahman
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Fazila Malik
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Sohel Choudhury
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Pernow
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Chandini R MacIntyre
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia; Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden; College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, USA; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Arhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Low ZY, Wong KH, Wen Yip AJ, Choo WS. The convergent evolution of influenza A virus: Implications, therapeutic strategies and what we need to know. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 5:100202. [PMID: 37700857 PMCID: PMC10493511 DOI: 10.1016/j.crmicr.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Influenza virus infection, more commonly known as the 'cold flu', is an etiological agent that gives rise to recurrent annual flu and many pandemics. Dated back to the 1918- Spanish Flu, the influenza infection has caused the loss of many human lives and significantly impacted the economy and daily lives. Influenza virus can be classified into four different genera: influenza A-D, with the former two, influenza A and B, relevant to humans. The capacity of antigenic drift and shift in Influenza A has given rise to many novel variants, rendering vaccines and antiviral therapies useless. In light of the emergence of a novel betacoronavirus, the SARS-CoV-2, unravelling the underpinning mechanisms that support the recurrent influenza epidemics and pandemics is essential. Given the symptom similarities between influenza and covid infection, it is crucial to reiterate what we know about the influenza infection. This review aims to describe the origin and evolution of influenza infection. Apart from that, the risk factors entail the implication of co-infections, especially regarding the COVID-19 pandemic is further discussed. In addition, antiviral strategies, including the potential of drug repositioning, are discussed in this context. The diagnostic approach is also critically discussed in an effort to understand better and prepare for upcoming variants and potential influenza pandemics in the future. Lastly, this review encapsulates the challenges in curbing the influenza spread and provides insights for future directions in influenza management.
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Affiliation(s)
- Zheng Yao Low
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ka Heng Wong
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ashley Jia Wen Yip
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Wee Sim Choo
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
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Lee HJ, Ryu G, Lee KI. Symptomatic Differences between Influenza A/H3N2 and A/H1N1 in Korea. J Clin Med 2023; 12:5651. [PMID: 37685717 PMCID: PMC10489067 DOI: 10.3390/jcm12175651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Limited understanding exists regarding clinical distinctions between influenza A/H3N2 and A/H1N1 subtypes, particularly in primary health care. We conducted a comparative analysis of symptomatic characteristics of influenza subtypes in Korea. This retrospective study analyzed medical records of patients who presented with positive test results for influenza-like illness (rapid influenza diagnostic test; RIDT) during the H3N2-dominant 2016-2017 and H1N1-dominant 2018-2019 seasons. Symptomatic manifestations, contact history, vaccination history, and clinical course were analyzed between the two seasons. The most frequent symptom in the RIDT-positive patients was fever (80.1% and 79.1%, respectively). The average body temperature was higher, and the number of patients with high fever was greater in the H3N2-dominant season than in the H1N1-dominant season (p < 0.001). Conversely, other symptoms, such as myalgia, cough, and sore throat, were significantly more common in the H1N1-dominant season than in the H3N2-dominant season (p < 0.001). Antiviral drugs were prescribed to most febrile RIDT-positive patients (82.2% and 81.3%, respectively, p = 0.516). Analyzing primary care data revealed different clinical manifestations according to the subtype. Therefore, physicians should consider these variable hallmarks and employ tailored therapeutic strategies to reduce the complication rate.
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Affiliation(s)
- Hyun-Jong Lee
- Lee and Hong ENT, Sleep and Cosmetic Center, Seongnam 13558, Republic of Korea;
| | - Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Ki-Il Lee
- Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
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6
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Cost Effectiveness of Quadrivalent Versus Trivalent Inactivated Influenza Vaccines for the Portuguese Elderly Population. Vaccines (Basel) 2022; 10:vaccines10081285. [PMID: 36016173 PMCID: PMC9416623 DOI: 10.3390/vaccines10081285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background: quadrivalent inactivated vaccine (QIV) has replaced trivalent inactivated vaccine (TIV). In Portugal, TIV is free of charge for risk groups, including older adults (≥65 years old). In its turn, QIV—which provides broader protection as it includes an additional lineage B strain—was introduced in Portugal in October 2018; only since the 2019/20 influenza season has it been provided free of charge for risk groups. This study evaluates the cost effectiveness of switching from TIV to QIV, from the National Health Service perspective, in the Portuguese elderly mainland population. Methods: A decision tree model was developed to compare TIV and QIV, based on Portuguese hospitalization data for the 2015/16 influenza season. The primary health economic outcome under consideration was the incremental cost-effectiveness ratio (ICER). In addition, one-way sensitivity analysis and probabilistic sensitivity analysis were performed. Results: the high cost of QIV (approximately three times the cost of TIV) would lead to a total increment of EUR 5,283,047, and the resulting ICER would be EUR 26,403,007/QALY, above the usual willingness-to-pay threshold. Conclusions: from the National Health Service perspective, our findings reveal that QIV is not cost effective for the Portuguese elderly population due to the high cost. If the QIV costs were the same as the TIV, then QIV would be cost effective.
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Rattanaburi S, Sawaswong V, Nimsamer P, Mayuramart O, Sivapornnukul P, Khamwut A, Chanchaem P, Kongnomnan K, Suntronwong N, Poovorawan Y, Payungporn S. Genome characterization and mutation analysis of human influenza A virus in Thailand. Genomics Inform 2022; 20:e21. [PMID: 35794701 PMCID: PMC9299564 DOI: 10.5808/gi.21077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
The influenza A viruses have high mutation rates and cause a serious health problem worldwide. Therefore, this study focused on genome characterization of the viruses isolated from Thai patients based on the next-generation sequencing technology. The nasal swabs were collected from patients with influenza-like illness in Thailand during 2017-2018. Then, the influenza A viruses were detected by reverse transcription-quantitative polymerase chain reaction and isolated by MDCK cells. The viral genomes were amplified and sequenced by Illumina MiSeq platform. Whole genome sequences were used for characterization, phylogenetic construction, mutation analysis and nucleotide diversity of the viruses. The result revealed that 90 samples were positive for the viruses including 44 of A/H1N1 and 46 of A/H3N2. Among these, 43 samples were successfully isolated and then the viral genomes of 25 samples were completely amplified. Finally, 17 whole genomes of the viruses (A/H1N1, n=12 and A/H3N2, n=5) were successfully sequenced with an average of 232,578 mapped reads and 1,720 genome coverage per sample. Phylogenetic analysis demonstrated that the A/H1N1 viruses were distinguishable from the recommended vaccine strains. However, the A/H3N2 viruses from this study were closely related to the recommended vaccine strains. The nonsynonymous mutations were found in all genes of both viruses, especially in HA and NA genes. The nucleotide diversity analysis revealed negative selection in the PB1, PA, hemagglutinin (HA) and neuraminidase (NA) genes of the A/H1N1 viruses. High-throughput data in this study allow for genetic characterization of circulating influenza viruses which would be crucial for preparation against pandemic and epidemic outbreaks in the future.
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Affiliation(s)
- Somruthai Rattanaburi
- Interdisciplinary Program of Biomedical Sciences, Graduate School, Chulalongkorn University, Bangkok 10330, Thailand.,Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Vorthon Sawaswong
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pattaraporn Nimsamer
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Oraphan Mayuramart
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pavaret Sivapornnukul
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Ariya Khamwut
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Prangwalai Chanchaem
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Kritsada Kongnomnan
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nungruthai Suntronwong
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sunchai Payungporn
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Debes S, Haug JB, de Blasio BF, Jonassen CM, Dudman SG. Etiology of viral respiratory tract infections in hospitalized adults, and evidence of the high frequency of prehospitalization antibiotic treatment in Norway. Health Sci Rep 2021; 4:e403. [PMID: 34646942 PMCID: PMC8499681 DOI: 10.1002/hsr2.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIMS Respiratory tract infections (RTIs) cause considerable morbidity and mortality in all age groups, but the epidemiology and role of several of the viral RTIs in the adult and elderly patients are still unclear, as is the extent of prehospitalization antibacterial drug use in this population. METHODS We conducted a three-year (2015-2018) observational study of viral RTIs in hospitalized patients in a 500-bed hospital in Southeastern Norway, including all patients ≥18 years with RTI symptoms where one of the following viral agents was detected in a respiratory specimen (Seegene Allplex): Influenza A/B, RSV A/B, human metapneumovirus (hMPV), adenovirus and parainfluenza virus 1-4. Viral findings, demographical data, and information on prehospital antibiotic prescriptions were recorded. RESULTS In 1182 patients 1222 viral infection events occurred. The mean patient age was 69.6 years, and 53% were females. Influenza virus A/B (63%), RSV A/B (15%) and hMPV (13%) were the most common agents detected. The proportional burden of influenza A H1 was found to be relatively high (65%) in the age groups <69 years, compared to older patients (P = .001, chi-square).As many as 20% of the patients had been treated with antibiotics prior to admission, with the lowest rate for influenza A H3 group at 17% (P = .036, chi-square), and highest for the RSV group at 28% (P = .004, chi-square).Oseltamivir was prescribed prior to hospitalization in only 3 cases (0.2%). CONCLUSIONS We found a high rate of prehospital antibiotic prescription in adults hospitalized with viral RTIs, warranting better stewardship programs to tackle the increasing antibiotic resistance problem.
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Affiliation(s)
- Sara Debes
- Østfold Hospital Trust, Center for Laboratory MedicineSarpsborgNorway
- Faculty of MedicineInstitute of Clinical Medicine, University of OsloOsloNorway
| | - Jon Birger Haug
- Department of Infection ControlØstfold Hospital TrustSarpsborgNorway
| | - Birgitte Freiesleben de Blasio
- Department of Methods Development and Analytics, Division of Infection Control and Environmental HealthNorwegian Institute of Public HealthOsloNorway
- Department of BiostatisticsCentre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of OsloOsloNorway
| | - Christine Monceyron Jonassen
- Østfold Hospital Trust, Center for Laboratory MedicineSarpsborgNorway
- Department of Chemistry, Biotechnology and Food ScienceNorwegian University of Life SciencesÅsNorway
| | - Susanne Gjeruldsen Dudman
- Faculty of MedicineInstitute of Clinical Medicine, University of OsloOsloNorway
- Department of MicrobiologyOslo University HospitalOsloNorway
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9
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Fröbert O, Götberg M, Erlinge D, Akhtar Z, Christiansen EH, MacIntyre CR, Oldroyd KG, Motovska Z, Erglis A, Moer R, Hlinomaz O, Jakobsen L, Engstrøm T, Jensen LO, Fallesen CO, Jensen SE, Angerås O, Calais F, Kåregren A, Lauermann J, Mokhtari A, Nilsson J, Persson J, Stalby P, Islam AKMM, Rahman A, Malik F, Choudhury S, Collier T, Pocock SJ, Pernow J. Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation 2021; 144:1476-1484. [PMID: 34459211 DOI: 10.1161/circulationaha.121.057042] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. METHODS We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis. RESULTS Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and individuals assigned to placebo equaled 1281; of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39-0.89]; P=0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39-0.90]; P=0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50-1.46]; P=0.57) in the influenza vaccine and placebo groups, respectively. CONCLUSIONS Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02831608.
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Affiliation(s)
- Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Sweden (O.F., F.C.)
| | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Sweden (M.G., D.E., A.M.)
| | - David Erlinge
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Sweden (M.G., D.E., A.M.)
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka (Z.A.)
| | | | - Chandini R MacIntyre
- The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, Australia (C.R.M.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom, and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (K.G.O.)
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M.)
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A.E.)
| | - Rasmus Moer
- LHL-sykehuset Gardermoen, Oslo, Norway (R.M.)
| | - Ota Hlinomaz
- International clinical research center, St. Anne University Hospital and Masaryk University, Brno, Czech Republic (O.H.)
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Denmark (E.H.C., L.J.)
| | | | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., C.O.F.)
| | | | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Denmark (S.E.J.)
| | - Oskar Angerås
- Sahlgrenska University Hospital and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Sweden (O.A.)
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Sweden (O.F., F.C.)
| | | | - Jörg Lauermann
- Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Sweden (J.L.)
| | - Arash Mokhtari
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Sweden (M.G., D.E., A.M.)
| | - Johan Nilsson
- Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Sweden (J.N.)
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden (J. Persson)
| | - Per Stalby
- Department of Cardiology, Karlstad Central Hospital, Sweden (P.S.)
| | - Abu K M M Islam
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Bangladesh (A.K.K.M.I., A.R.)
| | - Afzalur Rahman
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Bangladesh (A.K.K.M.I., A.R.)
| | - Fazila Malik
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh (F.M., S.C.)
| | - Sohel Choudhury
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh (F.M., S.C.)
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (T.C., S.J.P.)
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (T.C., S.J.P.)
| | - John Pernow
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (J. Pernow)
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10
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Influenza vaccine effectiveness within prospective cohorts of healthcare personnel in Israel and Peru 2016-2019. Vaccine 2021; 39:6956-6967. [PMID: 34509322 DOI: 10.1016/j.vaccine.2021.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are limited data on influenza vaccine effectiveness (IVE) in preventing laboratory-confirmed influenza illness among healthcare personnel (HCP). METHODS HCP with direct patient contact working full-time in hospitals were followed during three influenza seasons in Israel (2016-2017 to 2018-2019) and Peru (2016 to 2018). Trivalent influenza vaccines were available at all sites, except during 2018-2019 when Israel used quadrivalent vaccines; vaccination was documented by electronic medical records, vaccine registries, and/or self-report (for vaccinations outside the hospital). Twice-weekly active surveillance identified acute respiratory symptoms or febrile illness (ARFI); self-collected respiratory specimens were tested by real-time reverse transcription polymerase chain reaction (PCR) assay. IVE was 100 × 1-hazard ratio (adjusted for sex, age, occupation, and hospital). RESULTS Among 5,489 HCP who contributed 10,041 person-seasons, influenza vaccination coverage was 47% in Israel and 32% in Peru. Of 3,056 ARFIs in Israel and 3,538 in Peru, A or B influenza virus infections were identified in 205 (7%) in Israel and 87 (2.5%) in Peru. IVE against all viruses across seasons was 1% (95% confidence interval [CI] = -30%, 25%) in Israel and 12% (95% CI = -61%, 52%) in Peru. CONCLUSION Estimates of IVE were null using person-time models during six study seasons in Israel and Peru.
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11
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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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12
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Manini I, Camarri A, Marchi S, Trombetta CM, Vicenti I, Dragoni F, Lazzeri G, Bova G, Montomoli E, Capecchi PL. Surveillance for Severe Acute Respiratory Infections among Hospitalized Subjects from 2015/2016 to 2019/2020 Seasons in Tuscany, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083875. [PMID: 33917106 PMCID: PMC8067855 DOI: 10.3390/ijerph18083875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
In Italy, the influenza season lasts from October until April of the following year. Influenza A and B viruses are the two viral types that cocirculate during seasonal epidemics and are the main causes of respiratory infections. We analyzed influenza A and B viruses in samples from hospitalized patients at Le Scotte University Hospital in Siena (Central Italy). From 2015 to 2020, 182 patients with Severe Acute Respiratory Infections were enrolled. Oropharyngeal swabs were collected from patients and tested by means of reverse transcriptase-polymerase chain reaction to identify influenza A(H3N2), A(H1N1)pdm09 and B. Epidemiological and virological surveillance remain an essential tool for monitoring circulating viruses and possible mismatches with seasonal vaccine strains, and provide information that can be used to improve the composition of influenza vaccines.
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Affiliation(s)
- Ilaria Manini
- Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy; (S.M.); (C.M.T.); (G.L.); (E.M.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy
- Correspondence:
| | - Andrea Camarri
- Emergency and Transplants Department, University Hospital of Siena, Viale Bracci 16, 53100 Siena, Italy; (A.C.); (G.B.)
| | - Serena Marchi
- Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy; (S.M.); (C.M.T.); (G.L.); (E.M.)
| | - Claudia Maria Trombetta
- Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy; (S.M.); (C.M.T.); (G.L.); (E.M.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy
| | - Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (F.D.)
| | - Filippo Dragoni
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (F.D.)
| | - Giacomo Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy; (S.M.); (C.M.T.); (G.L.); (E.M.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy
| | - Giovanni Bova
- Emergency and Transplants Department, University Hospital of Siena, Viale Bracci 16, 53100 Siena, Italy; (A.C.); (G.B.)
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy; (S.M.); (C.M.T.); (G.L.); (E.M.)
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Via Pastore 1, 16132 Genoa, Italy
- VisMederi S.r.l., Strada del Petriccio e Belriguardo 35, 53100 Siena, Italy
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100 Siena, Italy;
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13
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Tanner AR, Dorey RB, Brendish NJ, Clark TW. Influenza vaccination: protecting the most vulnerable. Eur Respir Rev 2021; 30:30/159/200258. [PMID: 33650528 PMCID: PMC9488965 DOI: 10.1183/16000617.0258-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022] Open
Abstract
Influenza virus infection causes seasonal epidemics and occasional pandemics, leading to huge morbidity and mortality worldwide. Vaccination against influenza is needed annually as protection from constantly mutating strains is required. Groups at high risk of poor outcomes include the elderly, the very young, pregnant women and those with chronic health conditions. However, vaccine effectiveness in the elderly is generally poor due to immunosenescence and may be altered due to “original antigenic sin”. Strategies to overcome these challenges in the elderly include high-dose or adjuvant vaccines. Other options include vaccinating healthcare workers and children as this reduces community-level influenza transmission. Current guidelines in the UK are that young children receive a live attenuated nasal spray vaccine, adults aged >65 years receive an adjuvanted trivalent inactivated vaccine and adults aged <65 years with comorbidities receive a quadrivalent inactivated vaccine. The goal of a universal influenza vaccine targeting conserved regions of the virus and avoiding the need for annual vaccination is edging closer with early-phase trials under way. To protect the elderly from influenza, multiple strategies to overcome immunosenescence need to be utilised, such as improving vaccine efficacy, indirect protection via vaccinating children and healthcare workers, and developing a universal vaccinehttps://bit.ly/30KXzYn
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Affiliation(s)
- Alex R Tanner
- Dept of Medicine for the Elderly, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Robert B Dorey
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Dept of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Dept of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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14
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Ben Hamed S, Elargoubi A, Harrabi M, Srihi H, Souiai O, Mastouri M, Almalki MA, Gharbi J, Ben M'hadheb M. Phylogenetic analysis of the neuraminidase segment gene of Influenza A/H1N1 strains isolated from Monastir Region (Tunisia) during the 2017-2018 outbreak. Biologia (Bratisl) 2021; 76:1797-1806. [PMID: 33727729 PMCID: PMC7952816 DOI: 10.1007/s11756-021-00723-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Influenza A/H1N1 is widely considered to be a very evolutionary virus causing major public health problems. Since the pandemic of 2009, there has been a rapid rise in human Influenza virus characterization. However, little data is available in Tunisia regarding its genetic evolution. In light of this fact, our paper aim is to genetically characterize the Neuraminidase, known as the target of antiviral inhibitors, in Tunisian isolates circulating in Monastir region during 2017–2018. In total of 31 positive Influenza A/H1N1 detected by multiplex real-time PCR, RT-PCR of neuraminidase was performed. Among the 31 positive samples, 7 samples representing fatal and most severe cases were conducted for sequencing and genetic analysis. The results thus obtained showed genetic evolution of the A/H1N1 neuraminidase between 2009 and 2010 and 2018–2019 outbreaks. All Tunisian isolates were genetically related to the recommended vaccine strain with a specific evolution. Moreover, the phylogenetic analysis demonstrated that France and especially Italian strains were the major related strains. Interestingly, our results revealed a specific cluster of Tunisian isolates where two intragroup were evolved in correlation with the severity and the fatalities cases. From the outcome of our investigation, this study confirms the genetic evolution of the Influenza A virus circulating in Tunisia and gives a preliminary analysis for a better comprehension of new emerging Tunisian strain’s virulence and thus, a more appropriate monitoring of Influenza virus A/H1N1 during each round of outbreaks.
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Affiliation(s)
- Sabrine Ben Hamed
- Unité de Recherche UR17ES30 "Génomique Biotechnologie et Stratégies Antivirales" (ViroBiotech), Institut Supérieur de Biotechnologie, Université de Monastir, BP74, Avenue Tahar Hadded, Monastir, 5000 Tunisia
| | - Aida Elargoubi
- Laboratoire de Recherche LR99ES27 "Maladies Transmissibles & Substances Biologiquement Actives", Faculté de Pharmacie de Monastir, Avenue Avicenne, Monastir, Tunisia
| | - Myriam Harrabi
- Unité de Recherche UR17ES30 "Génomique Biotechnologie et Stratégies Antivirales" (ViroBiotech), Institut Supérieur de Biotechnologie, Université de Monastir, BP74, Avenue Tahar Hadded, Monastir, 5000 Tunisia.,Laboratoroire de "BioInformatique, bioMathematique & bioStatistique" (BIMS), Institut Pasteur de Tunis, BP 74, 13, place Pasteur Tunis, 1002 Tunis, Tunisia
| | - Haythem Srihi
- Unité de Recherche UR17ES30 "Génomique Biotechnologie et Stratégies Antivirales" (ViroBiotech), Institut Supérieur de Biotechnologie, Université de Monastir, BP74, Avenue Tahar Hadded, Monastir, 5000 Tunisia
| | - Oussema Souiai
- Laboratoroire de "BioInformatique, bioMathematique & bioStatistique" (BIMS), Institut Pasteur de Tunis, BP 74, 13, place Pasteur Tunis, 1002 Tunis, Tunisia
| | - Maha Mastouri
- Laboratoire de Recherche LR99ES27 "Maladies Transmissibles & Substances Biologiquement Actives", Faculté de Pharmacie de Monastir, Avenue Avicenne, Monastir, Tunisia
| | - Mohammed Awadh Almalki
- Department of Biological Sciences, College of Science, King Faisal University, P.O. Box 380, Al-Ahsa, 31982 Kingdom of Saudi Arabia
| | - Jawhar Gharbi
- Unité de Recherche UR17ES30 "Génomique Biotechnologie et Stratégies Antivirales" (ViroBiotech), Institut Supérieur de Biotechnologie, Université de Monastir, BP74, Avenue Tahar Hadded, Monastir, 5000 Tunisia.,Department of Biological Sciences, College of Science, King Faisal University, P.O. Box 380, Al-Ahsa, 31982 Kingdom of Saudi Arabia
| | - Manel Ben M'hadheb
- Unité de Recherche UR17ES30 "Génomique Biotechnologie et Stratégies Antivirales" (ViroBiotech), Institut Supérieur de Biotechnologie, Université de Monastir, BP74, Avenue Tahar Hadded, Monastir, 5000 Tunisia
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15
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Marbus SD, van der Hoek W, van Dissel JT, van Gageldonk-Lafeber AB. Experience of establishing severe acute respiratory surveillance in the Netherlands: Evaluation and challenges. PUBLIC HEALTH IN PRACTICE 2020; 1:100014. [PMID: 34171043 PMCID: PMC7260511 DOI: 10.1016/j.puhip.2020.100014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022] Open
Abstract
The 2009 influenza A (H1N1) pandemic prompted the World Health Organization (WHO) to recommend countries to establish a national severe acute respiratory infections (SARI) surveillance system for preparedness and emergency response. However, setting up or maintaining a robust SARI surveillance system has been challenging. Similar to other countries, surveillance data on hospitalisations for SARI in the Netherlands are still limited, in contrast to the robust surveillance data in primary care. The objective of this narrative review is to provide an overview, evaluation, and challenges of already available surveillance systems or datasets in the Netherlands, which might be used for near real-time surveillance of severe respiratory infections. Seven available surveillance systems or datasets in the Netherlands were reviewed. The evaluation criteria, including data quality, timeliness, representativeness, simplicity, flexibility, acceptability and stability were based on United States Centers for Disease Control and Prevention (CDC) and European Centre for Disease Prevention and Control (ECDC) guidelines for public health surveillance. We added sustainability as additional evaluation criterion. The best evaluated surveillance system or dataset currently available for SARI surveillance is crude mortality monitoring, although it lacks specificity. In contrast to influenza-like illness (ILI) in primary care, there is currently no gold standard for SARI surveillance in the Netherlands. Based on our experience with sentinel SARI surveillance, a fully or semi-automated, passive surveillance system seems most suited for a sustainable SARI surveillance system. An important future challenge remains integrating SARI surveillance into existing hospital programs in order to make surveillance data valuable for public health, as well as hospital quality of care management and individual patient care. Multiple surveillance systems or datasets are available in the Netherlands with potential use for SARI surveillance. There is currently no gold standard for SARI surveillance in the Netherlands. A potential sustainable SARI surveillance system for the long-term is a fully or semi-automated, passive surveillance system. SARI surveillance data should be valuable for both public health and individual patient care. An important future challenge remains integrating SARI surveillance into existing hospital programs.
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Affiliation(s)
- S D Marbus
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - J T van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Department of Infectious Diseases and Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - A B van Gageldonk-Lafeber
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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16
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de Lusignan S, Sherlock J, Akinyemi O, Pebody R, Elliot A, Byford R, Yonova I, Zambon M, Joy M. Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013-2018). BMC Public Health 2020; 20:1748. [PMID: 33218318 PMCID: PMC7677442 DOI: 10.1186/s12889-020-09790-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence. Methods We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality. Results The IRR where there was a child < 5 years were 1·62 (1·38–1·89, p < 0·0001), 2·40 (2.04–2.83, p < 0·0001) and 4·46 (3.79–5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness. The HR where there was a child < 5 years were 2·34 (95%CI 1·88–2·90, p < 0·0001), 2·97 (95%CI 2·76–3·2, p < 0·0001) and 10·32 (95%CI 10.04–10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size. Conclusions Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09790-3.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK. .,Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London, NW1 2FB, UK. .,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK.
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Richard Pebody
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Alex Elliot
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Ivelina Yonova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
| | - Maria Zambon
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.,Department of Clinical & Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK
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17
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Ward BJ, Makarkov A, Séguin A, Pillet S, Trépanier S, Dhaliwall J, Libman MD, Vesikari T, Landry N. Efficacy, immunogenicity, and safety of a plant-derived, quadrivalent, virus-like particle influenza vaccine in adults (18-64 years) and older adults (≥65 years): two multicentre, randomised phase 3 trials. Lancet 2020; 396:1491-1503. [PMID: 33065035 DOI: 10.1016/s0140-6736(20)32014-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Seasonal influenza remains a substantial public health threat despite the availability of egg-derived and other vaccines. Plant-based manufacturing might address some of the limitations of current vaccines. We describe two phase 3 efficacy studies of a recombinant quadrivalent virus-like particle (QVLP) influenza vaccine manufactured in plants, one in adults aged 18-64 years (the 18-64 study) and one in older people aged 65 years and older (the 65-plus study). METHODS We did two randomised, observer-blind, multinational studies in the northern hemisphere in the 2017-18 (the 18-64 study) and 2018-19 (the 65-plus study) influenza seasons. The 18-64 study was done at 73 sites and the 65-plus study was done at 104 sites, both across Asia, Europe, and North America. In the 18-64 study, inclusion criteria were body-mass index less than 40 kg/m2; age 18-64 years at screening visit; and good health. In the 65-plus study, inclusion criteria were body-mass index of maximum 35 kg/m2; aged 65 years or older at screening visit; not living in a rehabilitation centre or care home; and no acute or evolving medical problems. Participants in the 18-64 study were randomly assigned (1:1) to receive either QVLP vaccine (30 μg haemagglutinin per strain) or placebo. Participants in the 65-plus study were randomly assigned (1:1) to receive QVLP vaccine (30 μg haemagglutinin per strain) or quadrivalent inactivated vaccine (QIV; 15 μg haemagglutinin per strain). The primary outcome in the 18-64 study was absolute vaccine efficacy to prevent laboratory-confirmed, respiratory illness caused by antigenically matched influenza strains. The primary outcome in the 65-plus study was relative vaccine efficacy to prevent laboratory-confirmed influenza-like illness caused by any influenza strain. The primary analyses were done in the per-protocol population and safety was assessed in all participants who received the assigned treatment. These studies are registered with ClinicalTrials.gov (18-64 study NCT03301051; 65-plus study NCT03739112). FINDINGS In the 18-64 study, between Aug 30, 2017, and Jan 15, 2018, 10 160 participants were randomly assigned to receive either QVLP vaccine (5077 participants) or placebo (5083 participants). The per-protocol population consisted of 4814 participants in the QVLP group and 4812 in the placebo group. The study did not meet its primary endpoint of 70% absolute vaccine efficacy for the QVLP vaccine (35·1% [95% CI 17·9 to 48·7]) against respiratory illness caused by matched strains. 55 (1·1%) of 5064 participants in the QVLP group versus 51 (1·0%) of 5072 in the placebo group had a serious adverse event. Four (0·1%) and six [0·1%] participants had severe treatment-related treatment-emergent adverse events. In the 65-plus study, between Sept 18, 2018, and Feb 22, 2019, 12 794 participants were randomly assigned to receive either QVLP vaccine (6396 participants) or QIV (6398 participants). The per-protocol population consisted of 5996 participants in the QVLP group and 6026 in the QIV group. The study met its primary non-inferiority endpoint with a relative vaccine efficacy of the QVLP vaccine for the prevention of influenza-like illness caused by any strain of 8·8% (-16·7 to 28·7). 263 (4·1%) of 6352 participants in the QVLP group versus 266 (4·2%) of 6366 in the QIV group had serious adverse events (one [<0·1%] vs two [<0·1%] were considered treatment-related); one (<0·1%) versus three (<0·1%) participants had severe treatment-related treatment-emergent adverse events. INTERPRETATION These efficacy studies are the first large-scale studies of any plant-derived human vaccine. Together, they show that the plant-derived QVLP vaccine can provide substantial protection against respiratory illness and influenza-like illness caused by influenza viruses in adults. QVLP vaccine was well tolerated and no major safety signal arose in participants who received QVLP vaccine across the two studies. FUNDING Medicago.
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Affiliation(s)
- Brian J Ward
- Medicago, Quebec, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | | | | | - Michael D Libman
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Rizzo C, Gesualdo F, Loconsole D, Pandolfi E, Bella A, Orsi A, Guarona G, Panatto D, Icardi G, Napoli C, Orsi GB, Manini I, Montomoli E, Campagna I, Russo L, Alfonsi V, Puzelli S, Reale A, Raucci U, Piccioni L, Concato C, Ciofi Degli Atti ML, Villani A, Chironna M, Tozzi AE. Moderate Vaccine Effectiveness against Severe Acute Respiratory Infection Caused by A(H1N1)pdm09 Influenza Virus and No Effectiveness against A(H3N2) Influenza Virus in the 2018/2019 Season in Italy. Vaccines (Basel) 2020; 8:vaccines8030427. [PMID: 32751584 PMCID: PMC7564262 DOI: 10.3390/vaccines8030427] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/05/2023] Open
Abstract
Every season, circulating influenza viruses change; therefore, vaccines must be reformulated each year. We aimed to estimate vaccine effectiveness (VE) against severe influenza infection for the 2018/19 season in Italy. We conducted a test-negative design case-control study at five Italian hospitals. We estimated influenza VE against severe acute respiratory infection (SARI) requiring hospitalisation overall, and by virus subtype, vaccine brand, and age. The 2018/19 season was characterised by A(H1N1)pmd09 and A(H3N2) influenza viruses. Vaccine coverage among <18 years recruited SARI cases was very low (3.2%). Seasonal vaccines were moderately effective against type A influenza overall (adjusted VE = 40.5%; 95% confidence interval (CI) = 18.7–56.4%) and subtype A(H1N1)pmd09 viruses (adjusted VE = 55%; 95% CI = 34.5–69.1%), but ineffective against subtype A(H3N2) viruses (adjusted VE = 2.5%; 95% CI = −50.0–36.7%). Both Fluad and Fluarix Tetra vaccines were effective against type A influenza overall and subtype A(H1N1)pdm09 viruses. VE appeared to be similar across age groups (0–64 years, ≥65 years). Seasonal influenza vaccines in the 2018/19 season were moderately effective in preventing SARI caused by A(H1N1)pdm09 influenza but ineffective against A(H3N2).
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Affiliation(s)
- Caterina Rizzo
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
- Correspondence:
| | - Francesco Gesualdo
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Daniela Loconsole
- Department of Biomedical Science and Medical, Oncology of the University of Bari, 70120 Bari, Italy; (D.L.); (M.C.)
| | - Elisabetta Pandolfi
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, 00161 Rome, Italy; (A.B.); (S.P.)
| | - Andrea Orsi
- IRCCS University Hospital San Martino, 16100 Genoa, Italy; (A.O.); (G.G.); (D.P.); (G.I.)
| | - Giulia Guarona
- IRCCS University Hospital San Martino, 16100 Genoa, Italy; (A.O.); (G.G.); (D.P.); (G.I.)
| | - Donatella Panatto
- IRCCS University Hospital San Martino, 16100 Genoa, Italy; (A.O.); (G.G.); (D.P.); (G.I.)
| | - Giancarlo Icardi
- IRCCS University Hospital San Martino, 16100 Genoa, Italy; (A.O.); (G.G.); (D.P.); (G.I.)
| | - Christian Napoli
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza”, 00185 Rome, Italy;
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (G.B.O.); (I.M.)
| | - Ilaria Manini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (G.B.O.); (I.M.)
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy;
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy;
- Vaccine Assessment VisMederi Srl, 53100 Siena, Italy
| | - Ilaria Campagna
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Luisa Russo
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Valeria Alfonsi
- Medical Direction, University Hospital Sant’Andrea, 00189 Rome, Italy;
| | - Simona Puzelli
- Department of Infectious Diseases, National Institute of Health, 00161 Rome, Italy; (A.B.); (S.P.)
| | - Antonino Reale
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Umberto Raucci
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Livia Piccioni
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Carlo Concato
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Marta Luisa Ciofi Degli Atti
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Alberto Villani
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
| | - Maria Chironna
- Department of Biomedical Science and Medical, Oncology of the University of Bari, 70120 Bari, Italy; (D.L.); (M.C.)
| | - Alberto Eugenio Tozzi
- IRCCS, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.G.); (E.P.); (I.C.); (L.R.); (A.R.); (U.R.); (L.P.); (C.C.); (M.L.C.D.A.); (A.V.); (A.E.T.)
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19
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Mira-Iglesias A, López-Labrador FX, Baselga-Moreno V, Tortajada-Girbés M, Mollar-Maseres J, Carballido-Fernández M, Schwarz-Chavarri G, Puig-Barberà J, Díez-Domingo J, On Behalf Of The Valencia Hospital Network For The Study Of Influenza And Respiratory Viruses Disease. Influenza vaccine effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, Spain, 2017/18 influenza season. ACTA ACUST UNITED AC 2020; 24. [PMID: 31387672 PMCID: PMC6685101 DOI: 10.2807/1560-7917.es.2019.24.31.1800461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Influenza immunisation is recommended for elderly people each season. The influenza vaccine effectiveness (IVE) varies annually due to influenza viruses evolving and the vaccine composition. Aim To estimate, in inpatients ≥ 60 years old, the 2017/18 trivalent IVE, overall, by vaccine type and by strain. The impact of vaccination in any of the two previous seasons (2016/17 and 2015/16) on current (2017/18) IVE was also explored. Methods This was a multicentre prospective observational study within the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI, Spain). The test-negative design was applied taking laboratory-confirmed influenza as outcome and vaccination status as main exposure. Information about potential confounders was obtained from clinical registries and/or by interviewing patients; vaccine information was only ascertained by registries. Results Overall, 2017/18 IVE was 9.9% (95% CI: −15.5 to 29.6%), and specifically, 48.3% (95% CI: 13.5% to 69.1%), −29.9% (95% CI: −79.1% to 5.8%) and 25.7% (95% CI: −8.8% to 49.3%) against A(H1N1)pdm09, A(H3N2) and B/Yamagata lineage, respectively. For the adjuvanted and non-adjuvanted vaccines, overall IVE was 10.0% (95% CI: −24.4% to 34.9%) and 7.8% (95% CI: −23.1% to 31.0%) respectively. Prior vaccination significantly protected against influenza B/Yamagata lineage (IVE: 50.2%; 95% CI: 2.3% to 74.6%) in patients not vaccinated in the current season. For those repeatedly vaccinated against influenza A(H1N1)pdm09, IVE was 46.4% (95% CI: 6.8% to 69.2%). Conclusion Our data revealed low vaccine effectiveness against influenza in hospitalised patients ≥60 years old in 2017/18. Prior vaccination protected against influenza A(H1N1)pdm09 and B/Yamagata-lineage.
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Affiliation(s)
- Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - F Xavier López-Labrador
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | | | - Mario Carballido-Fernández
- Universidad CEU Cardenal Herrera, Castellón, Spain.,Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Joan Puig-Barberà
- Centro de Salud Pública de Castellón, Castellón, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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Pebody R, Djennad A, Ellis J, Andrews N, Marques DFP, Cottrell S, Reynolds AJ, Gunson R, Galiano M, Hoschler K, Lackenby A, Robertson C, O'Doherty M, Sinnathamby M, Panagiotopoulos N, Yonova I, Webb R, Moore C, Donati M, Sartaj M, Shepherd SJ, McMenamin J, de Lusignan S, Zambon M. End of season influenza vaccine effectiveness in adults and children in the United Kingdom in 2017/18. ACTA ACUST UNITED AC 2020; 24. [PMID: 31387673 PMCID: PMC6685099 DOI: 10.2807/1560-7917.es.2019.24.31.1800488] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In the United Kingdom (UK), in recent influenza seasons, children are offered a quadrivalent live attenuated influenza vaccine (LAIV4), and eligible adults mainly trivalent inactivated vaccine (TIV). Aim To estimate the UK end-of-season 2017/18 adjusted vaccine effectiveness (aVE) and the seroprevalence in England of antibodies against influenza viruses cultured in eggs or tissue. Methods This observational study employed the test-negative case–control approach to estimate aVE in primary care. The population-based seroprevalence survey used residual age-stratified samples. Results Influenza viruses A(H3N2) (particularly subgroup 3C.2a2) and B (mainly B/Yamagata/16/88-lineage, similar to the quadrivalent vaccine B-virus component but mismatched to TIV) dominated. All-age aVE was 15% (95% confidence interval (CI): −6.3 to 32) against all influenza; −16.4% (95% CI: −59.3 to 14.9) against A(H3N2); 24.7% (95% CI: 1.1 to 42.7) against B and 66.3% (95% CI: 33.4 to 82.9) against A(H1N1)pdm09. For 2–17 year olds, LAIV4 aVE was 26.9% (95% CI: −32.6 to 59.7) against all influenza; −75.5% (95% CI: −289.6 to 21) against A(H3N2); 60.8% (95% CI: 8.2 to 83.3) against B and 90.3% (95% CI: 16.4 to 98.9) against A(H1N1)pdm09. For ≥ 18 year olds, TIV aVE against influenza B was 1.9% (95% CI: −63.6 to 41.2). The 2017 seroprevalence of antibody recognising tissue-grown A(H3N2) virus was significantly lower than that recognising egg-grown virus in all groups except 15–24 year olds. Conclusions Overall aVE was low driven by no effectiveness against A(H3N2) possibly related to vaccine virus egg-adaption and a new A(H3N2) subgroup emergence. The TIV was not effective against influenza B. LAIV4 against influenza B and A(H1N1)pdm09 was effective.
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Affiliation(s)
| | | | | | | | | | | | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | | | | | | | | | - Mark O'Doherty
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | | | - Ivelina Yonova
- Royal College of General Practitioners, London, United Kingdom.,University of Surrey, Guildford, United Kingdom
| | | | | | | | - Muhammad Sartaj
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | | | - Simon de Lusignan
- Royal College of General Practitioners, London, United Kingdom.,University of Surrey, Guildford, United Kingdom
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21
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Incidence and characteristics of nosocomial influenza in a country with low vaccine coverage. J Hosp Infect 2020; 105:619-624. [PMID: 32540461 DOI: 10.1016/j.jhin.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Influenza vaccination coverage is low in France, in at-risk patients and in healthcare workers. AIM We aimed to estimate the incidence of nosocomial influenza, its characteristics and outcome. METHODS During one influenza season, we retrospectively evaluated all cases of documented influenza. Inpatients with symptoms onset ≥48 h after admission were enrolled. Data were collected on a standardized questionnaire. RESULTS From November 2017 to April 2018, 860 patients tested positive for influenza by polymerase chain reaction analysis on a respiratory sample. Among them, 204 (23.7%) were diagnosed ≥48 h after admission, of whom 57 (6.6% of all influenza cases) fulfilled inclusion criteria for nosocomial influenza: 26 women and 31 men, median age 82 years (interquartile range, 72.2-86.9). Twenty patients (38.6%) had recently (<6 months) received the seasonal influenza vaccine. Median time between admission and symptoms onset, and between symptoms onset and diagnosis were, respectively, 11 days (7-19.5) and 29 h (15.5-48). Influenza was mostly acquired in a double-bedded room (N = 39, 68.4%), with documented exposure in 14 cases. Influenza B virus was more common in nosocomial (46/57, 80.7%), than in community-acquired cases (359/803, 44.6%), P<0.001. Mortality rate at three months was 15.8% (N = 9). Incidence of nosocomial influenza was estimated at 0.22 per 1000 hospital-days during the study period. CONCLUSION Nosocomial influenza is not rare in elderly inpatients, and may have severe consequences. Influenza B virus was over-represented, which suggests higher transmissibility and/or transmission clusters.
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22
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Health Economic Evaluation of an Influenza Vaccination Program to Prevent Sick Leave in Employees: A Prospective Cohort Study. J Occup Environ Med 2020; 62:549-556. [PMID: 32358470 DOI: 10.1097/jom.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of an influenza vaccination program (IVP) among employees. METHODS This health economic evaluation was embedded in a prospective cohort study of a voluntary IVP. Data on incidence, direct, and indirect costs were collected via questionnaires. Bootstrapping and modeling techniques were used to assess uncertainty of the results. RESULTS In the base-scenario, the IVP was less effective, more expensive and thus, neither cost-effective nor cost-beneficial. When applying a sensitivity analysis using published estimates of IVP effectiveness on the data, the IVP became cost-effective and cost-beneficial. CONCLUSIONS Like in many evaluations of real-world settings, lack of randomization may have caused selection bias which may explain the surprising results of the main analysis. This indicates the importance of sensitivity analyses and modeling approaches for future studies assessing the cost-effectiveness of IVP in a real-world setting.
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Viruses of Respiratory Tract: an Observational Retrospective Study on Hospitalized Patients in Rome, Italy. Microorganisms 2020; 8:microorganisms8040501. [PMID: 32244685 PMCID: PMC7232519 DOI: 10.3390/microorganisms8040501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Respiratory tract infections account for high morbidity and mortality around the world. Fragile patients are at high risk of developing complications such as pneumonia and may die from it. Limited information is available on the extent of the circulation of respiratory viruses in the hospital setting. Most knowledge relates to influenza viruses (FLU) but several other viruses produce flu-like illness. The study was conducted at the University Hospital Policlinico Tor Vergata, Rome, Italy. Clinical and laboratory data from hospitalized patients with respiratory tract infections during the period October 2016-March 2019 were analysed. The retrospective analysis included 17 viral agents detected by FilmArray test and clinical data from medical records and hospital discharge sheets. Models were adjusted for relevant confounders such as clinical severity and risk of death, socio-demographic characteristics and surgical procedures. From a total of 539 specimens analysed, 180 (33.39%) were positive for one or more respiratory viruses. Among them, 83 (46.1 %) were positive for influenza viruses (FLU), 36 (20%) rhino/enteroviruses (RHV/EV), 17 (9.44%) human coronaviruses (HCOV-229E, -HKU1, -NL63, and -OC43), 17 (9.44%) respiratory syncytial virus, 15 (8.33%) human metapneumovirus (HMPV), 8 (4.44%) parainfluenza viruses (PIV) and 4 (2.22%) adenoviruses (ADV). The distribution of viral agents varied across age groups and month of detection. The positive specimens were from 168 patients [102 M, 66 F; median age (range): 64 years (19-93)]. Overall, 40% of them had a high-grade clinical severity and a 27% risk of death; 27 patients died and 22 of them (81.5%) had received a clinical diagnosis of pneumonia. Respiratory viral infections may have a severe course and a poor prognosis in hospitalized patients, due to underlying comorbidities. Monitoring the circulation of respiratory viruses in hospital settings is important to improve diagnosis, prevention and treatment.
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Navarro Alonso JA. La gripe: 76 años de vacuna antigripal… ¡y de la hemaglutinina! REVISTA MADRILEÑA DE SALUD PÚBLICA 2020. [DOI: 10.36300/remasp.2020.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Se revisa someramente la historia de los virus gripales y los pasos dados desde que se utilizó masivamente la primera vacuna de virus completos, hasta la descripción de las distintas vías de vehiculizar o de administrar la hemaglutinina de las que disponemos en
la actualidad, en aras de mejorar la respuesta inmune y por tanto la protección clínica de toda la población.
Se exponen brevemente los requisitos que debería cumplir una futura vacuna “universal” para que pudiera ser usada con carácter sistemático y los distintos proyectos en marcha.
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Affiliation(s)
- José Antonio Navarro Alonso
- Dirección General de Salud Pública y Adicciones Consejería de Salud. Comunidad Autónoma de la Región de Murcia
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Redlberger-Fritz M, Kundi M, Popow-Kraupp T. Heterogeneity of Circulating Influenza Viruses and Their Impact on Influenza Virus Vaccine Effectiveness During the Influenza Seasons 2016/17 to 2018/19 in Austria. Front Immunol 2020; 11:434. [PMID: 32256493 PMCID: PMC7092378 DOI: 10.3389/fimmu.2020.00434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
The constantly changing pattern in the dominance of viral strains and their evolving subclades during the seasons substantially influences influenza vaccine effectiveness (IVE). In order to further substantiate the importance of detailed data of genetic virus characterization for IVE estimates during the seasons, we performed influenza virus type and subtype specific IVE estimates. IVE estimates were assessed using a test-negative case-control design, in the context of the intraseasonal changes of the heterogeneous mix of circulating influenza virus strains for three influenza seasons (2016/17 to 2018/19) in Austria. Adjusted overall IVE over the three seasons 2016/17, 2017/18, and 2018/19 were -26, 39, and 63%, respectively. In accordance with the changing pattern of the circulating strains a broad range of overall and subtype specific IVEs was obtained: A(H3N2) specific IVE ranged between -26% for season 2016/17 to 58% in season 2018/19, A(H1N1)pdm09 specific IVE was 25% for the season 2017/18 and 65% for the season 2018/19 and Influenza B specific IVE for season 2017/18 was 45%. The results obtained in our study over the three seasons demonstrate the increasingly complex dynamic of the ever changing genetic pattern of the circulating influenza viruses and their influence on IVE estimates. This emphasizes the importance of detailed genetic virus surveillance for reliable IVE estimates.
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Affiliation(s)
| | - Michael Kundi
- Department of Environmental Health, Medical University Vienna, Vienna, Austria
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Rose AMC, Kissling E, Gherasim A, Casado I, Bella A, Launay O, Lazăr M, Marbus S, Kuliese M, Syrjänen R, Machado A, Kurečić Filipović S, Larrauri A, Castilla J, Alfonsi V, Galtier F, Ivanciuc A, Meijer A, Mickiene A, Ikonen N, Gómez V, Lovrić Makarić Z, Moren A, Valenciano M. Vaccine effectiveness against influenza A(H3N2) and B among laboratory-confirmed, hospitalised older adults, Europe, 2017-18: A season of B lineage mismatched to the trivalent vaccine. Influenza Other Respir Viruses 2020; 14:302-310. [PMID: 32022450 PMCID: PMC7182608 DOI: 10.1111/irv.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/22/2023] Open
Abstract
Background Influenza A(H3N2), A(H1N1)pdm09 and B viruses co‐circulated in Europe in 2017‐18, predominated by influenza B. WHO‐recommended, trivalent vaccine components were lineage‐mismatched for B. The I‐MOVE hospital network measured 2017‐18 seasonal influenza vaccine effectiveness (IVE) against influenza A(H3N2) and B among hospitalised patients (≥65 years) in Europe. Methods Following the same generic protocol for test‐negative design, hospital teams in nine countries swabbed patients ≥65 years with recent onset (≤7 days) severe acute respiratory infection (SARI), collecting information on demographics, vaccination status and underlying conditions. Cases were RT‐PCR positive for influenza A(H3N2) or B; controls: negative for any influenza. “Vaccinated” patients had SARI onset >14 days after vaccination. We measured pooled IVE against influenza, adjusted for study site, age, sex, onset date and chronic conditions. Results We included 3483 patients: 376 influenza A(H3N2) and 928 B cases, and 2028 controls. Most (>99%) vaccinated patients received the B lineage‐mismatched trivalent vaccine. IVE against influenza A(H3N2) was 24% (95% CI: 2 to 40); 35% (95% CI: 6 to 55) in 65‐ to 79‐year‐olds and 14% (95% CI: −22 to 39) in ≥80‐year‐olds. Against influenza B, IVE was 30% (95% CI: 16 to 41); 37% (95% CI: 19 to 51) in 65‐ to 79‐year‐olds and 19% (95% CI: −7 to 38) in ≥80‐year‐olds. Conclusions IVE against influenza B was similar to A(H3N2) in hospitalised older adults, despite trivalent vaccine and circulating B lineage mismatch, suggesting some cross‐protection. IVE was lower in those ≥80 than 65‐79 years. We reinforce the importance of influenza vaccination in older adults as, even with a poorly matched vaccine, it still protects one in three to four of this population from severe influenza.
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Affiliation(s)
| | | | - Alin Gherasim
- National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain
| | - Itziar Casado
- Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC Cochin Pasteur, université Paris Descartes, Sorbonne Paris Cité, hôpital Cochin, AP-HP, Paris, France
| | - Mihaela Lazăr
- National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Sierk Marbus
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Monika Kuliese
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ritva Syrjänen
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Ausenda Machado
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sanja Kurečić Filipović
- Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBERESP, Institute of Health Carlos III, Madrid, Spain
| | - Jesús Castilla
- Navarra Public Health Institute, IdiSNA-CIBERESP, Pamplona, Spain
| | - Valeria Alfonsi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Florence Galtier
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CHU de Montpellier, Inserm CIC 1411, Hôpital Saint-Eloi, Montpellier, France
| | - Alina Ivanciuc
- National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Adam Meijer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aukse Mickiene
- Department of Infectious diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Niina Ikonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Verónica Gómez
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Zvjezdana Lovrić Makarić
- Division for epidemiology of communicable diseases, Croatian Institute of Public Health, Zagreb, Croatia
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Siewert B, Gowin E, Wesołek M, Wysocki J, Januszkiewicz‐Lewandowska D. Paediatric hospitalisation numbers for influenza in 2016-2019 seasons underline importance of vaccination. Acta Paediatr 2020; 109:417-418. [PMID: 31606906 PMCID: PMC7004104 DOI: 10.1111/apa.15055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Bartosz Siewert
- Poznan University of Medical Science Department of Preventive Health Poznan Poland
- Infectious Diseases Ward Children’s Hospital in Poznan Poznan Poland
| | - Ewelina Gowin
- Poznan University of Medical Science Department of Preventive Health Poznan Poland
- Infectious Diseases Ward Children’s Hospital in Poznan Poznan Poland
| | - Martyna Wesołek
- Infectious Diseases Ward Children’s Hospital in Poznan Poznan Poland
| | - Jacek Wysocki
- Poznan University of Medical Science Department of Preventive Health Poznan Poland
- Infectious Diseases Ward Children’s Hospital in Poznan Poznan Poland
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28
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Isakova-Sivak I, Grigorieva E, Rudenko L. Insights into current clinical research on the immunogenicity of live attenuated influenza vaccines. Expert Rev Vaccines 2020; 19:43-55. [PMID: 31903816 DOI: 10.1080/14760584.2020.1711056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Live attenuated influenza vaccines (LAIVs) have been in use for more than three decades and are now licensed in many countries. There is evidence that LAIVs can have greater efficacy than inactivated influenza vaccines, especially against mismatched influenza, however, in recent years, a number of trials have found a lack of LAIV efficacy, mainly in relation to the H1N1 virus.Areas covered: In this review, we summarize the results of clinical research published in the past 5 years on the immunogenicity of LAIVs, with special attention to the mechanisms of establishing protective immunity and some factors that may influence immunogenicity and efficacy.Expert opinion: A number of recent clinical studies confirmed that the immune responses to LAIVs are multifaceted, involving different immune mechanisms. These trials suggest that the intrinsic replicative properties of each LAIV component should be taken into account, and the precise effects of adding a fourth vaccine strain to trivalent LAIV formulations are still to be identified. In addition, new data are emerging regarding the impact of pre-vaccination conditions, such as preexisting immunity or concurrent asymptomatic viral and bacterial respiratory infections, on LAIV immunogenicity, suggesting the importance of monitoring them during clinical trials or vaccination campaigns.
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Affiliation(s)
- Irina Isakova-Sivak
- Department of Virology, Institute of Experimental Medicine, St. Petersburg, Russia
| | - Elena Grigorieva
- Department of Virology, Institute of Experimental Medicine, St. Petersburg, Russia
| | - Larisa Rudenko
- Department of Virology, Institute of Experimental Medicine, St. Petersburg, Russia
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29
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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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30
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Brunner I, Schmedders K, Wolfensberger A, Schreiber PW, Kuster SP. The economic and public health impact of influenza vaccinations: contributions of Swiss pharmacies in the 2016/17 and 2017/18 influenza seasons and implications for vaccination policy. Swiss Med Wkly 2019; 149:w20161. [DOI: 10.57187/smw.2019.20161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS OPF THE STUDY
Healthy adults have had the option to receive prescriptionless vaccination against influenza in pharmacies of several Swiss cantons since the 2015/16 influenza season. We aimed to assess in a cost-benefit analysis the resulting net benefits for the Swiss economy and public health, and the benefits that could be expected if an extension of the current vaccination recommendations was implemented.
METHODS
The proportion of influenza vaccines administered in pharmacies was calculated from data provided by pharmacies entering information in phS-net.ch, data from vaccines covered by insurance companies, and vaccine supply data. The economic and public health impact was estimated in a cost-benefit analysis based on published data.
RESULTS
In the 2016/17 and 2017/18 influenza seasons, 7306 of a total of 1.07 million (0.7%) and 15,617 of a total of 1.15 million (1.4%) influenza vaccine doses, respectively, were administered in pharmacies in Switzerland. The net cost savings for the economy due to vaccination in pharmacies in the 2016/17 and 2017/18 seasons were CHF 66,633 and CHF 143,021, respectively. In the 2017/18 season, this resulted –in a net saving per 100,000 inhabitants of CHF 1918, 94.4 cases of illness, 17.6 visits to primary care physicians, 0.328 hospitalisations, 1.1 hospitalisation days, 0.019 deaths prevented, and 0.353 life-years gained. Influenza vaccination proved to be cost-effective provided that a vaccine efficacy of 59% is exceeded. Extrapolations for the healthy, working-age population revealed that a vaccination coverage rate of 50% and a vaccine efficacy of 70% could save the Swiss economy CHF 18.4 million annually.
CONCLUSIONS
The service allowing citizens to receive influenza vaccination in Swiss pharmacies is sparsely used. Since influenza vaccination is cost-beneficial as soon as vaccine efficacy surpasses a critical threshold, an extension of the vaccine recommendation for healthy, working-age adults should be considered from an economic point of view.
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Machado A, Kislaya I, Larrauri A, Matias Dias C, Nunes B. Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population. BMC Public Health 2019; 19:1690. [PMID: 31842831 PMCID: PMC6916191 DOI: 10.1186/s12889-019-7958-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.
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Affiliation(s)
- Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal. .,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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32
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Intrahospital mortality of influenza patients during the 2017–2018 influenza season. Wien Klin Wochenschr 2019; 132:176-181. [DOI: 10.1007/s00508-019-01578-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
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Smatti MK, Nasrallah GK, Al Thani AA, Yassine HM. Measuring influenza hemagglutinin (HA) stem-specific antibody-dependent cellular cytotoxicity (ADCC) in human sera using novel stabilized stem nanoparticle probes. Vaccine 2019; 38:815-821. [PMID: 31735504 DOI: 10.1016/j.vaccine.2019.10.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Generating vaccine that confers a complete protection is a major goal in designing a universal influenza vaccine. Currently, there is a considerable interest in the broadly neutralizing antibodies (bnAb) targeting the conserved HA stem region. These antibodies have been shown to activate cellular immune responses, such as ADCC, in addition to their neutralization activity. We had previously demonstrated that immunization with H1-based stabilized stem (SS) nanoparticles (np) protects against heterosubtypic lethal H5N1 challenge, despite the absence of detectable neutralizing activity. Utilizing these novel SS probes to develop an ADCC assay would help in understanding the mechanism of action of stem-specific antibodies, as well as evaluating future influenza vaccines. OBJECTIVES To develop a new protocol to assess the ADCC activity mediated by stem-directed antibodies in human sera using novel SS np probes. STUDY DESIGN Human sera samples were screened for binding and ADCC activities to different influenza group 1 SS probes (H1, H2, and H5) using trimeric SS or multivalent SS-np (n = 8 trimers) formats. RESULTS Initial screening revealed 63% (57/90) seroprevalence of anti-HA (H1) stem-epitope antibodies, as determined by the differential binding to HA SS and its corresponding epitope-mutant (Ile45Arg/Thr49Arg) probe. Using equimolar amounts, the multivalent presentation of HA SS on np induced significantly higher ADCC activity compared to the monovalent (trimer) SS probes (2-6 fold increase). Further, ADCC activity was similarly reported against different group 1 influenza subtypes: H1, H2, and H5. Importantly, ADCC was mediated mainly by antibodies targeting the bnAb-epitope on the HA stem. CONCLUSION We report on an assay to measure stem-specific ADCC activity using SS np probes. Our results indicate high prevalence of HA-stem antibodies with cross-reactive ADCC activity. Such assay could be utilized in the assessment of next generation influenza vaccines.
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Affiliation(s)
- Maria K Smatti
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Qatar University, Doha, Qatar; Biomedical Sciences Program, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A Al Thani
- Biomedical Research Center, Qatar University, Doha, Qatar; Biomedical Sciences Program, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar; Biomedical Sciences Program, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Abstract
This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in children during the 2019-2020 season. The American Academy of Pediatrics continues to recommend routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference of one product or formulation over another. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication continues to be recommended for children with suspected or confirmed influenza, particularly those who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza.
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MESH Headings
- Adolescent
- Age Factors
- Antiviral Agents/administration & dosage
- Antiviral Agents/adverse effects
- Breast Feeding
- Cause of Death
- Child
- Child, Hospitalized
- Child, Preschool
- Contraindications
- Disease Progression
- Drug Resistance, Viral
- Egg Hypersensitivity
- Female
- Humans
- Immunocompromised Host
- Infant
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza, Human/complications
- Influenza, Human/drug therapy
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Pediatrics
- Pregnancy
- United States/epidemiology
- Vaccines, Inactivated/administration & dosage
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European all-cause excess and influenza-attributable mortality in the 2017/18 season: should the burden of influenza B be reconsidered? Clin Microbiol Infect 2019; 25:1266-1276. [DOI: 10.1016/j.cmi.2019.02.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/18/2022]
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BASSETTI M, PEGHIN M, GALLO T, PIPAN C, D’AGARO P, SARTOR A, BOVE T, COCCONI R, GRAZIANO E, CASTALDO N. The burden of severe cases of Influenza disease: the Friuli Venezia Giulia Region experience. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E163-E170. [PMID: 31650049 PMCID: PMC6797893 DOI: 10.15167/2421-4248/jpmh2019.60.3.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/31/2019] [Indexed: 11/21/2022]
Abstract
Introduction Influenza is a matter of serious concern for clinicians, in both outpatient and in-hospital settings. Worldwide, the 2017-18 epidemic proved to be the most severe since 2003-04. We report a real-world experience regarding the management of patients with influenza admitted to a large teaching hospital in the Friuli Venezia Giulia region during the 2017-2018 influenza season. We also provide a practical guide for the management of hospitalized influenza patients. Methods A retrospective observational analysis was conducted among all influenza patients requiring admission to our center during the 2017-18 season. Results Overall, 29 patients were admitted to the University Hospital of Udine during the 2017-18 season with a diagnosis of influenza. B virus was responsible for the majority of cases. More than 65.5% of the subjects presented with a complication. We estimated that 41.4% of the patients admitted were affected by a “severe form”. All these cases required admission to the Intensive Care Unit, with 27.6% and 10.3% needing Orotracheal Intubation and Extracorporeal Membrane Oxygenation, respectively. The fatality rate was 24.1%. Notably, only 9 subjects in our cohort had been vaccinated. Based on the experience acquired during the past season, we propose a practical guide to the management of influenza cases in everyday hospital practice. Conclusion The cornerstones of the management of all hospitalized influenza patients are the rapid identification and treatment of severe forms. Timely and strict adherence to contact and respiratory precautions are also fundamental to reducing the risk of intra-hospital outbreaks. Despite improvements in antiviral therapies and supportive measures, influenza-related morbidity and mortality remain high. In our opinion, a universal vaccination program is the only safe and effective method of filling the gap.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antiviral Agents/therapeutic use
- Child
- Child, Preschool
- Coinfection/therapy
- Early Diagnosis
- Early Medical Intervention
- Extracorporeal Membrane Oxygenation
- Female
- Hospitalization
- Humans
- Infant
- Infant, Newborn
- Infection Control
- Influenza Vaccines/therapeutic use
- Influenza, Human/complications
- Influenza, Human/prevention & control
- Influenza, Human/therapy
- Intensive Care Units
- Intubation, Intratracheal
- Italy
- Male
- Middle Aged
- Myocarditis/therapy
- Patient Isolation
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/therapy
- Respiration, Artificial
- Respiratory Distress Syndrome/etiology
- Respiratory Distress Syndrome/therapy
- Retrospective Studies
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- M. BASSETTI
- Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
- Correspondence: Matteo Bassetti, Infectious Diseases Division, Department of Medicine University of Udine, piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy - Tel. +39 0432 559355 - Fax. +39 0432 559371 - E mail:
| | - M. PEGHIN
- Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - T. GALLO
- Department of Prevention, Local Health Unit 4 Medio Friuli, Udine, Italy
| | - C. PIPAN
- Microbiology Unit, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - P. D’AGARO
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - A. SARTOR
- Microbiology Unit, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - T. BOVE
- Anesthesiology and Intensive Care Medicine, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - R. COCCONI
- SOC Direzione Medica di Presidio, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - E. GRAZIANO
- Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - N. CASTALDO
- Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Italy
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Meijer A, Swaan CM, Voerknecht M, Jusic E, van den Brink S, Wijsman LA, Voordouw BC, Donker GA, Sleven J, Dorigo-Zetsma WW, Svraka S, van Boven M, Haverkate MR, Timen A, van Dissel JT, Koopmans MP, Bestebroer TM, Fouchier RA. Case of seasonal reassortant A(H1N2) influenza virus infection, the Netherlands, March 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 29667576 PMCID: PMC6836195 DOI: 10.2807/1560-7917.es.2018.23.15.18-00160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A seasonal reassortant A(H1N2) influenza virus harbouring genome segments from seasonal influenza viruses A(H1N1)pdm09 (HA and NS) and A(H3N2) (PB2, PB1, PA, NP, NA and M) was identified in March 2018 in a 19-months-old patient with influenza-like illness (ILI) who presented to a general practitioner participating in the routine sentinel surveillance of ILI in the Netherlands. The patient recovered fully. Further epidemiological and virological investigation did not reveal additional cases.
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Affiliation(s)
- Adam Meijer
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Corien M Swaan
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Martin Voerknecht
- General practitioner participating in the Primary Care Database sentinel surveillance coordinated by NIVEL Netherlands institute for health services research, Utrecht, the Netherlands
| | - Edin Jusic
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Sharon van den Brink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lisa A Wijsman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bettie Cg Voordouw
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Gé A Donker
- Coordinator NIVEL Primary Care Database sentinel surveillance, NIVEL Netherlands institute for health services research, Utrecht, the Netherlands
| | - Jacqueline Sleven
- Municipal Health Services 'Gooi en Vechtstreek', Bussum, the Netherlands
| | | | - Sanela Svraka
- Central Bacteriology and Serology Laboratory, Tergooi Hospitals, Hilversum, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Manon R Haverkate
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Aura Timen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jaap T van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marion Pg Koopmans
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Theo M Bestebroer
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron Am Fouchier
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
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38
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Adlhoch C, Snacken R, Melidou A, Ionescu S, Penttinen P. Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively. ACTA ACUST UNITED AC 2019; 23. [PMID: 29616611 PMCID: PMC5883452 DOI: 10.2807/1560-7917.es.2018.23.13.18-00146] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We use surveillance data to describe influenza A and B virus circulation over two consecutive seasons with excess all-cause mortality in Europe, especially in people aged 60 years and older. Influenza A(H3N2) virus dominated in 2016/17 and B/Yamagata in 2017/18. The latter season was prolonged with positivity rates above 50% among sentinel detections for at least 12 weeks. With a current west–east geographical spread, high influenza activity might still be expected in eastern Europe.
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Affiliation(s)
- Cornelia Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - René Snacken
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Angeliki Melidou
- Microbiology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Silviu Ionescu
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The members of the European Influenza Surveillance Network are listed at the end of article
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39
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Kissling E, Pozo F, Buda S, Vilcu AM, Rizzo C, Gherasim A, Horváth JK, Brytting M, Domegan L, Meijer A, Paradowska-Stankiewicz I, Machado A, Vučina VV, Lazar M, Johansen K, Dürrwald R, van der Werf S, Bella A, Larrauri A, Ferenczi A, Zakikhany K, O'Donnell J, Dijkstra F, Bogusz J, Guiomar R, Filipović SK, Pitigoi D, Penttinen P, Valenciano M. Effectiveness of influenza vaccine against influenza A in Europe in seasons of different A(H1N1)pdm09 and the same A(H3N2) vaccine components (2016-17 and 2017-18). Vaccine X 2019; 3:100042. [PMID: 31660536 PMCID: PMC6807025 DOI: 10.1016/j.jvacx.2019.100042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022] Open
Abstract
Influenza A(H3N2) circulated in Europe in 2016–17 and 2017–18 and A(H1N1)pdm09 in 2017–18. Changed A(H1N1)pdm09 vaccine component VE was 58% against A(H1N1)pdm09 in 2017–18. A(H3N2) VE was 13% and 28% among all ages in 2016–17 and 2017–18, respectively.
Introduction Influenza A(H3N2) viruses predominated in Europe in 2016–17. In 2017–18 A(H3N2) and A(H1N1)pdm09 viruses co-circulated. The A(H3N2) vaccine component was the same in both seasons; while the A(H1N1)pdm09 component changed in 2017–18. In both seasons, vaccine seed A(H3N2) viruses developed adaptations/alterations during propagation in eggs, impacting antigenicity. Methods We used the test-negative design in a multicentre primary care case-control study in 12 European countries to measure 2016–17 and 2017–18 influenza vaccine effectiveness (VE) against laboratory-confirmed influenza A(H1N1)pdm09 and A(H3N2) overall and by age group. Results During the 2017–18 season, the overall VE against influenza A(H1N1)pdm09 was 59% (95% CI: 47–69). Among those aged 0–14, 15–64 and ≥65 years, VE against A(H1N1)pdm09 was 64% (95% CI: 37–79), 50% (95% CI: 28–66) and 66% (95% CI: 42–80), respectively. Overall VE against influenza A(H3N2) was 28% (95% CI: 17–38) in 2016–17 and 13% (95% CI: −15 to 34) in 2017–18. Among 0–14-year-olds VE against A(H3N2) was 28% (95%CI: −10 to 53) and 29% (95% CI: −87 to 73), among 15–64-year-olds 34% (95% CI: 18–46) and 33% (95% CI: −3 to 56) and among those aged ≥65 years 15% (95% CI: −10 to 34) and −9% (95% CI: −74 to 32) in 2016–17 and 2017–18, respectively. Conclusions Our study suggests the new A(H1N1)pdm09 vaccine component conferred good protection against circulating strains, while VE against A(H3N2) was <35% in 2016–17 and 2017–18. The egg propagation derived antigenic mismatch of the vaccine seed virus with circulating strains may have contributed to this low effectiveness. A(H3N2) seed viruses for vaccines in subsequent seasons may be subject to the same adaptations; in years with lower than expected VE, recommendations of preventive measures other than vaccination should be given in a timely manner.
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Affiliation(s)
- Esther Kissling
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Caterina Rizzo
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.,Bambino Gesù Children's Hospital, Rome, Italy
| | - Alin Gherasim
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | - Mia Brytting
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Mihaela Lazar
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Kari Johansen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Ralf Dürrwald
- Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany
| | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France.,CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Amparo Larrauri
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joanna Bogusz
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Raquel Guiomar
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal
| | | | - Daniela Pitigoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Marta Valenciano
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
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40
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Gaillat J. [Vaccine hesitancy: How to lift the brake?]. Rev Mal Respir 2019; 36:962-970. [PMID: 31522949 DOI: 10.1016/j.rmr.2018.10.620] [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: 10/17/2017] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We are at a "post-trust" period, characterised by vaccine hesitancy which is being widely diffused by the media and social networks. The consequences of this include: measles, whooping cough epidemics, vaccine coverage decreasing for the youngest, and remaining at low levels in adults. Mandatory vaccination has been extended for children less than two years in France, with the objective to increase vaccination rates during this period. STATE OF THE ART The medical literature on this topic is increasing, mainly regarding descriptions of reasons for vaccine hesitancy. These include doubt about vaccine efficacy, safety, and real need as well as with regard to social aspects, cultural, religious beliefs. The literature that explores the best way to address vaccine hesitancy is still scarce. Healthcare workers are a key in promoting vaccine acceptance. There is a need to address the issue of vaccine hesitancy in a multicompartmental way. Health authorities must communicate in a clear and concise style that is trust-based and science-informed, being transparent both on vaccine benefits and on issues around vaccine safety. For caregivers, motivational interviewing can help patients change behaviour. CONCLUSION Anti-vaccine ideas were born with vaccines; they are abundantly spread through the Internet and social networks and can give a false impression of their basis in reality. It is time for positive action not merely a defensive approach.
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Affiliation(s)
- J Gaillat
- Centre de recherche clinique, service des maladies infectieuses CHANGE, centre hospitalier Annecy-Genevois, 1, avenue de l'hôpital, 74374 Pringy cedex, France.
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Loconsole D, De Robertis AL, Morea A, Casulli D, Mallamaci R, Baldacci S, Centrone F, Bruno V, Quarto M, Accogli M, Chironna M. High Public-Health Impact in an Influenza-B-Mismatch Season in Southern Italy, 2017-2018. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4643260. [PMID: 31531353 PMCID: PMC6720359 DOI: 10.1155/2019/4643260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Yearly influenza epidemics have considerable effects on public health worldwide. The 2017-2018 influenza season in Italy was of greater severity than previous seasons. The aim of this study was to describe the 2017-2018 influenza season in Southern Italy and the molecular characteristics of the circulating viral strains. METHODS The incidence of influenza-like illness (ILI) was analysed. Nasopharyngeal swabs collected from patients with ILI from week 46/2017 to week 17/2018 were tested to identify influenza A viruses (IAV) and influenza B viruses (IBV). Sequencing and phylogenetic analysis of haemagglutinin genes were also performed on 73 positive samples (35 IBV, 36 IAV H1, and 2 IAV H3 strains). RESULTS During the 2017-2018 season, the peak incidence was 14.32 cases per 1,000 inhabitants. IBV strains were identified in 71.0% of cases. The 35 characterised IBV strains belonged to Yamagata lineage clade 3, the 36 A/H1N1pdm09 strains clustered with the genetic subgroup 6B.1, and the 2 A/H3N2 strains clustered with the genetic subgroup 3C.2a. Intensive-care unit (ICU) admission was required in 50 cases of acute respiratory distress syndrome (ARDS). Among the >64-year age group, 18 out of 26 ICU-ARDS cases (69.2%) were caused by IBV, and 14 of these (77.8%) were B/Yamagata lineage. CONCLUSIONS The 2017-2018 influenza season was one of the most severe in a decade in Southern Italy. IBV mismatch between the trivalent vaccine and the circulating strains occurred. The high number of ICU-ARDS cases caused by B/Yamagata strains in the >64-year age group suggests that further data on the effectiveness of the available influenza vaccines are needed to determine the best way to protect the elderly against both IBV lineages.
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Affiliation(s)
- Daniela Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Anna Lisa De Robertis
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Anna Morea
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Daniele Casulli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rosanna Mallamaci
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Via Orabona 4, 70124 Bari, Italy
| | - Simona Baldacci
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Francesca Centrone
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Viviana Bruno
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Michele Quarto
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marisa Accogli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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Roe M, Kaye M, Iannello P, Lau H, Buettner I, Tolosa MX, Zakis T, Leung VK, Chow MK. Report on influenza viruses received and tested by the Melbourne WHO Collaborating Centre for Reference and Research on Influenza in 2017. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As part of its role in the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received a record total of 5866 human influenza positive samples during 2017. Viruses were analysed for their antigenic, genetic and antiviral susceptibility properties and were propagated in qualified cells and hens’ eggs for use as potential seasonal influenza vaccine virus candidates. In 2017, influenza A(H3) viruses predominated over influenza A(H1)pdm09 and B viruses, accounting for a total of 54% of all viruses analysed. The majority of A(H1)pdm09, A(H3) and influenza B viruses analysed at the Centre were found to be antigenically similar to the respective WHO recommended vaccine strains for the Southern Hemisphere in 2017. However, phylogenetic analysis indicated that the majority of circulating A(H3) viruses had undergone genetic drift relative to the WHO recommended vaccine strain for 2017. Of 3733 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, only two A(H1)pdm09 viruses and one A(H3) virus showed highly reduced inhibition by oseltamivir, while just one A(H1)pdm09 virus showed highly reduced inhibition by zanamivir.
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Affiliation(s)
- Merryn Roe
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Matthew Kaye
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Pina Iannello
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Hilda Lau
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Iwona Buettner
- WHO Collaborating Centre for Reference and Research on Influenza
| | - M Ximena Tolosa
- WHO Collaborating Centre for Reference and Research on Influenza; National Centre for Epidemiology and Population Health, Australian National University
| | - Tasoula Zakis
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Vivian K Leung
- WHO Collaborating Centre for Reference and Research on Influenza
| | - Michelle K Chow
- WHO Collaborating Centre for Reference and Research on Influenza
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43
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Bella A, Gesualdo F, Orsi A, Arcuri C, Chironna M, Loconsole D, Napoli C, Orsi GB, Manini I, Montomoli E, Alfonsi V, Castrucci MR, Rizzo C. Effectiveness of the trivalent MF59 adjuvated influenza vaccine in preventing hospitalization due to influenza B and A(H1N1)pdm09 viruses in the elderly in Italy, 2017 - 2018 season. Expert Rev Vaccines 2019; 18:671-679. [PMID: 31159616 DOI: 10.1080/14760584.2019.1627206] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Evidence on influenza vaccine effectiveness (VE) in preventing mortality and morbidity in the elderly is weak. Our aim was to measure the VE against severe outcomes in the elderly. Methods: We conducted a multicentre hospital-based test-negative design (TND) case-control study, during the 2017/18 season, in four Italian hospitals. The study population included individuals aged ≥65 years hospitalized with Severe Acute Respiratory Infections (SARI). Patients were classified as cases and controls based on the results of the PCR influenza testing. We estimated VE by virus subtypes and specific VE for the trivalent adjuvanted vaccine (TIVadj). Results: 502 patients with SARI were enrolled: 118 (23.5%) tested positive (cases) and 384 (76.5%) tested negative (controls) for influenza. The adjusted VE of 48.5% for all vaccines was comparable to the adjusted VE for the TIVadj vaccine (48.3%). Adjusted VE for the TIVadj vaccine was 67.5% for A(H1N1)pdm09 and 44.5% for B viruses. Conclusion: We show a moderate adjusted VE of the TIVadj against all viruses, a good adjusted VE against A(H1N1)pdm09 strains and a moderate adjusted VE against B strains, despite a mismatch between the B circulating lineage and the lineage included in the vaccine. This is likely due to the cross-protection among B strains induced by the TIVadj in elderly patients.
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Affiliation(s)
- Antonino Bella
- a Department of Infectious Diseases , National Institute of Health , Rome , Italy
| | - Francesco Gesualdo
- b Direction of Cinical Department , Bambino Gesù Children's Hospital , Rome , Italy
| | - Andrea Orsi
- c Department of Health Sciences , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Claudia Arcuri
- c Department of Health Sciences , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Maria Chironna
- d Department of Biomedical Science and Medical Oncology of the University of Bari , Bari , Italy
| | - Daniela Loconsole
- d Department of Biomedical Science and Medical Oncology of the University of Bari , Bari , Italy
| | - Christian Napoli
- e Department of Medical-Surgical Sciences and Translational Medicine , University of Rome "Sapienza", Sant'Andrea Hospital , Rome , Italy
| | - Giovanni Battista Orsi
- f Department of Public Health and Infectious Diseases , University of Rome "Sapienza" , Rome , Italy
| | - Ilaria Manini
- g Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Emanuele Montomoli
- g Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Valeria Alfonsi
- a Department of Infectious Diseases , National Institute of Health , Rome , Italy.,e Department of Medical-Surgical Sciences and Translational Medicine , University of Rome "Sapienza", Sant'Andrea Hospital , Rome , Italy
| | - Maria Rita Castrucci
- a Department of Infectious Diseases , National Institute of Health , Rome , Italy
| | - Caterina Rizzo
- b Direction of Cinical Department , Bambino Gesù Children's Hospital , Rome , Italy
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44
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Shinjoh M, Sugaya N, Furuichi M, Araki E, Maeda N, Isshiki K, Ohnishi T, Nakamura S, Yamada G, Narabayashi A, Nishida M, Taguchi N, Nakata Y, Yoshida M, Tsunematsu K, Shibata M, Munenaga T, Hirano Y, Ookawara I, Sekiguchi S, Kobayashi Y, Yamaguchi Y, Yoshida N, Mitamura K, Takahashi T. Effectiveness of inactivated influenza vaccine in children by vaccine dose, 2013-18. Vaccine 2019; 37:4047-4054. [PMID: 31186191 DOI: 10.1016/j.vaccine.2019.05.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/19/2019] [Accepted: 05/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We assessed the vaccine effectiveness (VE) of inactivated influenza vaccine (IIV) by vaccine dose in children aged 6 months to 12 years for whom two doses are recommended in Japan to ascertain the appropriate vaccine doses. METHODS VE was assessed according to a test-negative case-control design based on rapid influenza diagnostic test (RIDT) results. Children aged 6 months to 12 years with a fever ≥38 °C who had received an RIDT in outpatient clinics of 24 hospitals were enrolled for all five seasons since 2013/14. VE by vaccine dose (none vs. once or twice, and once vs. twice) was analyzed. RESULTS In the dose analysis, 20,033 children were enrolled. Both one- and two-dose regimens significantly reduced cases in preventing any influenza, influenza A, and influenza B, but there was no significant difference in adjusted VE between one- and two-dose regimens overall (adjusted OR, 0.560 [95% CI, 0.505-0.621], 0.550 [95% CI, 0.516-0.586]), 0.549 [95% CI, 0.517-0.583], and 1.014 [95% CI, 0.907-1.135], for none vs. once, none vs. twice, none vs. once or twice, and once vs. twice for any influenza, respectively). Both one- and two-dose regimens significantly reduced cases with any influenza and influenza A every season. Also, both regimens significantly reduced cases of any influenza, influenza A, and influenza B among children aged 1-12 years, especially among those aged 1-5 years. In the 2013/14, 2015/16, and 2016/17 seasons, however, only the two-dose regimen was significantly effective in preventing influenza B. Both one- and two-dose regimens significantly reduced cases involving hospitalization due to any influenza and influenza A. CONCLUSIONS Both one- and two-doses regimens of IIV were effective in preventing influenza for children aged 6 months to 12 years. The two-dose regimen was more effective against influenza B in some seasons.
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Affiliation(s)
- Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, 220-0012 Kanagawa, Japan; Department of Infection Control, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, 220-0012 Kanagawa, Japan
| | - Munehiro Furuichi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Eriko Araki
- Pediatrics, Yokohama City Municipal Hospital, 56 Okazawacho, Hodogaya-ku, Yokohama-city, Kanagawa 240-8555, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo 152-0021, Japan
| | - Kyohei Isshiki
- Department of Pediatrics, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama 336-8522, Japan
| | - Takuma Ohnishi
- Department of Pediatrics, National Hospital Organization Saitama National Hospital, 2-1 Suwa, Wako-shi, Saitama 321-0102, Japan
| | - Shoko Nakamura
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo 170-8476, Japan
| | - Go Yamada
- Pediatrics, Saiseikai Utsunomiya Hospital, #201, 3-9-11 Nishiki, Utsunomiya-shi, Tochigi 321-0967, Japan
| | - Atsushi Narabayashi
- Department of Pediatrics, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki City, Kanagawa 210-0013, Japan
| | - Mitsuhiro Nishida
- Department of Pediatrics, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu-ku, Shizuoka-shi, Shizuoka 424-8636, Japan
| | - Nobuhiko Taguchi
- Department of Pediatrics, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa 220-8581, Japan
| | - Yuji Nakata
- Department of Pediatrics, Nippon Koukan Hospital, 1-2-1 Koukandori, Kawasaki, Kanagawa 210-0852, Japan
| | - Makoto Yoshida
- Department of Pediatrics, Sano Kousei General Hospital, 1728 Horigome-cho, Sano City, Tochigi 327-8511, Japan
| | - Kenichiro Tsunematsu
- Department of Pediatrics, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino-shi, Tokyo 191-0062, Japan
| | - Meiwa Shibata
- Division of Pediatrics, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-ku, Yokohama 222-0036, Japan
| | - Takeshi Munenaga
- Department of Pediatrics, Ota Memorial Hospital, 455-1 Oshima-chou, Ota-shi, Gumma 373-8585, Japan
| | - Yasuhiro Hirano
- Department of Pediatrics, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-Shi, Kanagawa 254-0065, Japan
| | - Ichiro Ookawara
- Department of Pediatrics, Japanese Red Cross Shizuoka Hospital, 8-2 Outemachi, Aoi-ku, Shizuoka 420-0853, Japan
| | - Shinichiro Sekiguchi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yasuaki Kobayashi
- Department of Pediatrics, Japanese Red Cross Ashikaga Hospital, 284-1, Yobecho, Ashikaga, Tochigi 326-0843, Japan
| | - Yoshio Yamaguchi
- Institute of Clinical Research, Department of Infection & Allergy, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-shi, Tochigi 320-8580, Japan
| | - Naoko Yoshida
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Keiko Mitamura
- Department of Pediatrics, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo 110-8645, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Zaffina S, Gilardi F, Rizzo C, Sannino S, Brugaletta R, Santoro A, Castelli Gattinara G, Ciofi degli Atti ML, Raponi M, Vinci MR. Seasonal influenza vaccination and absenteeism in health-care workers in two subsequent influenza seasons (2016/17 and 2017/18) in an Italian pediatric hospital. Expert Rev Vaccines 2019; 18:411-418. [DOI: 10.1080/14760584.2019.1586541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Salvatore Zaffina
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesco Gilardi
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Caterina Rizzo
- Unit of Innovation and Clinical Pathways, Direction of Clinical Departments, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Serena Sannino
- Health Directorate, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita Brugaletta
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annapaola Santoro
- Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Guido Castelli Gattinara
- Vaccination Unit, University Hospital Paediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Chung JR, Flannery B, Ambrose CS, Bégué RE, Caspard H, DeMarcus L, Fowlkes AL, Kersellius G, Steffens A, Fry AM. Live Attenuated and Inactivated Influenza Vaccine Effectiveness. Pediatrics 2019; 143:peds.2018-2094. [PMID: 30617239 PMCID: PMC6361354 DOI: 10.1542/peds.2018-2094] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Researchers in observational studies of vaccine effectiveness (VE) in which they compared quadrivalent live attenuated vaccine (LAIV4) and inactivated influenza vaccine (IIV) among children and adolescents have shown inconsistent results, and the studies have been limited by small samples. METHODS We combined data from 5 US studies from 2013-2014 through 2015-2016 to compare the VE of LAIV4 and IIV against medically attended, laboratory-confirmed influenza among patients aged 2 to 17 years by influenza season, subtype, age group, and prior vaccination status. The VE of IIV or LAIV4 was calculated as 100% × (1 - odds ratio), comparing the odds of vaccination among patients who were influenza-positive to patients who were influenza-negative from adjusted logistic regression models. Relative effectiveness was defined as the odds of influenza comparingLAIV4 and IIV recipients. RESULTS Of 17 173 patients aged 2 to 17 years, 4579 received IIV, 1979 received LAIV4, and 10 615 were unvaccinated. Against influenza A/H1N1pdm09, VE was 67% (95% confidence interval [CI]: 62% to 72%) for IIV and 20% (95% CI: -6% to 39%) for LAIV4. Results were similar when stratified by vaccination in the previous season. LAIV4 recipients had significantly higher odds of influenza A/H1N1pdm09 compared with IIV recipients (odds ratio 2.66; 95% CI: 2.06 to 3.44). LAIV4 and IIV had similar effectiveness against influenza A/H3N2 and B. Our overall findings were consistent when stratified by influenza season and age group. CONCLUSIONS From this pooled individual patient-level data analysis, we found reduced effectiveness of LAIV4 against influenza A/H1N1pdm09 compared with IIV, which is consistent with published results from the individual studies included.
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Affiliation(s)
- Jessie R. Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Rodolfo E. Bégué
- Department of Pediatrics, Lousiana State University, New Orleans, Louisiana; and
| | | | - Laurie DeMarcus
- Air Force Satellite Cell, Defense Health Agency and Armed Forces Health Surveillance Branch, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Ashley L. Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Geeta Kersellius
- Air Force Satellite Cell, Defense Health Agency and Armed Forces Health Surveillance Branch, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Andrea Steffens
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M. Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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47
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Note from the editors: Open access and sound science for rapid public health action. Euro Surveill 2019; 24:1901101. [PMID: 30646980 PMCID: PMC6337059 DOI: 10.2807/1560-7917.es.2019.24.2.1901101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Chan YWD, Wong ML, Au KW, Chuang SK. Seasonal influenza vaccine effectiveness at primary care level, Hong Kong SAR, 2017/2018 winter. Hum Vaccin Immunother 2018; 15:97-101. [PMID: 30148689 PMCID: PMC6363165 DOI: 10.1080/21645515.2018.1514222] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The 2017/18 winter influenza season in Hong Kong started in early January 2018, predominated by influenza B/Yamagata. We collaborated with private medical practitioners of our sentinel surveillance system to collect respiratory specimens and clinical information from patients with influenza-like illness for estimation of the influenza vaccine effectiveness (VE) using the test-negative case-control design. We found that the overall VE was 59.1% (95%CI 41.1 to 71.8%) against all influenza and 53.5% (95%CI 35.4 to 74.6%) against influenza B. Seasonal influenza vaccine provided moderate to good protection against laboratory-confirmed influenza infection at primary care level in Hong Kong in the 2017/18 winter influenza season.
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Affiliation(s)
- Yung-Wai Desmond Chan
- a Communicable Disease Division, Surveillance and Epidemiology Branch , Centre for Health Protection, Department of Health , Kowloon , Hong Kong SAR Government
| | - Miu-Ling Wong
- a Communicable Disease Division, Surveillance and Epidemiology Branch , Centre for Health Protection, Department of Health , Kowloon , Hong Kong SAR Government
| | - Ka-Wing Au
- a Communicable Disease Division, Surveillance and Epidemiology Branch , Centre for Health Protection, Department of Health , Kowloon , Hong Kong SAR Government
| | - Shuk-Kwan Chuang
- a Communicable Disease Division, Surveillance and Epidemiology Branch , Centre for Health Protection, Department of Health , Kowloon , Hong Kong SAR Government
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49
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Barr IG, Donis RO, Katz JM, McCauley JW, Odagiri T, Trusheim H, Tsai TF, Wentworth DE. Cell culture-derived influenza vaccines in the severe 2017-2018 epidemic season: a step towards improved influenza vaccine effectiveness. NPJ Vaccines 2018; 3:44. [PMID: 30323955 PMCID: PMC6177469 DOI: 10.1038/s41541-018-0079-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
Abstract
The 2017–2018 seasonal influenza epidemics were severe in the US and Australia where the A(H3N2) subtype viruses predominated. Although circulating A(H3N2) viruses did not differ antigenically from that recommended by the WHO for vaccine production, overall interim vaccine effectiveness estimates were below historic averages (33%) for A(H3N2) viruses. The majority (US) or all (Australian) vaccine doses contained multiple amino-acid changes in the hemagglutinin protein, resulting from the necessary adaptation of the virus to embryonated hen’s eggs used for most vaccine manufacturing. Previous reports have suggested a potential negative impact of egg-driven substitutions on vaccine performance. With BARDA support, two vaccines licensed in the US are produced in cell culture: recombinant influenza vaccine (RIV, Flublok™) manufactured in insect cells and inactivated mammalian cell-grown vaccine (ccIIV, Flucelvax™). Quadrivalent ccIIV (ccIIV4) vaccine for the 2017–2018 influenza season was produced using an A(H3N2) seed virus propagated exclusively in cell culture and therefore lacking egg adaptative changes. Sufficient ccIIV doses were distributed (but not RIV doses) to enable preliminary estimates of its higher effectiveness relative to the traditional egg-based vaccines, with study details pending. The increased availability of comparative product-specific vaccine effectiveness estimates for cell-based and egg-based vaccines may provide critical clues to inform vaccine product improvements moving forward.
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Affiliation(s)
- Ian G Barr
- 1WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute For Infection And Immunity, 792 Elizabeth Street, Melbourne, 3000 Australia
| | - Ruben O Donis
- Biomedical Advanced Research and Development Authority, Influenza and Emerging Infectious Diseases Division, 300 Independence Avenue, SW, Washington, DC 20201 USA
| | - Jacqueline M Katz
- 3Influenza Division, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road MS A-20, Atlanta, GA 30329-4027 USA
| | - John W McCauley
- 4WHO Collaborating Centre for Reference and Research on Influenza, Crick Worldwide Influenza Centre, The Francis Crick Institute, 1, Midland Road, London, NW1 1AT UK
| | - Takato Odagiri
- WHO Collaborating Centre for Reference and Research on Influenza, National Institute of Infectious Diseases, Influenza Virus Research Center, 4-7-1 Gakuen, Musashi-Murayama-shi, Tokyo 208-0011 Japan
| | - Heidi Trusheim
- IDT Biologika GmbH, Am Pharmapark, 06861 Dessau-Rosslau, Germany
| | - Theodore F Tsai
- 7Takeda Vaccines (USA), 75 Sidney St, Cambridge, MA 02139 USA
| | - David E Wentworth
- 8Influenza Division, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road MS A-20, Atlanta, GA 30329-4027 USA
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50
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Wu S, Pan Y, Zhang X, Zhang L, Duan W, Ma C, Zhang Y, Zhang M, Sun Y, Yang P, Wang Q, Ma J. Influenza vaccine effectiveness in preventing laboratory-confirmed influenza in outpatient settings: A test-negative case-control study in Beijing, China, 2016/17 season. Vaccine 2018; 36:5774-5780. [DOI: 10.1016/j.vaccine.2018.07.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 01/05/2023]
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