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Varea-Jiménez E, Aznar Cano E, Vega-Piris L, Martínez Sánchez EV, Mazagatos C, García San Miguel Rodríguez-Alarcón L, Casas I, Sierra Moros MJ, Iglesias-Caballero M, Vazquez-Morón S, Larrauri A, Monge S. Comparative severity of COVID-19 cases caused by Alpha, Delta or Omicron SARS-CoV-2 variants and its association with vaccination. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:187-194. [PMID: 36737369 PMCID: PMC9890374 DOI: 10.1016/j.eimce.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compares the severity of SARS-CoV-2 infections caused by Alpha, Delta or Omicron variants in periods of co-circulation in Spain, and estimates the variant-specific association of vaccination with severe disease. METHODS SARS-CoV-2 infections notified to the national epidemiological surveillance network with information on genetic variant and vaccination status were considered cases if they required hospitalisation or controls otherwise. Alpha and Delta were compared during June-July 2021; and Delta and Omicron during December 2021-January 2022. Adjusted odds ratios (aOR) were estimated using logistic regression, comparing variant and vaccination status between cases and controls. RESULTS We included 5,345 Alpha and 11,974 Delta infections in June-July and 5,272 Delta and 10,578 Omicron in December-January. Unvaccinated cases of Alpha (aOR: 0.57; 95% CI: 0.46-0.69) or Omicron (0.28; 0.21-0.36) had lower probability of hospitalisation vs. Delta. Complete vaccination reduced hospitalisation, similarly for Alpha (0.16; 0.13-0.21) and Delta (June-July: 0.16; 0.14-0.19; December-January: 0.36; 0.30-0.44) but lower from Omicron (0.63; 0.53-0.75) and individuals aged 65+ years. CONCLUSION Results indicate higher intrinsic severity of the Delta variant, compared with Alpha or Omicron, with smaller differences among vaccinated individuals. Nevertheless, vaccination was associated to reduced hospitalisation in all groups.
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Affiliation(s)
- Elena Varea-Jiménez
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
| | - Esteban Aznar Cano
- Centre for the Coordination of Alerts and Health Emergencies - Ministry of Health, Madrid, Spain
| | - Lorena Vega-Piris
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
| | - Elena Vanessa Martínez Sánchez
- Centre for the Coordination of Alerts and Health Emergencies - Ministry of Health, Madrid, Spain; CIBER Epidemiology and Public Health, Spain
| | - Clara Mazagatos
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain; CIBER Epidemiology and Public Health, Spain
| | | | - Inmaculada Casas
- CIBER Epidemiology and Public Health, Spain; National Centre of Microbiology - Institute of Health Carlos III, Madrid, Spain
| | - María José Sierra Moros
- Centre for the Coordination of Alerts and Health Emergencies - Ministry of Health, Madrid, Spain; CIBER Infectious Diseases, Spain
| | | | - Sonia Vazquez-Morón
- National Centre of Microbiology - Institute of Health Carlos III, Madrid, Spain
| | - Amparo Larrauri
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain; CIBER Epidemiology and Public Health, Spain
| | - Susana Monge
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain; CIBER Infectious Diseases, Spain.
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Lanièce Delaunay C, Martínez-Baz I, Sève N, Domegan L, Mazagatos C, Buda S, Meijer A, Kislaya I, Pascu C, Carnahan A, Oroszi B, Ilić M, Maurel M, Melo A, Sandonis Martín V, Trobajo-Sanmartín C, Enouf V, McKenna A, Pérez-Gimeno G, Goerlitz L, de Lange M, Rodrigues AP, Lazar M, Latorre-Margalef N, Túri G, Castilla J, Falchi A, Bennett C, Gallardo V, Dürrwald R, Eggink D, Guiomar R, Popescu R, Riess M, Horváth JK, Casado I, García MDC, Hooiveld M, Machado A, Bacci S, Kaczmarek M, Kissling E. COVID-19 vaccine effectiveness against symptomatic infection with SARS-CoV-2 BA.1/BA.2 lineages among adults and adolescents in a multicentre primary care study, Europe, December 2021 to June 2022. Euro Surveill 2024; 29:2300403. [PMID: 38551095 PMCID: PMC10979526 DOI: 10.2807/1560-7917.es.2024.29.13.2300403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/14/2023] [Indexed: 04/01/2024] Open
Abstract
BackgroundScarce European data in early 2021 suggested lower vaccine effectiveness (VE) against SARS-CoV-2 Omicron lineages than previous variants.AimWe aimed to estimate primary series (PS) and first booster VE against symptomatic BA.1/BA.2 infection and investigate potential biases.MethodsThis European test-negative multicentre study tested primary care patients with acute respiratory symptoms for SARS-CoV-2 in the BA.1/BA.2-dominant period. We estimated PS and booster VE among adults and adolescents (PS only) for all products combined and for Comirnaty alone, by time since vaccination, age and chronic condition. We investigated potential bias due to correlation between COVID-19 and influenza vaccination and explored effect modification and confounding by prior SARS-CoV-2 infection.ResultsAmong adults, PS VE was 37% (95% CI: 24-47%) overall and 60% (95% CI: 44-72%), 43% (95% CI: 26-55%) and 29% (95% CI: 13-43%) < 90, 90-179 and ≥ 180 days post vaccination, respectively. Booster VE was 42% (95% CI: 32-51%) overall and 56% (95% CI: 47-64%), 22% (95% CI: 2-38%) and 3% (95% CI: -78% to 48%), respectively. Primary series VE was similar among adolescents. Restricting analyses to Comirnaty had little impact. Vaccine effectiveness was higher among older adults. There was no signal of bias due to correlation between COVID-19 and influenza vaccination. Confounding by previous infection was low, but sample size precluded definite assessment of effect modification.ConclusionPrimary series and booster VE against symptomatic infection with BA.1/BA.2 ranged from 37% to 42%, with similar waning post vaccination. Comprehensive data on previous SARS-CoV-2 infection would help disentangle vaccine- and infection-induced immunity.
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Affiliation(s)
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Noémie Sève
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Lisa Domegan
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Clara Mazagatos
- National Centre of Epidemiology, CIBERESP, Carlos III Health Institute, Madrid, Spain
| | - Silke Buda
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Irina Kislaya
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Catalina Pascu
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Maja Ilić
- Croatian Institute of Public Health (CIPH), Zagreb, Croatia
| | | | - Aryse Melo
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Vincent Enouf
- Institut Pasteur, Pasteur International Bioresources network (PIBnet), Plateforme de Microbiologie Mutualisée (P2M), Paris, France
- Institut Pasteur, Centre National de Référence Virus des Infections Respiratoires (CNR VIR), Paris, France
| | - Adele McKenna
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Gloria Pérez-Gimeno
- National Centre of Epidemiology, CIBERESP, Carlos III Health Institute, Madrid, Spain
| | - Luise Goerlitz
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Marit de Lange
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Mihaela Lazar
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Charlene Bennett
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Virtudes Gallardo
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Sevilla, Spain
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Dirk Eggink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | | | - Judit Krisztina Horváth
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mª Del Carmen García
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de Salud, Mérida, Spain
| | | | - Ausenda Machado
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marlena Kaczmarek
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Maurel M, Howard J, Kissling E, Pozo F, Pérez-Gimeno G, Buda S, Sève N, McKenna A, Meijer A, Rodrigues AP, Martínez-Baz I, Mlinarić I, Latorre-Margalef N, Túri G, Lazăr M, Mazagatos C, Echeverria A, Abela S, Bourgeois M, Machado A, Dürrwald R, Petrović G, Oroszi B, Jancoriene L, Marin A, Husa P, Duffy R, Dijkstra F, Gallardo García V, Goerlitz L, Enouf V, Bennett C, Hooiveld M, Guiomar R, Trobajo-Sanmartín C, Višekruna Vučina V, Samuelsson Hagey T, Lameiras Azevedo AS, Castilla J, Xuereb G, Delaere B, Gómez V, Tolksdorf K, Bacci S, Nicolay N, Kaczmarek M, Rose AM. Interim 2023/24 influenza A vaccine effectiveness: VEBIS European primary care and hospital multicentre studies, September 2023 to January 2024. Euro Surveill 2024; 29:2400089. [PMID: 38390651 PMCID: PMC10899813 DOI: 10.2807/1560-7917.es.2024.29.8.2400089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/24/2024] Open
Abstract
Influenza A viruses circulated in Europe from September 2023 to January 2024, with influenza A(H1N1)pdm09 predominance. We provide interim 2023/24 influenza vaccine effectiveness (IVE) estimates from two European studies, covering 10 countries across primary care (EU-PC) and hospital (EU-H) settings. Interim IVE was higher against A(H1N1)pdm09 than A(H3N2): EU-PC influenza A(H1N1)pdm09 IVE was 53% (95% CI: 41 to 63) and 30% (95% CI: -3 to 54) against influenza A(H3N2). For EU-H, these were 44% (95% CI: 30 to 55) and 14% (95% CI: -32 to 43), respectively.
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Affiliation(s)
| | | | | | - Francisco Pozo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Gloria Pérez-Gimeno
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Noémie Sève
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Adele McKenna
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Adam Meijer
- National Institute for Public Health and the Environment, Centre for Infectious Diseases Control, Bilthoven, the Netherlands
| | - Ana Paula Rodrigues
- Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA - CIBERESP, Pamplona, Spain
| | - Ivan Mlinarić
- Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Mihaela Lazăr
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Stephen Abela
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | - Marc Bourgeois
- Department of Infectious Diseases, CHU UCL Namur (site Godinne), Université catholique de Louvain, Yvoir, Belgium
| | - Ausenda Machado
- Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | | | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Alexandru Marin
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Petr Husa
- University Hospital Brno and Masaryk University, Brno, Czechia
| | - Roisin Duffy
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment, Centre for Infectious Diseases Control, Bilthoven, the Netherlands
| | - Virtudes Gallardo García
- Servicio de Vigilancia y Salud Laboral, Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Consumo, Andalucía, Spain
| | - Luise Goerlitz
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Vincent Enouf
- Centre National de Référence Virus des Infections Respiratoire (CNR VIR), Institut Pasteur Université Paris Cité, Paris, France
| | - Charlene Bennett
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | - Raquel Guiomar
- Laboratório Nacional Referência Gripe e outros Vírus Respiratórios, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Ana Sofía Lameiras Azevedo
- Servicio de vigilancia y control epidemiológico, Subdirección general de Epidemiología y Vigilancia de la Salud, Dirección General de Salud pública, Valencia, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA - CIBERESP, Pamplona, Spain
| | - Gerd Xuereb
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | - Bénédicte Delaere
- Department of Infectious Diseases, CHU UCL Namur (site Godinne), Université catholique de Louvain, Yvoir, Belgium
| | - Verónica Gómez
- Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Kristin Tolksdorf
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marlena Kaczmarek
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Rose AMC, Pozo F, Martínez-Baz I, Mazagatos C, Bossuyt N, Cauchi JP, Petrović G, Loghin II, Vaikutyte R, Buda S, Machado A, Duffy R, Oroszi B, Howard J, Echeverria A, Andreu C, Barbezange C, Džiugytė A, Nonković D, Popescu CP, Majauskaite F, Tolksdorf K, Gomez V, Domegan L, Horváth JK, Castilla J, García M, Demuyser T, Borg ML, Tabain I, Lazar M, Kubiliute I, Dürrwald R, Guiomar R, O'Donnell J, Kristóf K, Nicolay N, Bacci S, Kissling E. Vaccine effectiveness against influenza hospitalisation in adults during the 2022/2023 mixed season of influenza A(H1N1)pdm09, A(H3N2) and B circulation, Europe: VEBIS SARI VE hospital network. Influenza Other Respir Viruses 2024; 18:e13255. [PMID: 38403302 PMCID: PMC10894713 DOI: 10.1111/irv.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/27/2024] Open
Abstract
We conducted a multicentre hospital-based test-negative case-control study to measure vaccine effectiveness (VE) against PCR-confirmed influenza in adult patients with severe acute respiratory infection (SARI) during the 2022/2023 influenza season in Europe. Among 5547 SARI patients ≥18 years, 2963 (53%) were vaccinated against influenza. Overall VE against influenza A(H1N1)pdm09 was 11% (95% CI: -23-36); 20% (95% CI: -4-39) against A(H3N2) and 56% (95% CI: 22-75) against B. During the 2022/2023 season, while VE against hospitalisation with influenza B was >55%, it was ≤20% for influenza A subtypes. While influenza vaccination should be a priority for future seasons, improved vaccines against influenza are needed.
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Affiliation(s)
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Iván Martínez-Baz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - John Paul Cauchi
- Department for Health Regulation, Health Promotion and Disease Prevention, Msida, Malta
| | | | - Isabela I Loghin
- St Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
| | | | | | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Aitziber Echeverria
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
| | - Cristina Andreu
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de Salud, Mérida, Spain
| | | | - Aušra Džiugytė
- Department for Health Regulation, Health Promotion and Disease Prevention, Msida, Malta
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Corneliu-Petru Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Fausta Majauskaite
- Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Verónica Gomez
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
| | - Miriam García
- Dirección General de Salud Pública, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, Spain
| | - Thomas Demuyser
- Department of Microbiology and Infection control, UZ Brussel, Brussels, Belgium
| | - Maria-Louise Borg
- Department for Health Regulation, Health Promotion and Disease Prevention, Msida, Malta
| | - Irena Tabain
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Mihaela Lazar
- "Cantacuzino" National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Ieva Kubiliute
- Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Raquel Guiomar
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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5
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Antunes L, Mazagatos C, Martínez-Baz I, Gomez V, Borg ML, Petrović G, Duffy R, Dufrasne FE, Dürrwald R, Lazar M, Jancoriene L, Oroszi B, Husa P, Howard J, Melo A, Pozo F, Pérez-Gimeno G, Castilla J, Machado A, Džiugytė A, Karabuva S, Fitzgerald M, Fierens S, Tolksdorf K, Popovici SO, Mickienė A, Túri G, Součková L, Nicolay N, Rose AM. Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023. Euro Surveill 2024; 29:2300708. [PMID: 38240061 PMCID: PMC10797659 DOI: 10.2807/1560-7917.es.2024.29.3.2300708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 01/22/2024] Open
Abstract
We conducted a multicentre hospital-based test-negative case-control study to measure the effectiveness of adapted bivalent COVID-19 mRNA vaccines against PCR-confirmed SARS-CoV-2 infection during the Omicron XBB lineage-predominant period in patients aged ≥ 60 years with severe acute respiratory infection from five countries in Europe. Bivalent vaccines provided short-term additional protection compared with those vaccinated > 6 months before the campaign: from 80% (95% CI: 50 to 94) for 14-89 days post-vaccination, 15% (95% CI: -12 to 35) at 90-179 days, and lower to no effect thereafter.
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Affiliation(s)
| | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Verónica Gomez
- Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Maria-Louise Borg
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | | | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - François E Dufrasne
- National Influenza Centre Laboratory of Viral Diseases, Sciensano, Brussels, Belgium
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Mihaela Lazar
- Cantacuzino National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Lithuania
| | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Petr Husa
- University Hospital Brno, Masaryk University, Brno, Czechia
| | | | - Aryse Melo
- Infectious Diseases Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Gloria Pérez-Gimeno
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ausenda Machado
- Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Aušra Džiugytė
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | | | - Margaret Fitzgerald
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Sébastien Fierens
- Service Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium
| | - Kristin Tolksdorf
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silvia-Odette Popovici
- National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, Bucharest, Romania
| | - Auksė Mickienė
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Lenka Součková
- University Hospital Brno, Masaryk University, Brno, Czechia
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Rose AM, Nicolay N, Sandonis Martín V, Mazagatos C, Petrović G, Baruch J, Denayer S, Seyler L, Domegan L, Launay O, Machado A, Burgui C, Vaikutyte R, Niessen FA, Loghin II, Husa P, Aouali N, Panagiotakopoulos G, Tolksdorf K, Horváth JK, Howard J, Pozo F, Gallardo V, Nonković D, Džiugytė A, Bossuyt N, Demuyser T, Duffy R, Luong Nguyen LB, Kislaya I, Martínez-Baz I, Gefenaite G, Knol MJ, Popescu C, Součková L, Simon M, Michelaki S, Reiche J, Ferenczi A, Delgado-Sanz C, Lovrić Makarić Z, Cauchi JP, Barbezange C, Van Nedervelde E, O'Donnell J, Durier C, Guiomar R, Castilla J, Jonikaite I, Bruijning-Verhagen PC, Lazar M, Demlová R, Wirtz G, Amerali M, Dürrwald R, Kunstár MP, Kissling E, Bacci S, Valenciano M. Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Omicron-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021 to 2022. Euro Surveill 2023; 28:2300187. [PMID: 37997665 PMCID: PMC10668256 DOI: 10.2807/1560-7917.es.2023.28.47.2300187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 11/25/2023] Open
Abstract
IntroductionThe I-MOVE-COVID-19 and VEBIS hospital networks have been measuring COVID-19 vaccine effectiveness (VE) in participating European countries since early 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in patients ≥ 20 years hospitalised with severe acute respiratory infection (SARI) from December 2021 to July 2022 (Omicron-dominant period).MethodsIn both networks, 46 hospitals (13 countries) follow a similar test-negative case-control protocol. We defined complete primary series vaccination (PSV) and first booster dose vaccination as last dose of either vaccine received ≥ 14 days before symptom onset (stratifying first booster into received < 150 and ≥ 150 days after last PSV dose). We measured VE overall, by vaccine category/product, age group and time since first mRNA booster dose, adjusting by site as a fixed effect, and by swab date, age, sex, and presence/absence of at least one commonly collected chronic condition.ResultsWe included 2,779 cases and 2,362 controls. The VE of all vaccine products combined against hospitalisation for laboratory-confirmed SARS-CoV-2 was 43% (95% CI: 29-54) for complete PSV (with last dose received ≥ 150 days before onset), while it was 59% (95% CI: 51-66) after addition of one booster dose. The VE was 85% (95% CI: 78-89), 70% (95% CI: 61-77) and 36% (95% CI: 17-51) for those with onset 14-59 days, 60-119 days and 120-179 days after booster vaccination, respectively.ConclusionsOur results suggest that, during the Omicron period, observed VE against SARI hospitalisation improved with first mRNA booster dose, particularly for those having symptom onset < 120 days after first booster dose.
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Affiliation(s)
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Joaquin Baruch
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Odile Launay
- Inserm, CIC Cochin-Pasteur, Paris, France
- AP-HP, Hôpital Cochin, Paris, France
- Faculty of Medicine, University of Paris City, Paris, France
| | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - F Annabel Niessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Isabela I Loghin
- St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Petr Husa
- Faculty of Medicine, Masaryk University, Brno, Czechia
- University Hospital Brno, Brno, Czechia
| | | | | | | | - Judit Krisztina Horváth
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Virtudes Gallardo
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Spain
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Aušra Džiugytė
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | | | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Irina Kislaya
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Giedre Gefenaite
- Faculty of Medicine, Lund University, Lund, Sweden
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Marc Simon
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | | | - Annamária Ferenczi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Concepción Delgado-Sanz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - John Paul Cauchi
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Raquel Guiomar
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Patricia Cjl Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mihaela Lazar
- "Cantacuzino" National Military Medical Institute for Research-Development, Bucharest, Romania
| | | | - Gil Wirtz
- Centre Hospitalier de Luxembourg, Luxembourg
| | - Marina Amerali
- National Public Health Organisation (EODY), Athens, Greece
| | | | - Mihály Pál Kunstár
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Rose AM, Nicolay N, Sandonis Martín V, Mazagatos C, Petrović G, Niessen FA, Machado A, Launay O, Denayer S, Seyler L, Baruch J, Burgui C, Loghin II, Domegan L, Vaikutytė R, Husa P, Panagiotakopoulos G, Aouali N, Dürrwald R, Howard J, Pozo F, Sastre-Palou B, Nonković D, Knol MJ, Kislaya I, Luong Nguyen LB, Bossuyt N, Demuyser T, Džiugytė A, Martínez-Baz I, Popescu C, Duffy R, Kuliešė M, Součková L, Michelaki S, Simon M, Reiche J, Otero-Barrós MT, Lovrić Makarić Z, Bruijning-Verhagen PC, Gomez V, Lesieur Z, Barbezange C, Van Nedervelde E, Borg ML, Castilla J, Lazar M, O'Donnell J, Jonikaitė I, Demlová R, Amerali M, Wirtz G, Tolksdorf K, Valenciano M, Bacci S, Kissling E. Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Alpha- and Delta-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021. Euro Surveill 2023; 28:2300186. [PMID: 37997666 PMCID: PMC10668259 DOI: 10.2807/1560-7917.es.2023.28.47.2300186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 11/25/2023] Open
Abstract
IntroductionTwo large multicentre European hospital networks have estimated vaccine effectiveness (VE) against COVID-19 since 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in hospitalised severe acute respiratory illness (SARI) patients ≥ 20 years, combining data from these networks during Alpha (March-June)- and Delta (June-December)-dominant periods, 2021.MethodsForty-six participating hospitals across 14 countries follow a similar generic protocol using the test-negative case-control design. We defined complete primary series vaccination (PSV) as two doses of a two-dose or one of a single-dose vaccine ≥ 14 days before onset.ResultsWe included 1,087 cases (538 controls) and 1,669 cases (1,442 controls) in the Alpha- and Delta-dominant periods, respectively. During the Alpha period, VE against hospitalisation with SARS-CoV2 for complete Comirnaty PSV was 85% (95% CI: 69-92) overall and 75% (95% CI: 42-90) in those aged ≥ 80 years. During the Delta period, among SARI patients ≥ 20 years with symptom onset ≥ 150 days from last PSV dose, VE for complete Comirnaty PSV was 54% (95% CI: 18-74). Among those receiving Comirnaty PSV and mRNA booster (any product) ≥ 150 days after last PSV dose, VE was 91% (95% CI: 57-98). In time-since-vaccination analysis, complete all-product PSV VE was > 90% in those with their last dose < 90 days before onset; ≥ 70% in those 90-179 days before onset.ConclusionsOur results from this EU multi-country hospital setting showed that VE for complete PSV alone was higher in the Alpha- than the Delta-dominant period, and addition of a first booster dose during the latter period increased VE to over 90%.
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Affiliation(s)
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - F Annabel Niessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Odile Launay
- Inserm, CIC Cochin-Pasteur, Paris, France
- AP-HP, Hôpital Cochin, Paris, France
- Faculty of Medicine, University of Paris City, Paris, France
| | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Joaquin Baruch
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Isabela I Loghin
- St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Petr Husa
- Faculty of Medicine, Masaryk University, Brno, Czechia
- University Hospital Brno, Brno, Czechia
| | | | | | | | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Bartolomé Sastre-Palou
- Servicio de Medicina Preventiva Hospital Universitario Son Espases, Servicio de Epidemiología, Consellería de Salut, Palma, Spain
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Irina Kislaya
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Aušra Džiugytė
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Monika Kuliešė
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Marc Simon
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | - María Teresa Otero-Barrós
- Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de Galicia, Santiago de Compostela, A Coruna, Spain
| | | | - Patricia Cjl Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Verónica Gomez
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Maria-Louise Borg
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mihaela Lazar
- "Cantacuzino" National Military Medical Institute for Research-Development, Bucharest, Romania
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Marina Amerali
- National Public Health Organisation (EODY), Athens, Greece
| | - Gil Wirtz
- Luxembourg Institute of Health, Luxembourg
| | | | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Canelas-Fernández J, Mazagatos C, Delgado-Sanz C, Larrauri A. Influenza hospitalisations in Spain between the last influenza and COVID-19 pandemic (2009-2019). Epidemiol Infect 2023; 151:e177. [PMID: 37791484 PMCID: PMC10600905 DOI: 10.1017/s0950268823001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
Knowing the burden of severe disease caused by influenza is essential for disease risk communication, to understand the true impact of vaccination programmes and to guide public health and disease control measures. We estimated the number of influenza-attributable hospitalisations in Spain during the 2010-2011 to 2019-2020 seasons - based on the hospitalisations due to severe acute respiratory infection (SARI) in Spain using the hospital discharge database and virological influenza information from the Spanish Influenza Sentinel Surveillance System (SISSS). The weekly numbers of influenza-attributable hospitalisations were calculated by multiplying the weekly SARI hospitalisations by the weekly influenza virus positivity, obtained from the SISSS in each season, stratified by age group and sex. The influenza-related hospitalisation burden is age-specific and varies significantly by influenza season. People aged 65 and over yielded the highest average influenza-attributable hospitalisation rates per season (615.6 per 100,000), followed by children aged under 5 (251.2 per 100,000). These results provide an essential contribution to influenza control and to improving existing vaccination programmes, as well as to the optimisation and planning of health resources and policies.
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Affiliation(s)
| | - Clara Mazagatos
- National Centre of Epidemiology, CIBERESP, Carlos III Health Institute, Madrid, Spain
| | | | - Amparo Larrauri
- National Centre of Epidemiology, CIBERESP, Carlos III Health Institute, Madrid, Spain
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Mazagatos C, Delgado-Sanz C, Milagro A, Liébana-Rodríguez M, Larrauri A. Impact of Influenza Vaccination on the Burden of Severe Influenza in the Elderly: Spain, 2017-2020. Vaccines (Basel) 2023; 11:1110. [PMID: 37376499 DOI: 10.3390/vaccines11061110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Annual influenza vaccination is the main strategy to reduce the burden of seasonal influenza epidemics and is recommended for the elderly in most countries with influenza vaccination strategies, with the main objective of preventing hospitalizations and mortality associated with seasonal influenza in this age group. Studies from different countries have estimated the benefits of seasonal influenza vaccination programs in the elderly, preventing a considerable number of cases, hospitalizations and deaths every year. A study measured the number of medically attended confirmed influenza cases in primary care that are prevented annually by vaccination in the population aged 65 and older in Spain, the Netherlands and Portugal, but estimates of the impact of the national influenza vaccination program in the prevention of severe disease in Spain are lacking. The two objectives of this study were to estimate the burden of severe influenza disease in the Spanish population and to measure the impact of influenza vaccination in the prevention of these outcomes in the population aged 65 years and older. Using influenza surveillance systems put in place before the COVID-19 pandemic, we conducted a retrospective observational study to estimate the burden of hospitalizations and ICU admissions in Spain between 2017-18 and 2019-20, by season and age group. Burden estimates for the 65+ group, combined with vaccine effectiveness (VE) and vaccination coverage (VC) data, were used as input data in an ecological, observational study to estimate the impact of the influenza vaccination program on the elderly. We found a higher burden of severe influenza disease in seasons 2017-18 and 2018-19, with A(H3N2) circulation, and in the youngest and oldest age groups. In those aged 65 and older, we estimated an average of 9900 influenza hospitalizations and 1541 ICU admissions averted by vaccination each year. Seasonal influenza vaccination was able to prevent between 11 and 26% influenza hospitalizations and around 40% ICU admissions in the elderly in the three pre-pandemic seasons. In conclusion, our study complements previous analyses in the primary care setting in Spain and demonstrates the benefits of the annual influenza vaccination program in the prevention of severe influenza disease in the elderly, even in seasons with moderate VE.
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Affiliation(s)
- Clara Mazagatos
- National Centre of Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Concepción Delgado-Sanz
- National Centre of Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Ana Milagro
- Miguel Servet University Hospital, Microbiology, 50009 Zaragoza, Spain
- Health Research Institute Aragón, 50009 Zaragoza, Spain
| | - María Liébana-Rodríguez
- Servicio Medicina Preventiva, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Amparo Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Monge S, Rojas-Benedicto A, Olmedo C, Martín-Merino E, Mazagatos C, Limia A, Sierra MJ, Larrauri A, Hernán MA. Effectiveness of a Second Dose of an mRNA Vaccine Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Omicron Infection in Individuals Previously Infected by Other Variants. Clin Infect Dis 2023; 76:e367-e374. [PMID: 35687580 PMCID: PMC9214148 DOI: 10.1093/cid/ciac429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Single-dose vaccination was widely recommended in the pre-Omicron era for persons with previous SARS-CoV-2 infection. The effectiveness of a second vaccine dose in this group in the Omicron era is unknown. METHODS We linked nationwide population registries in Spain to identify community-dwelling individuals aged 18-64, with a positive SARS-CoV-2 test before single-dose mRNA vaccination (mRNA-1273 or BNT162b2). Every day between 3 January and 6 February 2022 we matched 1:1 individuals receiving a second mRNA vaccine dose and controls on sex, age, province, first dose type and time, month of primary infection, and number of previous tests. We then estimated Kaplan-Meier risks of confirmed SARS-CoV-2 reinfection. We performed a similar analysis in a Delta-dominant period, between 19 July and 30 November 2021. RESULTS In the Omicron period, estimated effectiveness (95% CI) of a second dose was 62.2% (58.2-66.4%) 7-34 days after administration, similar across groups defined by age, sex, type of first vaccine, and time since the first dose. Estimated effectiveness was 65.4% (61.1-69.9%) for mRNA-1273 and 52.0% (41.8-63.1%) for BNT162b2. Estimated effectiveness was 78.5% (67.4-89.9%), 66.1% (54.9-77.5%), and 60.2% (55.5-64.8%) when primary infection had occurred in the Delta, Alpha, and pre-Alpha periods, respectively. In the Delta period, the estimated effectiveness of a second dose was 8.8% (-55.3% to 81.1%). CONCLUSIONS Our results suggest that, over 1 month after administration, a second dose of mRNA vaccine increases protection against SARS-CoV-2 reinfection with the Omicron variant among individuals with single-dose vaccination and previously infected with another variant.
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Affiliation(s)
- Susana Monge
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Ayelén Rojas-Benedicto
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER on Epidemiology and Public Health, Madrid, Spain
- National Distance Education University, Madrid, Spain
| | - Carmen Olmedo
- Vaccines Division, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | | | - Clara Mazagatos
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER on Epidemiology and Public Health, Madrid, Spain
| | - Aurora Limia
- Vaccines Division, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - María José Sierra
- CIBER on Infectious Diseases, Madrid, Spain
- Centre for the Coordination of Heath Alerts and Emergencies, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Amparo Larrauri
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER on Epidemiology and Public Health, Madrid, Spain
| | - Miguel A Hernán
- CAUSALab and Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Varea-Jiménez E, Cano EA, Vega-Piris L, Sánchez EVM, Mazagatos C, Rodríguez-Alarcón LGSM, Casas I, Moros MJS, Iglesias-Caballero M, Vazquez-Morón S, Larrauri A, Monge S. [Comparative severity of COVID-19 cases caused by Alpha, Delta or Omicron SARS-CoV-2 variants and its association with vaccination]. Enferm Infecc Microbiol Clin 2022:S0213-005X(22)00281-6. [PMID: 36506460 PMCID: PMC9722675 DOI: 10.1016/j.eimc.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study compares the severity of SARS-CoV-2 infections caused by Alpha, Delta or Omicron variants in periods of co-circulation in Spain, and estimates the variant-specific association of vaccination with severe disease. METHODS SARS-CoV-2 infections notified to the national epidemiological surveillance network with information on genetic variant and vaccination status were considered cases if they required hospitalisation or controls otherwise. Alpha and Delta were compared during June-July 2021; and Delta and Omicron during December 2021-January 2022. Adjusted Odds Ratios (aOR) were estimated using logistic regression, comparing variant and vaccination status between cases and controls. RESULTS We included 5,345 Alpha and 11,974 Delta infections in June-July and, 5,272 Delta and 10,578 Omicron in December-January. Unvaccinated cases of Alpha (aOR: 0.57; 95% CI: 0.46-0.69) or Omicron (0.28; 0.21-0.36) had lower probability of hospitalisation vs. Delta. Complete vaccination reduced hospitalisation, similarly for Alpha (0.16; 0.13-0.21) and Delta (June-July: 0.16; 0.14-0.19; December-January: 0.36; 0.30-0.44) but lower from Omicron (0.63; 0.53-0.75) and individuals aged 65+ years. CONCLUSION Results indicate higher intrinsic severity of the Delta variant, compared with Alpha or Omicron, with smaller differences among vaccinated individuals. Nevertheless, vaccination was associated to reduced hospitalisation in all groups.
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Affiliation(s)
- Elena Varea-Jiménez
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
| | - Esteban Aznar Cano
- Centre for the Coordination of Alerts and Health Emergencies - Ministry of Health, Madrid, Spain
| | - Lorena Vega-Piris
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
| | - Elena Vanessa Martínez Sánchez
- Centre for the Coordination of Alerts and Health Emergencies - Ministry of Health, Madrid, Spain
- CIBER Epidemiology and Public Health, Spain
| | - Clara Mazagatos
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
- CIBER Epidemiology and Public Health, Spain
| | | | - Inmaculada Casas
- National Centre of Microbiology - Institute of Health Carlos III, Madrid, Spain
- CIBER Epidemiology and Public Health, Spain
| | - María José Sierra Moros
- Centre for the Coordination of Alerts and Health Emergencies - Ministry of Health, Madrid, Spain
- CIBER Infectious Diseases, Spain
| | | | - Sonia Vazquez-Morón
- National Centre of Microbiology - Institute of Health Carlos III, Madrid, Spain
| | - Amparo Larrauri
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
- CIBER Epidemiology and Public Health, Spain
| | - Susana Monge
- National Centre of Epidemiology - Institute of Health Carlos III, Madrid, Spain
- CIBER Infectious Diseases, Spain
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Kissling E, Pozo F, Martínez‐Baz I, Buda S, Vilcu A, Domegan L, Mazagatos C, Dijkstra F, Latorre‐Margalef N, Kurečić Filipović S, Machado A, Lazar M, Casado I, Dürrwald R, van der Werf S, O'Donnell J, Linares Dopido JA, Meijer A, Riess M, Višekruna Vučina V, Rodrigues AP, Mihai ME, Castilla J, Goerlitz L, Falchi A, Connell J, Castrillejo D, Hooiveld M, Carnahan A, Ilić M, Guiomar R, Ivanciuc A, Maurel M, Omokanye A, Valenciano M. Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021-2022 I-MOVE primary care multicentre study. Influenza Other Respir Viruses 2022; 17:e13069. [PMID: 36702797 PMCID: PMC9835407 DOI: 10.1111/irv.13069] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 2021-2022, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE). METHODS Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive, and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions. RESULTS Between week 40 2021 and week 20 2022, we included over 11 000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95% CI: 43-89) and 81% (95% CI: 45-93) among those aged 15-64 years. Overall VE against influenza A(H3N2) was 29% (95% CI: 12-42) and 25% (95% CI: -41 to 61), 33% (95% CI: 14-49), and 26% (95% CI: -22 to 55) among those aged 0-14, 15-64, and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95% CI: -6 to 39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but eight belonged to clade 3C.2a1b.2a.2. DISCUSSION Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021-2022 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.
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Affiliation(s)
| | - Francisco Pozo
- National Centre for MicrobiologyInstitute of Health Carlos IIIMadridSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Iván Martínez‐Baz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | - Ana‐Maria Vilcu
- INSERM, Sorbonne UniversitéInstitut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136)ParisFrance
| | - Lisa Domegan
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,National Centre for EpidemiologyInstitute of Health Carlos IIIMadridSpain
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | | | - Mihaela Lazar
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Itziar Casado
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut PasteurUniversité Paris Cité, UMR 3569 CNRSParisFrance,CNR virus des infections respiratoires, Institut PasteurParisFrance
| | - Joan O'Donnell
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Juan Antonio Linares Dopido
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de SaludExtremaduraSpain
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | | | - Maria Elena Mihai
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | | | - Jeff Connell
- National Virus Reference LaboratoryUniversity College DublinDublinIreland
| | - Daniel Castrillejo
- Servicio de Epidemiología, DGSP, Consejería de Políticas Sociales, Salud Pública y Bienestar Animal, Ciudad Autónoma de MelillaMelillaSpain
| | | | | | - Maja Ilić
- Croatian Institute of Public HealthZagrebCroatia
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo JorgeLisbonPortugal
| | - Alina Ivanciuc
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | | | - Ajibola Omokanye
- European Centre for Disease Prevention and ControlStockholmSweden
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13
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Monge S, Rojas-Benedicto A, Olmedo C, Mazagatos C, José Sierra M, Limia A, Martín-Merino E, Larrauri A, Hernán MA. Effectiveness of mRNA vaccine boosters against infection with the SARS-CoV-2 omicron (B.1.1.529) variant in Spain: a nationwide cohort study. Lancet Infect Dis 2022; 22:1313-1320. [PMID: 35658998 PMCID: PMC9162477 DOI: 10.1016/s1473-3099(22)00292-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The omicron (B.1.1.529) variant of SARS-CoV-2 has increased capacity to elude immunity and cause breakthrough infections. The aim of this study was to estimate the effectiveness of mRNA-based vaccine boosters (third dose) against infection with the omicron variant by age, sex, time since complete vaccination, type of primary vaccine, and type of booster. METHODS In this nationwide cohort study, we linked data from three nationwide population registries in Spain (Vaccination Registry, Laboratory Results Registry, and National Health System registry) to select community-dwelling individuals aged 40 years or older, who completed their primary vaccine schedule at least 3 months before the start of follow-up, and had not tested positive for SARS-CoV-2 since the start of the pandemic. On each day between Jan 3, and Feb 6, 2022, we matched individuals who received a booster mRNA vaccine and controls of the same sex, age group, postal code, type of vaccine, time since primary vaccination, and number of previous tests. We estimated risk of laboratory-confirmed SARS-CoV-2 infection using the Kaplan-Meier method and compared groups using risk ratios (RR) and risk differences. Vaccine effectiveness was calculated as one minus RR. FINDINGS Between Jan 3, and Feb 6, 2022, 3 111 159 matched pairs were included in our study. Overall, the estimated effectiveness from day 7 to 34 after a booster was 51·3% (95% CI 50·2-52·4). Estimated effectiveness was 52·5% (51·3-53·7) for an mRNA-1273 booster and 46·2% (43·5-48·7) for a BNT162b2 booster. Effectiveness was 58·6% (55·5-61·6) if primary vaccination had been with ChAdOx1 nCoV-19 (Oxford-AstraZeneca), 55·3% (52·3-58·2) with mRNA-1273 (Moderna), 49·7% (48·3-51·1) with BNT162b2 (Pfizer-BioNTech), and 48·0% (42·5-53·7) with Ad26.COV2.S (Janssen). Estimated effectiveness was 43·6% (40·0-47·1) when the booster was administered between 151 days and 180 days after complete vaccination and 52·2% (51·0-53·3) if administered more than 180 days after primary scheduled completion. INTERPRETATION Booster mRNA vaccine-doses were moderately effective in preventing infection with the omicron variant of SARS-CoV-2 for over a month after administration, which indicates their suitability as a strategy to limit the health effects of COVID-19 in periods of omicron variant domination. Estimated effectiveness was higher for mRNA-1273 compared with BNT162b2 and increased with time between completed primary vaccination and booster. FUNDING None.
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Affiliation(s)
- Susana Monge
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red (CIBER) on Infectious Diseases, Madrid, Spain.
| | - Ayelén Rojas-Benedicto
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain; CIBER on Epidemiology and Public Health, Madrid, Spain; National Distance Education University, Madrid, Spain
| | - Carmen Olmedo
- Vaccines Division, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Clara Mazagatos
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain; CIBER on Epidemiology and Public Health, Madrid, Spain
| | - María José Sierra
- Centre for the Coordination of Heath Alerts and Emergencies, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Aurora Limia
- Vaccines Division, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | | | - Amparo Larrauri
- Department of Communicable Diseases, National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain; CIBER on Epidemiology and Public Health, Madrid, Spain
| | - Miguel A Hernán
- CAUSALab and Departments of Epidemiology and Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
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14
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Mazagatos C, Delgado-Sanz C, Monge S, Pozo F, Oliva J, Sandonis V, Gandarillas A, Quiñones-Rubio C, Ruiz-Sopeña C, Gallardo-García V, Basile L, Barranco-Boada MI, Hidalgo-Pardo O, Vazquez-Cancela O, García-Vázquez M, Fernández-Sierra A, Milagro-Beamonte A, Ordobás M, Martínez-Ochoa E, Fernández-Arribas S, Lorusso N, Martínez A, García-Fulgueiras A, Sastre-Palou B, Losada-Castillo I, Martínez-Cuenca S, Rodríguez-Del Águila M, Latorre M, Larrauri A. COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain. Influenza Other Respir Viruses 2022; 16:1014-1025. [PMID: 35880469 PMCID: PMC9350393 DOI: 10.1111/irv.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background With the emergence of SARS‐CoV‐2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. Methods Using a test‐negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID‐19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS‐CoV‐2 variant. Results VE was 89% (95% CI: 83–93) against COVID‐19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS‐CoV‐2 variants, although variant‐specific VE was slightly higher against Alpha. Conclusions The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID‐19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID‐19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS‐CoV‐2 variants (Alpha vs. Delta).
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Affiliation(s)
- Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Concepción Delgado-Sanz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Susana Monge
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Francisco Pozo
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Jesús Oliva
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Virginia Sandonis
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Ana Gandarillas
- Subdirección General de Epidemiología, Dirección General de Salud Pública, Madrid, Spain
| | - Carmen Quiñones-Rubio
- Servicio de Epidemiología y Prevención Sanitaria, Dirección General de Salud Pública, Consumo y Cuidados, Logroño, Spain
| | | | - Virtudes Gallardo-García
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Seville, Spain
| | - Luca Basile
- Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública, Catalonia, Spain
| | | | - Olga Hidalgo-Pardo
- Servicio de Medicina Preventiva Hospital Universitario Son Espases, Servicio de Epidemiología, Consellería de Salut, Palma, Spain
| | - Olalla Vazquez-Cancela
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Miriam García-Vázquez
- Vigilancia Epidemiológica, Dirección General de Salud Pública, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, Spain
| | | | - Ana Milagro-Beamonte
- Laboratorio de Microbiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - María Ordobás
- Subdirección General de Epidemiología, Dirección General de Salud Pública, Madrid, Spain
| | - Eva Martínez-Ochoa
- Servicio de Epidemiología y Prevención Sanitaria, Dirección General de Salud Pública, Consumo y Cuidados, Logroño, Spain
| | | | - Nicola Lorusso
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Seville, Spain
| | - Ana Martínez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública, Catalonia, Spain
| | - Ana García-Fulgueiras
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Salud, Murcia, Spain
| | - Bartolomé Sastre-Palou
- Servicio de Medicina Preventiva Hospital Universitario Son Espases, Servicio de Epidemiología, Consellería de Salut, Palma, Spain
| | - Isabel Losada-Castillo
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Galicia, Spain
| | - Silvia Martínez-Cuenca
- Vigilancia Epidemiológica, Dirección General de Salud Pública, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, Spain
| | | | - Miriam Latorre
- Laboratorio de Microbiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Amparo Larrauri
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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15
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Bagaria J, Jansen T, Marques DF, Hooiveld M, McMenamin J, de Lusignan S, Vilcu AM, Meijer A, Rodrigues AP, Brytting M, Mazagatos C, Cogdale J, van der Werf S, Dijkstra F, Guiomar R, Enkirch T, Valenciano M. Rapidly adapting primary care sentinel surveillance across seven countries in Europe for COVID-19 in the first half of 2020: strengths, challenges, and lessons learned. Euro Surveill 2022; 27. [PMID: 35775429 PMCID: PMC9248262 DOI: 10.2807/1560-7917.es.2022.27.26.2100864] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
As the COVID-19 pandemic began in early 2020, primary care influenza sentinel surveillance networks within the Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE) consortium rapidly adapted to COVID-19 surveillance. This study maps system adaptations and lessons learned about aligning influenza and COVID-19 surveillance following ECDC / WHO/Europe recommendations and preparing for other diseases possibly emerging in the future. Using a qualitative approach, we describe the adaptations of seven sentinel sites in five European Union countries and the United Kingdom during the first pandemic phase (March–September 2020). Adaptations to sentinel systems were substantial (2/7 sites), moderate (2/7) or minor (3/7 sites). Most adaptations encompassed patient referral and sample collection pathways, laboratory testing and data collection. Strengths included established networks of primary care providers, highly qualified testing laboratories and stakeholder commitments. One challenge was the decreasing number of samples due to altered patient pathways. Lessons learned included flexibility establishing new routines and new laboratory testing. To enable simultaneous sentinel surveillance of influenza and COVID-19, experiences of the sentinel sites and testing infrastructure should be considered. The contradicting aims of rapid case finding and contact tracing, which are needed for control during a pandemic and regular surveillance, should be carefully balanced.
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Affiliation(s)
| | | | | | | | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Ana-Maria Vilcu
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Adam Meijer
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Mia Brytting
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Sylvie van der Werf
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Molecular Genetics of RNA viruses unit, National Reference Center for Respiratory Viruses, Paris, France
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
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- The members of the I-MOVE-COVID-19 primary care study team are listed under Collaborators
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16
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Kissling E, Hooiveld M, Martínez-Baz I, Mazagatos C, William N, Vilcu AM, Kooijman MN, Ilić M, Domegan L, Machado A, de Lusignan S, Lazar M, Meijer A, Brytting M, Casado I, Larrauri A, Murray JLK, Behillil S, de Gier B, Mlinarić I, O’Donnell J, Rodrigues AP, Tsang R, Timnea O, de Lange M, Riess M, Castilla J, Pozo F, Hamilton M, Falchi A, Knol MJ, Kurečić Filipović S, Dunford L, Guiomar R, Cogdale J, Cherciu C, Jansen T, Enkirch T, Basile L, Connell J, Gomez V, Sandonis Martín V, Bacci S, Rose AMC, Pastore Celentano L, Valenciano M. Effectiveness of complete primary vaccination against COVID-19 at primary care and community level during predominant Delta circulation in Europe: multicentre analysis, I-MOVE-COVID-19 and ECDC networks, July to August 2021. Euro Surveill 2022; 27:2101104. [PMID: 35620997 PMCID: PMC9137272 DOI: 10.2807/1560-7917.es.2022.27.21.2101104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.MethodsIndividuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination.ResultsOverall VE was 74% (95% CI: 69-79), 76% (95% CI: 71-80), 63% (95% CI: 48-75) and 63% (95% CI: 16-83) among those aged 30-44, 45-59, 60-74 and ≥ 75 years, respectively. VE among those aged 30-59 years was 78% (95% CI: 75-81), 66% (95% CI: 58-73), 91% (95% CI: 87-94) and 52% (95% CI: 40-61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52-77), 65% (95% CI: 48-76) and 83% (95% CI: 64-92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30-59 years was 87% (95% CI: 83-89) at 14-29 days and 65% (95% CI: 56-71%) at ≥ 90 days between vaccination and onset of symptoms.ConclusionsVE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.
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Affiliation(s)
| | | | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Ana-Maria Vilcu
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Marjolein N Kooijman
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Maja Ilić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Ausenda Machado
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Mihaela Lazar
- “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest, Romania
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mia Brytting
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Amparo Larrauri
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Sylvie Behillil
- Unité de Génétique Moléculaire des Virus à ARN, UMR 3569 CNRS, Université Paris Diderot SPC, Institut Pasteur, Paris, France,CNR des virus des infections respiratoires, Institut Pasteur, Paris, France
| | - Brechje de Gier
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ivan Mlinarić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Joan O’Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Olivia Timnea
- “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest, Romania
| | - Marit de Lange
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | | | | | - Mirjam J Knol
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Linda Dunford
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Carmen Cherciu
- “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | | | - Luca Basile
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain,Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública, Catalunya, Spain
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Verónica Gomez
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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17
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Meslé MM, Brown J, Mook P, Hagan J, Pastore R, Bundle N, Spiteri G, Ravasi G, Nicolay N, Andrews N, Dykhanovska T, Mossong J, Sadkowska-Todys M, Nikiforova R, Riccardo F, Meijerink H, Mazagatos C, Kyncl J, McMenamin J, Melillo T, Kaoustou S, Lévy-Bruhl D, Haarhuis F, Rich R, Kall M, Nitzan D, Smallwood C, Pebody RG. Estimated number of deaths directly averted in people 60 years and older as a result of COVID-19 vaccination in the WHO European Region, December 2020 to November 2021. Euro Surveill 2021; 26:2101021. [PMID: 34823641 PMCID: PMC8619871 DOI: 10.2807/1560-7917.es.2021.26.47.2101021] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 01/31/2023] Open
Abstract
Since December 2019, over 1.5 million SARS-CoV-2-related fatalities have been recorded in the World Health Organization European Region - 90.2% in people ≥ 60 years. We calculated lives saved in this age group by COVID-19 vaccination in 33 countries from December 2020 to November 2021, using weekly reported deaths and vaccination coverage. We estimated that vaccination averted 469,186 deaths (51% of 911,302 expected deaths; sensitivity range: 129,851-733,744; 23-62%). Impact by country ranged 6-93%, largest when implementation was early.
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Affiliation(s)
- Margaux Mi Meslé
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Jeremy Brown
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Piers Mook
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - José Hagan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Roberta Pastore
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Nick Bundle
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Giovanni Ravasi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | | | | | | | - Raina Nikiforova
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | | | | | - Jan Kyncl
- National Institute of Public Health, Prague, Czechia
| | | | | | | | | | | | - Rivka Rich
- Israel Ministry of Health, Jerusalem, Israel
| | - Meaghan Kall
- UK Health Security Agency, London, United Kingdom
| | - Dorit Nitzan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Catherine Smallwood
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Richard G Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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18
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Kissling E, Hooiveld M, Sandonis Martín V, Martínez-Baz I, William N, Vilcu AM, Mazagatos C, Domegan L, de Lusignan S, Meijer A, Machado A, Brytting M, Casado I, Murray JLK, Belhillil S, Larrauri A, O'Donnell J, Tsang R, de Lange M, Rodrigues AP, Riess M, Castilla J, Hamilton M, Falchi A, Pozo F, Dunford L, Cogdale J, Jansen T, Guiomar R, Enkirch T, Burgui C, Sigerson D, Blanchon T, Martínez Ochoa EM, Connell J, Ellis J, van Gageldonk-Lafeber R, Kislaya I, Rose AM, Valenciano M. Vaccine effectiveness against symptomatic SARS-CoV-2 infection in adults aged 65 years and older in primary care: I-MOVE-COVID-19 project, Europe, December 2020 to May 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34296676 PMCID: PMC8299744 DOI: 10.2807/1560-7917.es.2021.26.29.2100670] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We measured COVID-19 vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection at primary care/outpatient level among adults ≥ 65 years old using a multicentre test-negative design in eight European countries. We included 592 SARS-CoV-2 cases and 4,372 test-negative controls in the main analysis. The VE was 62% (95% CI: 45–74) for one dose only and 89% (95% CI: 79–94) for complete vaccination. COVID-19 vaccines provide good protection against COVID-19 presentation at primary care/outpatient level, particularly among fully vaccinated individuals.
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Affiliation(s)
| | | | | | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Ana-Maria Vilcu
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ausenda Machado
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Mia Brytting
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Itziar Casado
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Sylvie Belhillil
- Unité de Génétique Moléculaire des Virus à ARN, UMR 3569 CNRS, Université Paris Diderot SPC, Institut Pasteur, Paris, France.,CNR des virus des infections respiratoires, Institut Pasteur, Paris, France
| | - Amparo Larrauri
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Marit de Lange
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Linda Dunford
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | | | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Cristina Burgui
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Thierry Blanchon
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Eva María Martínez Ochoa
- Servicio de Epidemiología y Prevención Sanitaria, Dirección General de Salud Pública, Consumo y Cuidados, La Rioja, Spain
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | | | - Irina Kislaya
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
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- The members of the I-MOVE-COVID-19 primary care study team are listed in the Investigators tab
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19
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Cortes-Serra N, Mendes MT, Mazagatos C, Segui-Barber J, Ellis CC, Ballart C, Garcia-Alvarez A, Gállego M, Gascon J, Almeida IC, Pinazo MJ, Fernandez-Becerra C. Plasma-Derived Extracellular Vesicles as Potential Biomarkers in Heart Transplant Patient with Chronic Chagas Disease. Emerg Infect Dis 2021; 26:1846-1851. [PMID: 32687028 PMCID: PMC7392439 DOI: 10.3201/eid2608.191042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chagas disease is emerging in countries to which it is not endemic. Biomarkers for earlier therapeutic response assessment in patients with chronic Chagas disease are needed. We profiled plasma-derived extracellular vesicles from a heart transplant patient with chronic Chagas disease and showed the potential of this approach for discovering such biomarkers.
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20
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Mazagatos C, Monge S, Olmedo C, Vega L, Gallego P, Martín-Merino E, Sierra MJ, Limia A, Larrauri A. Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021. Euro Surveill 2021; 26:2100452. [PMID: 34142647 PMCID: PMC8212595 DOI: 10.2807/1560-7917.es.2021.26.24.2100452] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
Residents in long-term care facilities (LTCF) experienced a large morbidity and mortality during the COVID-19 pandemic in Spain and were prioritised for early COVID-19 vaccination. We used the screening method and population-based data sources to obtain estimates of mRNA COVID-19 vaccine effectiveness for elderly LTCF residents. The estimates were 71% (95% CI: 56-82%), 88% (95% CI: 75-95%), and 97% (95% CI: 92-99%), against SARS-CoV-2 infections (symptomatic and asymptomatic), and COVID-19 hospitalisations and deaths, respectively.
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Affiliation(s)
- Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Susana Monge
- Centre for the Coordination of Alerts and Health Emergencies, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Carmen Olmedo
- Vaccines Division, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Lorena Vega
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Pilar Gallego
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - María José Sierra
- Centre for the Coordination of Alerts and Health Emergencies, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Aurora Limia
- Vaccines Division, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Amparo Larrauri
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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21
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Rosillo N, Del-Águila-Mejía J, Rojas-Benedicto A, Guerrero-Vadillo M, Peñuelas M, Mazagatos C, Segú-Tell J, Ramis R, Gómez-Barroso D. Real time surveillance of COVID-19 space and time clusters during the summer 2020 in Spain. BMC Public Health 2021; 21:961. [PMID: 34016076 PMCID: PMC8137313 DOI: 10.1186/s12889-021-10961-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND On June 21st de-escalation measures and state-of-alarm ended in Spain after the COVID-19 first wave. New surveillance and control strategy was set up to detect emerging outbreaks. AIM To detect and describe the evolution of COVID-19 clusters and cases during the 2020 summer in Spain. METHODS A near-real time surveillance system to detect active clusters of COVID-19 was developed based on Kulldorf's prospective space-time scan statistic (STSS) to detect daily emerging active clusters. RESULTS Analyses were performed daily during the summer 2020 (June 21st - August 31st) in Spain, showing an increase of active clusters and municipalities affected. Spread happened in the study period from a few, low-cases, regional-located clusters in June to a nationwide distribution of bigger clusters encompassing a higher average number of municipalities and total cases by end-August. CONCLUSION STSS-based surveillance of COVID-19 can be of utility in a low-incidence scenario to help tackle emerging outbreaks that could potentially drive a widespread transmission. If that happens, spatial trends and disease distribution can be followed with this method. Finally, cluster aggregation in space and time, as observed in our results, could suggest the occurrence of community transmission.
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Affiliation(s)
- Nicolás Rosillo
- Servicio de Medicina Preventiva. Centro de Actividades Ambulatorias, 6ª planta, Bloque C, Hospital Universitario 12 de Octubre. Avenida de Córdoba, s/n, 28041, Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain
| | - Javier Del-Águila-Mejía
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain.,Servicio de Medicina Preventiva, Hospital Universitario de Móstoles, Calle Río Júcar, s/n, 28935, Móstoles, Spain
| | - Ayelén Rojas-Benedicto
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Calle Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - María Guerrero-Vadillo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain
| | - Marina Peñuelas
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain
| | - Clara Mazagatos
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Calle Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Jordi Segú-Tell
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Calle Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Rebeca Ramis
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Calle Monforte de Lemos 3-5, 28029, Madrid, Spain.
| | - Diana Gómez-Barroso
- Centro Nacional de Epidemiología, Instituto de Salud Carlos IIII, Calle de Melchor Fernández Almagro 5, 28029, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Calle Monforte de Lemos 3-5, 28029, Madrid, Spain
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22
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Machado A, Mazagatos C, Dijkstra F, Kislaya I, Gherasim A, McDonald SA, Kissling E, Valenciano M, Meijer A, Hooiveld M, Nunes B, Larrauri A. Impact of influenza vaccination programmes among the elderly population on primary care, Portugal, Spain and the Netherlands: 2015/16 to 2017/18 influenza seasons. ACTA ACUST UNITED AC 2020; 24. [PMID: 31718740 PMCID: PMC6852314 DOI: 10.2807/1560-7917.es.2019.24.45.1900268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background To increase the acceptability of influenza vaccine, it is important to quantify the overall benefits of the vaccination programme. Aim To assess the impact of influenza vaccination in Portugal, Spain and the Netherlands, we estimated the number of medically attended influenza-confirmed cases (MAICC) in primary care averted in the seasons 2015/16 to 2017/18 among those ≥ 65 years. Methods We used an ecological approach to estimate vaccination impact. We compared the number of observed MAICC (n) to the estimated number that would have occurred without the vaccination programme (N). To estimate N, we used: (i) MAICC estimated from influenza surveillance systems, (ii) vaccine coverage, (iii) pooled (sub)type-specific influenza vaccine effectiveness estimates for seasons 2015/16 to 2017/18, weighted by the proportion of virus circulation in each season and country. We estimated the number of MAICC averted (NAE) and the prevented fraction (PF) by the vaccination programme. Results The annual average of NAE in the population ≥ 65 years was 33, 58 and 204 MAICC per 100,000 in Portugal, Spain and the Netherlands, respectively. On average, influenza vaccination prevented 10.7%, 10.9% and 14.2% of potential influenza MAICC each season in these countries. The lowest PF was in 2016/17 (4.9–6.1%) with an NAE ranging from 24 to 69 per 100,000. Conclusions Our results suggest that influenza vaccination programmes reduced a substantial number of MAICC. Together with studies on hospitalisations and deaths averted by influenza vaccination programmes, this will contribute to the evaluation of the impact of vaccination strategies and strengthen public health communication.
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Affiliation(s)
- Ausenda Machado
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,These authors contributed equally.,National Institute for Health Doutor Ricardo Jorge, Epidemiology department, Lisbon, Portugal
| | - Clara Mazagatos
- National Centre of Epidemiology, Carlos III Health Institute, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,These authors contributed equally
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,These authors contributed equally
| | - Irina Kislaya
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,National Institute for Health Doutor Ricardo Jorge, Epidemiology department, Lisbon, Portugal
| | - Alin Gherasim
- National Centre of Epidemiology, Carlos III Health Institute, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Scott A McDonald
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mariëtte Hooiveld
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Baltazar Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,National Institute for Health Doutor Ricardo Jorge, Epidemiology department, Lisbon, Portugal
| | - Amparo Larrauri
- National Centre of Epidemiology, Carlos III Health Institute, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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23
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Mazagatos C, Godoy P, Muñoz Almagro C, Pozo F, Larrauri A. Effectiveness of influenza vaccination during pregnancy to prevent severe infection in children under 6 months of age, Spain, 2017-2019. Vaccine 2020; 38:8405-8410. [PMID: 32741669 DOI: 10.1016/j.vaccine.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/14/2020] [Accepted: 07/09/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Influenza vaccination is recommended to pregnant women in Spain to reduce the risk of influenza-related complications. Influenza related hospitalizations pose a significant disease burden in children every year. Although children below 6 months are too young to be vaccinated, they can receive protection against influenza through vaccination of their mothers during pregnancy. We estimated the effectiveness of maternal influenza vaccination to prevent influenza hospitalizations in infants under 6 months of age. METHODS This is a retrospective pilot study, using data from the Severe Hospitalized Confirmed Influenza Cases (SHCIC) surveillance system in seasons 2017/18 and 2018/19 in Spain. Maternal vaccination status during pregnancy was collected for cases in children 6 months and younger hospitalized with confirmed influenza infection. Influenza vaccine effectiveness was estimated using the screening method, by comparing the proportion of children with vaccinated mothers during pregnancy (proportion of cases vaccinated, PCV), with the vaccination coverage among pregnant women in Spain (proportion of population vaccinated, PPV). RESULTS For all the study period, the PCV was 17% and the PPV was 35%. Influenza vaccination in mothers during pregnancy prevented influenza confirmed hospitalizations in infants aged 6 months and younger with a 61% (95%CI: 27-79%) effectiveness. CONCLUSIONS In line with evidence from other countries, influenza vaccination during pregnancy protects infants up to 6 months of age from influenza hospitalizations in Spain. These results support current recommendations of influenza vaccination in pregnant women, and more studies are needed in Spain to confirm the double protection of maternal vaccination in mothers and infants.
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Affiliation(s)
- Clara Mazagatos
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Pere Godoy
- Servicio de Vigilancia y Salud, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Carmen Muñoz Almagro
- Dirección General de Salud Pública, Aragón, Spain; Servicio de Vigilancia Epidemiológica, Dirección General de Salud Pública, Consejería de Sanidad, Asturias, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - Francisco Pozo
- Servicio de Epidemiología, Dirección General de Salud Pública y Participación, Baleares, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain
| | - A Larrauri
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud, Andalucía, Spain; Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Canarias, Spain.
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24
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Kissling E, Rose A, Emborg HD, Gherasim A, Pebody R, Pozo F, Trebbien R, Mazagatos C, Whitaker H, Valenciano M. Interim 2018/19 influenza vaccine effectiveness: six European studies, October 2018 to January 2019. ACTA ACUST UNITED AC 2020; 24. [PMID: 30808440 PMCID: PMC6446950 DOI: 10.2807/1560-7917.es.2019.24.1900121] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Influenza A(H1N1)pdm09 and A(H3N2) viruses both circulated in Europe in October 2018–January 2019. Interim results from six studies indicate that 2018/19 influenza vaccine effectiveness (VE) estimates among all ages in primary care was 32–43% against influenza A; higher against A(H1N1)pdm09 and lower against A(H3N2). Among hospitalised older adults, VE estimates were 34–38% against influenza A and slightly lower against A(H1N1)pdm09. Influenza vaccination is of continued benefit during the ongoing 2018/19 influenza season.
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Affiliation(s)
- Esther Kissling
- These authors contributed equally to the study and manuscript writing.,EpiConcept, Paris, France
| | - Angela Rose
- These authors contributed equally to the study and manuscript writing.,EpiConcept, Paris, France
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - 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
| | | | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Ramona Trebbien
- Department of Virus and Microbiological Special diagnostics, National Influenza Center, Statens Serum Institut, Copenhagen, Denmark
| | - Clara Mazagatos
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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25
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Rose A, Kissling E, Emborg HD, Larrauri A, McMenamin J, Pozo F, Trebbien R, Mazagatos C, Whitaker H, Valenciano M. Interim 2019/20 influenza vaccine effectiveness: six European studies, September 2019 to January 2020. Euro Surveill 2020; 25:2000153. [PMID: 32183932 PMCID: PMC7078828 DOI: 10.2807/1560-7917.es.2020.25.10.2000153] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BackgroundInfluenza A(H1N1)pdm09, A(H3N2) and B viruses were co-circulating in Europe between September 2019 and January 2020.AimTo provide interim 2019/20 influenza vaccine effectiveness (VE) estimates from six European studies, covering 10 countries and both primary care and hospital settings.MethodsAll studies used the test-negative design, although there were some differences in other study characteristics, e.g. patient selection, data sources, case definitions and included age groups. Overall and influenza (sub)type-specific VE was estimated for each study using logistic regression adjusted for potential confounders.ResultsThere were 31,537 patients recruited across the six studies, of which 5,300 (17%) were cases with 5,310 infections. Most of these (4,466; 84%) were influenza A. The VE point estimates for all ages were 29% to 61% against any influenza in the primary care setting and 35% to 60% in hospitalised older adults (aged 65 years and over). The VE point estimates against A(H1N1)pdm09 (all ages, both settings) was 48% to 75%, and against A(H3N2) ranged from -58% to 57% (primary care) and -16% to 60% (hospital). Against influenza B, VE for all ages was 62% to 83% (primary care only).ConclusionsInfluenza vaccination is of continued benefit during the ongoing 2019/20 influenza season. Robust end-of-season VE estimates and genetic virus characterisation results may help understand the variability in influenza (sub)type-specific results across studies.
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Affiliation(s)
- Angela Rose
- Epiconcept, Paris, France,Authors contributed equally to the study and manuscript writing
| | - Esther Kissling
- Epiconcept, Paris, France,Authors contributed equally to the study and manuscript writing
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - 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
| | | | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Ramona Trebbien
- Department of Virus and Microbiological Special diagnostics, National Influenza Center, Statens Serum Institut, Copenhagen, Denmark
| | - Clara Mazagatos
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | | | - European IVE group
- European Influenza Vaccine Effectiveness (IVE) group members are listed at the end of the article
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Mazagatos C, Delgado-Sanz C, Oliva J, Gherasim A, Larrauri A. Exploring the risk of severe outcomes and the role of seasonal influenza vaccination in pregnant women hospitalized with confirmed influenza, Spain, 2010/11-2015/16. PLoS One 2018; 13:e0200934. [PMID: 30089148 PMCID: PMC6082521 DOI: 10.1371/journal.pone.0200934] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
Based on previous observations during pandemics and seasonal epidemics, pregnant women are considered at risk of developing severe influenza outcomes after influenza infection. With the aim of preventing severe influenza illness, the World Health Organization (WHO) includes pregnant women as a target group for seasonal influenza vaccination. However, influenza vaccine uptake during pregnancy remains low in many countries, including Spain. The objectives of this study were to increase the evidence of pregnancy as a risk factor for severe influenza illness and to study the potential role of seasonal influenza vaccination in the prevention of severe outcomes in infected pregnant women. Using information from the surveillance of Severe Hospitalized Confirmed Influenza Cases (SHCIC) in Spain, from seasons 2010/11 to 2015/16, we estimated that pregnant women in our study had a relative risk of hospitalization with severe influenza nearly 7.8 times higher than non-pregnant women of reproductive age. Only 5 out of 167 pregnant women with known vaccination status in our study had been vaccinated (3.6%). Such extremely low vaccination coverage only allowed obtaining crude estimates suggesting a protective effect of the vaccine against influenza complications (ICU admission or death). Our overall results support that pregnant women could benefit from seasonal influenza vaccination, in line with national and international recommendations.
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Affiliation(s)
- Clara Mazagatos
- CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Centre of Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Concepción Delgado-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Centre of Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Jesús Oliva
- CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Centre of Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Alin Gherasim
- CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Centre of Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Amparo Larrauri
- CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
- National Centre of Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
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