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Raina MacIntyre C, Kevin Yin J, Felter C, Menzies RI, Thommes E, Largeron N, Moa AM, Trent M, Costantino V, Choi S, Alvarez FP. Estimated health and economic impact of using high-dose influenza vaccine on respiratory and circulatory plus respiratory hospitalizations of older adults in Australia. Vaccine X 2023; 15:100365. [PMID: 37609557 PMCID: PMC10440578 DOI: 10.1016/j.jvacx.2023.100365] [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: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Background Standard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia. Methods This is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002-2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza. Results Between 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315-9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9-38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations. Conclusions From the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.
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Affiliation(s)
| | - J. Kevin Yin
- Medical Department, Greater China, Sanofi Vaccines, Beijing, China
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Edward Thommes
- New Products and Innovation, Sanofi, Toronto, Ontario, Canada
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | | | - Aye M. Moa
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Seulki Choi
- Market Access, Sanofi, Sydney, NSW, Australia
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2
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Lee JK, Lam GK, Yin JK, Loiacono MM, Samson SI. High-dose influenza vaccine in older adults by age and seasonal characteristics: Systematic review and meta-analysis update. Vaccine X 2023; 14:100327. [PMID: 37333054 PMCID: PMC10276206 DOI: 10.1016/j.jvacx.2023.100327] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
This updated systematic review and meta-analysis of randomized and observational studies published up to April 2023 assessed the relative performance of high-dose inactivated influenza vaccine (HD-IIV) and standard-dose influenza vaccines (SD-IIV) against influenza-associated outcomes in older adults (≥65 years). The analysis included studies conducted over 12 influenza seasons (2009/2010 to 2019/2020, 2021/2022), including over 45 million individuals aged ≥ 65 years, and showed that HD-IIV provided significantly better protection than SD-IIV against influenza-like illness and influenza-related hospitalizations, as well as cardiovascular, cardiorespiratory, and all-cause hospitalizations. Subgroup analyses showed HD-IIV consistently provided better protection than SD-IIV against influenza outcomes across the age range (65+, 75+ 85+ years), and regardless of the predominantly circulating influenza strain and vaccine antigenic match/mismatch. Randomized studies continue to drive high-quality evidence on the effectiveness of high-dose inactivated influenza vaccine relative to SD-IIV against severe influenza outcomes in adults aged ≥ 65 years, supported by observational data.
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Affiliation(s)
- Jason K.H. Lee
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, ON, Canada
- Sanofi, Toronto, ON, Canada
| | - Gary K.L. Lam
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, ON, Canada
- Sanofi, Toronto, ON, Canada
| | - J. Kevin Yin
- University of Sydney, Camperdown, NSW, Australia
- Sanofi, Singapore
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3
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Kevin Yin J, Harris RC, Loiacono MM, Chit A, Samson SI. Letter to editor regarding a review of MF59-adjuvanted influenza vaccine by Gärtner et al. Vaccine 2023; 41:3948. [PMID: 36631360 DOI: 10.1016/j.vaccine.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023]
Affiliation(s)
- J Kevin Yin
- Global Medical Affairs, Sanofi, Singapore; The University of Sydney, NSW, Australia.
| | - Rebecca C Harris
- Global Medical Evidence Generation, Sanofi, Singapore; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ayman Chit
- Global Medical Affairs, Sanofi, Lyon, France; University of Toronto, Toronto, Ontario, Canada
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4
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Yin JK, Pepin S, van Aalst R, Loiacono MM, Samson SI. Reply to letter to editor by Hadigal et al. regarding the immunogenicity and safety trial of high-dose influenza vaccine in adults aged ≥60 years. Hum Vaccin Immunother 2022; 18:2106749. [PMID: 35914122 DOI: 10.1080/21645515.2022.2106749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hadigal et al. argued the recommendation of high-dose influenza vaccine over standard-dose formulation is not supported by comparisons of numbers-needed-to-vaccinate (NNV) nor aligned with the WHO mandate of improving vaccine coverage. However, the authors' NNV calculation was inaccurate. A preferential recommendation for vaccines preventing influenza/complications can increase coverage. Furthermore, the impact of vaccination is a function of efficacy/effectiveness and the vaccine-preventable fraction of disease burden; therefore Hadigal et al. should interpret the absolute risk reduction by vaccination within the context of overall disease burden. To address the threat of COVID-19 pandemic, authorities should implement concomitant influenza/COVID-19 vaccination to reduce the burden of cocirculation of influenza and SARS- CoV- 2 viruses and increase the coverage of proven influenza vaccines as per WHO mandate.
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Affiliation(s)
- J Kevin Yin
- Global Medical Affairs, Sanofi, Singapore.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | | | - Robertus van Aalst
- Department of Modeling, Epidemiology and Data Science, Global Medical Affairs, Sanofi, Lyon, France.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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5
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Chen JY, Hsieh SM, Hwang SJ, Liu CS, Li X, Fournier M, Yeh TY, Yin JK, Samson SI. Immunogenicity and safety of high-dose quadrivalent influenza vaccine in older adults in Taiwan: A phase III, randomized, multi-center study. Vaccine 2022; 40:6450-6454. [PMID: 36216650 DOI: 10.1016/j.vaccine.2022.09.078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND High-dose influenza vaccine offers better protection against influenza/associated complications compared with standard-dose formulation. We evaluated immunogenicity and safety of high-dose influenza vaccine (QIV-HD) and standard-dose (QIV-SD) in older adults (≥ 65 years) in Taiwan. METHODS This was a phase III, randomized, modified double-blind, active-controlled, multi-center, descriptive study in older adults. Participants (N = 165) were randomized 1:1 to receive QIV-HD or QIV-SD vaccine (clinicaltrials.gov#NCT04537234). RESULTS For all four influenza strains, geometric means titers (GMTs) of hemagglutination inhibition were higher for the QIV-HD than QIV-SD with adjusted GMT ratios (95 % CI) of 2.65 (1.87-3.75) for A/H1N1; 1.76 (1.31-2.38) for A/H3N2; 2.60 (1.90-3.56) for B/Victoria; and 2.01 (1.57-2.56) for B/Yamagata. The seroconversion was higher for QIV-HD than QIV-SD with similar safety profiles across both groups. CONCLUSION QIV-HD was highly immunogenic for four influenza strains and have acceptable safety profile in older adults aged ≥ 65 years in Taiwan.
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Affiliation(s)
- Jau-Yuan Chen
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Shinn-Jang Hwang
- Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | | | | | | | | | - J Kevin Yin
- Sanofi, Singapore; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Yin JK, Samson SI, Nealon J. Letter to editor regarding the systematic review and meta-analysis by Coleman et al. on the effectiveness of MF59-adjuvanted seasonal influenza vaccine in older adults. Influenza Other Respir Viruses 2021; 15:826-827. [PMID: 34342136 PMCID: PMC8542953 DOI: 10.1111/irv.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- J. Kevin Yin
- Global MedicalSanofi PasteurSingapore
- The University of SydneyCamperdownNSWAustralia
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7
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Moa AM, Menzies RI, Yin JK, MacIntyre CR. Modelling the influenza disease burden in people aged 50-64 and ≥65 years in Australia. Influenza Other Respir Viruses 2021; 16:132-141. [PMID: 34586749 PMCID: PMC8692809 DOI: 10.1111/irv.12902] [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: 05/19/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Estimation of influenza disease burden is necessary to monitor the impact of intervention programmes. This study aims to estimate the attributable fraction of respiratory and circulatory disease due to influenza among Australian adults 50–64 and ≥65 years of age. Methods A semi‐parametric generalised‐additive model was used to estimate annual and average rate of influenza‐attributable hospitalisation and death per 100,000 population under the principal diagnosis of influenza/pneumonia, respiratory, circulatory and myocardial infarction (MI) from 2001 through 2017. Results Over the study period, seasonal influenza accounted for an estimated annual average respiratory hospitalisation rate of 78.9 (95%CI: 76.3, 81.4) and 287.5 (95%CI: 279.8, 295.3) per 100,000 population in adults aged 50–64 and ≥65 years, respectively. The corresponding respiratory mortality rates were 0.9 (95%CI: 0.7, 1.2) and 18.2 (95%CI: 16.9, 19.4) per 100,000 population. The 2017 season had the highest influenza‐attributable respiratory hospitalisations in both age groups, and respiratory complications were estimated approximately 2.5 times higher than the average annual estimate in adults aged ≥65 years in 2017. For mortality, on average, influenza attributed 1,080 circulatory and 361 MI deaths in adults aged ≥65 years per year. Influenza accounted for 1% and 2.8% of total MI deaths in adults aged 50–64 and ≥65 years, respectively. Conclusion Rates of cardiorespiratory morbidity and mortality were high in older adults, whilst the younger age group contributed a lower disease burden. Extension of influenza vaccination programme beyond the targeted population could be an alternative strategy to reduce the burden of influenza.
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Affiliation(s)
- Aye M Moa
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert I Menzies
- Medical, Sanofi Pasteur Australia and New Zealand, Sydney, New South Wales, Australia
| | - J Kevin Yin
- Medical Department of Global Influenza Franchise, Sanofi Pasteur, Singapore.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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El Guerche-Séblain C, Rigoine De Fougerolles T, Sampson K, Jennings L, Van Buynder P, Shu Y, Sekawi Z, Yee-Sin L, Walls T, Vitoux O, Yin JK, Wong A, Schellevis F, Vanhems P. Comparison of influenza surveillance systems in Australia, China, Malaysia and expert recommendations for influenza control. BMC Public Health 2021; 21:1750. [PMID: 34563151 PMCID: PMC8466892 DOI: 10.1186/s12889-021-11765-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/25/2021] [Accepted: 08/29/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Western Pacific Region (WPR) is exposed each year to seasonal influenza and is often the source of new influenza virus variants and novel pathogen emergence. National influenza surveillance systems play a critical role in detecting emerging viruses, monitoring influenza epidemics, improving public disease awareness and promoting pandemic preparedness, but vary widely across WPR countries. The aim of this study is to improve existing influenza surveillance systems by systematically comparing selected WPR influenza surveillance systems. METHODS Three national influenza surveillance systems with different levels of development (Australia, China and Malaysia) were compared and their adherence to World Health Organization (WHO) guidance was evaluated using a structured framework previously tested in several European countries consisting of seven surveillance sub-systems, 19 comparable outcomes and five evaluation criteria. Based on the results, experts from the Asia-Pacific Alliance for the Control of Influenza (APACI) issued recommendations for the improvement of existing surveillance systems. RESULTS Australia demonstrated the broadest scope of influenza surveillance followed by China and Malaysia. In Australia, surveillance tools covered all sub-systems. In China, surveillance did not cover non-medically attended respiratory events, primary care consultations, and excess mortality modelling. In Malaysia, surveillance consisted of primary care and hospital sentinel schemes. There were disparities between the countries across the 5 evaluation criteria, particularly regarding data granularity from health authorities, information on data representativeness, and data communication, especially the absence of publicly available influenza epidemiological reports in Malaysia. This dual approach describing the scope of surveillance and evaluating the adherence to WHO guidance enabled APACI experts to make a number of recommendations for each country that included but were not limited to introducing new surveillance tools, broadening the use of specific existing surveillance tools, collecting and sharing data on virus characteristics, developing immunization status registries, and improving public health communication. CONCLUSIONS Influenza monitoring in Australia, China, and Malaysia could benefit from the expansion of existing surveillance sentinel schemes, the broadened use of laboratory confirmation and the introduction of excess-mortality modelling. The results from the evaluation can be used as a basis to support expert recommendations and to enhance influenza surveillance capabilities.
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Affiliation(s)
- Clotilde El Guerche-Séblain
- Global Medical Evidence Generation (MEG) Lead, Influenza Sanofi Pasteur, Medical Influenza Franchise, Sanofi-Aventis (Singapore) Pte. Ltd. 38, Beach Road, #18-11, South Beach Tower, Sanofi Pasteur, Singapore, Singapore.
- University Claude Bernard Lyon 1, Lyon, France.
| | | | - Kim Sampson
- Asia-Pacific Alliance for the Control of Influenza (APACI), Melbourne, Australia
- Australian Immunisation Coalition, Melbourne, Australia
| | - Lance Jennings
- University of Otago, Christchurch, New Zealand
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Paul Van Buynder
- Department of Public Health, Griffith University, Griffith, Victoria, Australia
| | - Yuelong Shu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zamberi Sekawi
- Chair Malaysia Influenza Working Group (MIWG), Universiti Putra, Seri Kembangan, Malaysia
| | - Leo Yee-Sin
- National Center for Infectious Diseases (NCID), Singapore, Singapore
| | - Tony Walls
- University of Otago, Christchurch, New Zealand
- Paediatric Society of New Zealand Infection and Immunization Special Interest Group, Christchurch, New Zealand
| | | | - J Kevin Yin
- Global Medical Affairs, Sanofi Pasteur, Singapore, Singapore
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ada Wong
- Public Affairs, Sanofi Pasteur, Singapore, Singapore
| | - Francois Schellevis
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Philippe Vanhems
- Unité d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Makenga G, Mtove G, Yin JK, Mziray A, Bwana VM, Kisinza W, Mjema J, Amos B, Antony L, Shingadia D, Oftadeh S, Booy R. Immunogenicity and Efficacy of Pneumococcal Conjugate Vaccine (Prevenar13 ®) in Preventing Acquisition of Carriage of Pneumococcal Vaccine Serotypes in Tanzanian Children With HIV/AIDS. Front Immunol 2021; 12:673392. [PMID: 34220819 PMCID: PMC8248180 DOI: 10.3389/fimmu.2021.673392] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
In every year, up to one million children die due to pneumococcal disease. Children infected with Human Immunodeficiency Virus (HIV) are mostly affected, as they appear to have higher rates of pneumococcal carriage and invasive disease. Successful immunity is dependent on mounting a sufficient immune response to the vaccine. We conducted a double blinded crossover randomised controlled trial to determine the serum antibody response (≥4-fold and geometric mean concentration) to pneumococcal vaccine (PCV13) serotypes at 3 months after second vaccination. We also determined the number and proportion of children carrying new (not present at baseline) vaccine serotypes of S. pneumoniae isolated from nasopharynx at 6 months post initial vaccination in recipients of Prevenar13® compared with those given Haemophilus influenzae-type b (Hib) vaccine (control). The study was conducted at St Augustine's also known as Teule Hospital in Muheza, Tanga Tanzania. 225 HIV infected children aged 1-14 years were enrolled from Jan 2013 to Nov 2013 and randomised to Prevenar13® or Hib vaccines each given at baseline and 2-3 months later. Nasopharyngeal and serum samples were collected at baseline and 4-6 months later. Serotyping was done by Quellung Reaction using Staten antisera. Serum antibodies were ELISA quantified. The study revealed a non-significant reduction in the acquisition of new vaccine serotypes of S. pneumoniae in the recipients of PCV13 by nearly a third compared to those who received Hib vaccine. The vaccine efficacy was 30.5% (95% confidence interval [CI] -6.4-54.6%, P = 0.100)]. The antibody response was not enough to induce a 4-fold rise in GMC in 7 of the 13 vaccine serotypes. When combining the effects of preventing new acquisition and clearing existing vaccine type carriage, the overall efficacy was 31.5% (95% CI 1.5-52.4%, P = 0.045). In the PCV13 group, the proportion of participants carrying vaccine serotype was significantly lower after 2 doses of PCV13 (30%; 32/107), compared with the baseline proportion (48%; 51/107). The introduction of PCV13 targeting HIV-positive children in a setting similar to Tanzania is likely to be associated with appreciable decrease in the acquisition and carriage of pneumococci, which is an important marker of the likely effect of the vaccine on pneumococcal disease. Clinical Trial Registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335579, identifier ACTRN12610000999033.
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Affiliation(s)
- Geofrey Makenga
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - George Mtove
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - J. Kevin Yin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, NSW, Australia
| | - Abubakary Mziray
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - Veneranda M. Bwana
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - William Kisinza
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - Julius Mjema
- St Augustine’s, Hospitali Teule, Private Bag, Tanga, Tanzania
| | - Ben Amos
- St Augustine’s, Hospitali Teule, Private Bag, Tanga, Tanzania
| | - Laura Antony
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Delane Shingadia
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Shahin Oftadeh
- NSW and ACT Pneumococcal Reference Laboratory, Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Robert Booy
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, NSW, Australia
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10
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Whitford K, Liu B, Micallef J, Yin JK, Macartney K, Van Damme P, Kaldor JM. Long-term impact of infant immunization on hepatitis B prevalence: a systematic review and meta-analysis. Bull World Health Organ 2018; 96:484-497. [PMID: 29962551 PMCID: PMC6022616 DOI: 10.2471/blt.17.205153] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 11/09/2017] [Revised: 03/28/2018] [Accepted: 04/18/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of the long-term impact of infant vaccination on the prevalence of hepatitis B virus (HBV) infection at the population level. METHODS We searched online databases for articles reporting comparisons between population cohorts aged ≥ 15 years who were exposed or unexposed to infant HBV immunization programmes. We categorized programmes as universal or targeted to infants whose mothers were positive for hepatitis B surface antigen (HBsAg). We included studies reporting prevalence of hepatitis B core antibody (HBcAb), HBsAg, or both. We evaluated the quality of the study methods and estimated the relative reduction in the prevalence of infection. FINDINGS Of 26 studies that met the inclusion criteria, most were from China (20 studies). The prevalence of HBV infection in unvaccinated and universally vaccinated cohorts ranged from 0.6% (116 of 20 305 people) to 16.3% (60/367) and from 0.3% (1/300) to 8.5% (73/857), respectively. Comparing cohorts with universal vaccination to those without vaccination, relative prevalences were 0.24 (95% confidence interval, CI: 0.16-0.35) for HBsAg and 0.23 (95% CI: 0.17-0.32) for HBcAb. For populations with targeted vaccination, relative prevalences were 0.32 (95% CI: 0.24-0.43) and 0.33 (95% CI: 0.23-0.45), respectively. CONCLUSION The residual burden of infection in cohorts offered vaccination suggests that longer-term evaluations of vaccination coverage, timeliness and other aspects of programme quality are needed. As HBV-vaccinated infant cohorts reach adulthood, ongoing analysis of prevalence in adolescents and young adults will ensure that elimination efforts are on track.
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Affiliation(s)
- Kate Whitford
- Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, Sydney, 2052 Australia
| | - Bette Liu
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Joanne Micallef
- Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, Sydney, 2052 Australia
| | - J Kevin Yin
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kristine Macartney
- National Centre for Immunisation, Research and Surveillance, Sydney, Australia
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - John M Kaldor
- Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, Sydney, 2052 Australia
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11
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Yin JK, Heywood AE, Georgousakis M, King C, Chiu C, Isaacs D, Macartney KK. Systematic Review and Meta-analysis of Indirect Protection Afforded by Vaccinating Children Against Seasonal Influenza: Implications for Policy. Clin Infect Dis 2018; 65:719-728. [PMID: 28475770 DOI: 10.1093/cid/cix420] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/16/2016] [Accepted: 04/28/2017] [Indexed: 11/12/2022] Open
Abstract
Background Universal childhood vaccination is a potential solution to reduce seasonal influenza burden. Methods We reviewed systematically the literature on "herd"/indirect protection from vaccinating children aged 6 months to 17 years against influenza. Results Of 30 studies included, 14 (including 1 cluster randomized controlled trial [cRCT]) used live attenuated influenza vaccine, 11 (7 cRCTs) used inactivated influenza vaccine, and 5 (1 cRCT) compared both vaccine types. Twenty of 30 studies reported statistically significant indirect protection effectiveness (IPE) with point estimates ranging from 4% to 66%. Meta-regression suggests that studies with high quality and/or sufficiently large sample size are more likely to report significant IPE. In meta-analyses of 6 cRCTs with full randomization (rated as moderate quality overall), significant IPE was found in 1 cRCT in closely connected communities where school-aged children were vaccinated: 60% (95% confidence interval [CI], 41%-72%; I2 = 0%; N = 2326) against laboratory-confirmed influenza, and 3 household cRCTs in which preschool-aged children were vaccinated: 22% (95% CI, 1%-38%; I2 = 0%; N = 1903) against acute respiratory infections or influenza-like illness. Significant IPE was also reported in a large-scale cRCT (N = 8510) that was not fully randomized, and 3 ecological studies (N > 10000) of moderate quality including 36% reduction in influenza-related mortality among the elderly in a Japanese school-based program. Data on IPE in other settings are heterogeneous and lacked power to draw a firm conclusion. Conclusions The available evidence suggests that influenza vaccination of children confers indirect protection in some but not all settings. Robust, large-scaled studies are required to better quantify the indirect protection from vaccinating children for different settings/endpoints.
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Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Sydney School of Public Health, Faculty of Medicine, University of Sydney
| | - Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales
| | - Melina Georgousakis
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Sydney School of Public Health, Faculty of Medicine, University of Sydney
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - David Isaacs
- The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - Kristine K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead.,The Children's Hospital at Westmead.,Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
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12
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Yin JK, Jayasinghe SH, Charles PG, King C, Chiu CK, Menzies RI, McIntyre PB. Determining the contribution of
Streptococcus pneumoniae
to community‐acquired pneumonia in Australia. Med J Aust 2017; 207:396-400. [DOI: 10.5694/mja16.01102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Sanjay H Jayasinghe
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Catherine King
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | - Clayton K Chiu
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | | | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
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13
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Khandaker G, Jung J, Britton PN, King C, Yin JK, Jones CA. Long-term outcomes of infective encephalitis in children: a systematic review and meta-analysis. Dev Med Child Neurol 2016; 58:1108-1115. [PMID: 27422743 DOI: 10.1111/dmcn.13197] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
AIM The long-term outcomes of childhood infective encephalitis are variable and not well quantified. We aimed to systematically review the literature and undertake meta-analyses on predetermined outcomes to address this knowledge gap and identify areas for future research. METHOD We searched electronic databases, performed complementary reviews of references of fully extracted articles, and made contact with experts on infective encephalitis. Articles published up until April 2016 were selected for screening. RESULTS We evaluated sequelae of 1018 survivors of childhood infective encephalitis (934 with complete follow-up) from 16 studies. Mean age during acute encephalitis episodes was 5 years 3.6 months (range 1.2mo-17y), 57.6% were male (500/868), and mean follow-up period was 4 years 1.2 months (range 1-12y). Incomplete recovery was reported in 312 children (42.0%; 95% confidence interval [CI] 31.6-53.1% in pooled estimate). Among the other sequelae, developmental delay, abnormal behaviour, motor impairment, and seizures were reported among 35.0% (95% CI 10.0-65.0%), 18.0% (95% CI 8.0-31.0%), 17.0% (95% CI 10.0-26.0%), and 10.0% (95% CI 6.0-14.0%) respectively. INTERPRETATION Almost half of childhood infective encephalitis survivors report incomplete recovery in the long-term; most commonly developmental delay, behavioural abnormality, and neurological impairments (i.e. seizure). Well designed, large-scale prospective studies are needed to better quantify neurodevelopmental sequelae among childhood encephalitis survivors.
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Affiliation(s)
- Gulam Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.
| | - Jenny Jung
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Philip N Britton
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - J Kevin Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Cheryl A Jones
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia
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14
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Wattiaux AL, Yin JK, Beard F, Wesselingh S, Cowie B, Ward J, Macartney K. Hepatitis B immunization for indigenous adults, Australia. Bull World Health Organ 2016; 94:826-834A. [PMID: 27821885 PMCID: PMC5096351 DOI: 10.2471/blt.16.169524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 12/01/2022] Open
Abstract
Objective To quantify the disparity in incidence of hepatitis B between indigenous and non-indigenous people in Australia, and to estimate the potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults. Methods Using national data on persons with newly acquired hepatitis B disease notified between 2005 and 2012, we estimated incident infection rates and rate ratios comparing indigenous and non-indigenous people, with adjustments for underreporting. The potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults was projected using a Markov chain Monte Carlo simulation model. Findings Of the 54 522 persons with hepatitis B disease notified between 1 January 2005 and 31 December 2012, 1953 infections were newly acquired. Acute hepatitis B infection notification rates were significantly higher for indigenous than non-indigenous Australians. The rates per 100 000 population for all ages were 3.6 (156/4 368 511) and 1.1 (1797/168 449 302) for indigenous and non-indigenous people respectively. The rate ratio of age-standardized notifications was 4.0 (95% confidence interval: 3.7–4.3). If 50% of non-immune indigenous adults (20% of all indigenous adults) were vaccinated over a 10-year programme a projected 527–549 new cases of acute hepatitis B would be prevented. Conclusion There continues to be significant health inequity between indigenous and non-indigenous Australians in relation to vaccine-preventable hepatitis B disease. An immunization programme targeting indigenous Australian adults could have considerable impact in terms of cases of acute hepatitis B prevented, with a relatively low number needed to vaccinate to prevent each case.
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Affiliation(s)
- Andre Louis Wattiaux
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
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15
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Li-Kim-Moy J, Yin JK, Rashid H, Khandaker G, King C, Wood N, Macartney KK, Jones C, Booy R. Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children. ACTA ACUST UNITED AC 2015; 20. [PMID: 26111238 DOI: 10.2807/1560-7917.es2015.20.24.21159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In 2010, increased febrile convulsions (FC) occurred after administration of inactivated trivalent influenza vaccine (TIV) in Australia. We systematically reviewed the rates of fever, FC and serious adverse events (SAEs) after TIV, focussing on published and unpublished clinical trial data from 2005 to 2012, and performed meta-analysis of fever rates. From 4,372 records in electronic databases, 18 randomised controlled trials (RCTs), 14 non-randomised clinical trials, six observational studies and 12 registered trials (five RCTs and seven non-randomised) were identified. In published RCTs, fever ≥ 38 °C rates after first dose of non-adjuvanted TIV were 6.7% and 6.9% for children aged 6–35 months and ≥ 3 years, respectively. Analysis of RCTs by vaccine manufacturer showed pooled fever estimates up to 5.1% with Sanofi or GlaxoSmithKline vaccines; bioCSL vaccines were used in two non-randomised clinical trials and one unpublished RCT and were associated with fever in 22.5–37.1% for children aged 6–35 months. In RCTs, FCs occurred at a rate of 1.1 per 1,000 vaccinated children. While most TIVs induced acceptably low fever rates, bioCSL influenza vaccines were associated with much higher rates of fever in young children. Future standardised study methodology and access to individual level data would be illuminating.
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Affiliation(s)
- J Li-Kim-Moy
- National Centre for Immunisation Research and Surveillance, The Children s Hospital at Westmead, New South Wales, Australia
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16
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Wood NJ, Blyth CC, Willis GA, Richmond P, Gold MS, Buttery JP, Crawford N, Crampton M, Yin JK, Chow MYK, Macartney K. The safety of seasonal influenza vaccines in Australian children in 2013. Med J Aust 2014; 201:596-600. [DOI: 10.5694/mja13.00097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/12/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Nicholas J Wood
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
| | - Chris C Blyth
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, WA
| | - Gabriela A Willis
- Vaccine Trials Group, Telethon Institute for Child Health Research, Perth, WA
| | - Peter Richmond
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, WA
| | - Michael S Gold
- Discipline of Paediatrics, University of Adelaide, Adelaide, SA
| | - Jim P Buttery
- SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community), Murdoch Childrens Research Institute, Melbourne, VIC
| | - Nigel Crawford
- Department of General Medicine, Royal Children's Hospital, Melbourne, VIC
| | | | - J Kevin Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
| | - Maria Yui Kwan Chow
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
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17
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Yin JK, Heron L, Salkeld G, Rashid H, Booy R. Oseltamivir use in adolescents and adults: clinical and economic considerations. Infect Disord Drug Targets 2013; 13:53-58. [PMID: 23675927 DOI: 10.2174/18715265112129990008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 04/29/2013] [Indexed: 06/02/2023]
Abstract
Influenza remains an important cause of morbidity and mortality, and incurs substantial economic costs (mainly due to hospitalisation) especially for the elderly aged 65 years or more, and among those with high-risk medical conditions. Influenza vaccination is the most effective control measure for both healthy populations and the chronically ill in whom complications of influenza cluster. Unfortunately, vaccination is less effective in the elderly and immunocompromised persons. Additional benefit may accrue from other health care interventions including antiviral therapy. Oseltamivir, a neuraminidase inhibitor, has become a drug of public health importance since it was included in influenza pandemic management plans. Many systematic reviews and meta-analyses of oseltamivir treatment and prophylaxis trials have been published. We provide a summary of the conclusions and review the various findings of economic analyses. Future randomised controlled trials should focus upon costly outcomes such as hospital admissions and should be conducted in populations at high risk of complications from influenza. Future economic analyses need to address variation in (1) willing-to-pay value, (2) annual attack rate of influenza, and (3) influenza vaccination effectiveness and uptake rates.
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Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead , Australia.
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18
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Yin JK, Lahra MM, Iskander M, Lambert SB, Heron L, Nissen MD, Rost L, Murphy J, Sloots TP, Booy R. Pilot study of influenza vaccine effectiveness in urban Australian children attending childcare. J Paediatr Child Health 2011; 47:857-62. [PMID: 21658144 PMCID: PMC7166895 DOI: 10.1111/j.1440-1754.2011.02098.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Influenza outbreaks in the childcare setting are a significant cause of excess winter morbidity. This study explored methods of follow up and sample collection for a proposed randomised controlled trial of influenza vaccination in children attending childcare. METHODS The study was conducted in four Sydney childcare centres during 2007. Healthy children aged 6-59 months eligible for vaccination were recruited in two centres, with another two acting as controls. Data on influenza-like illness (ILI: ≥37.8°C plus at least one respiratory symptom) occurrence were collected weekly. In those children with an ILI, parents were asked to collect nasal swabs and send via surface mail for viral polymerase chain reaction. Vaccine efficacy (VE) for ILI was estimated overall and for subgroups aged 6-23 and 24-59 months using the formula VE = 1 - relative risk (RR). RESULTS Sixty-three per cent (151/238) of eligible children had parents give consent. Sixty-three children received influenza vaccine and 88 participated as controls. Of 26 specimens returned, a virus was detected in 18 (69%); none with influenza. Two symptomatic children had positive near-patient influenza tests in general practice (one a vaccine failure). The RR with 95% confidence interval in all children and those aged 6-23 months were less than one, 0.56 (0.32-1.02) and 0.46 (0.15-1.45), respectively. CONCLUSIONS This study demonstrated the feasibility and utility of parent-collected and mailed respiratory specimens for VE research in the childcare setting. Two-thirds of parent-collected swabs proved positive for at least one virus. Finding ways to reduce reluctance of parents to submit samples could improve the representativeness of samples collected and the power of the study. No evidence was found for influenza VE, but point estimates were in the direction of protection.
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Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead, Australia.
| | - Monica M Lahra
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead,Sydney Medical School, The University of Sydney, Sydney, New South Wales
| | - Mary Iskander
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead
| | - Stephen B Lambert
- Queensland Paediatric Infectious Disease Laboratory, Queensland Children's Medical Research Institute and, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Brisbane,Clinical Medical Virology Centre, The University of Queensland
| | - Leon Heron
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead,Sydney Medical School, The University of Sydney, Sydney, New South Wales
| | - Michael D Nissen
- Queensland Paediatric Infectious Disease Laboratory, Queensland Children's Medical Research Institute and, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Brisbane,Clinical Medical Virology Centre, The University of Queensland,Clinical and Statewide Services Division, Pathology Queensland, Royal Brisbane Hospital Campus, Herston, Queensland, Australia
| | - Laura Rost
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead
| | - Jennifer Murphy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead
| | - Theo P Sloots
- Queensland Paediatric Infectious Disease Laboratory, Queensland Children's Medical Research Institute and, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Brisbane,Clinical Medical Virology Centre, The University of Queensland,Clinical and Statewide Services Division, Pathology Queensland, Royal Brisbane Hospital Campus, Herston, Queensland, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital, Westmead,Sydney Medical School, The University of Sydney, Sydney, New South Wales
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Yin JK, Wang H, Skinner SR, Salkeld G, Booy R. Assessing seasonal vaccine-related cross-protection from 2009 pandemic H1N1 influenza through teacher absenteeism. Aust N Z J Public Health 2011; 35:393-4. [DOI: 10.1111/j.1753-6405.2011.00748.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Yin JK, Khandaker G, Rashid H, Heron L, Ridda I, Booy R. Immunogenicity and safety of pandemic influenza A (H1N1) 2009 vaccine: systematic review and meta-analysis. Influenza Other Respir Viruses 2011; 5:299-305. [PMID: 21668694 PMCID: PMC4986623 DOI: 10.1111/j.1750-2659.2011.00229.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The emergence of the 2009 H1N1 pandemic has highlighted the need to have immunogenicity and safety data on the new pandemic vaccines. There is already considerable heterogeneity in the types of vaccine available and of study performed around the world. A systematic review and meta-analysis is needed to assess the immunogenicity and safety of pandemic influenza A (H1N1) 2009 vaccines. We searched Medline, EMBASE, the Cochrane Library and other online databases up to 1st October 2010 for studies in any language comparing different pandemic H1N1 vaccines, with or without placebo, in healthy populations aged at least 6 months. The primary outcome was seroprotection according to haemagglutination inhibition (HI). Safety outcomes were adverse events. Meta-analysis was performed for the primary outcome. We identified 18 articles, 1 only on safety and 17 on immunogenicity, although 1 was a duplicate. We included 16 articles in the meta-analysis, covering 17,921 subjects. Adequate seroprotection (≥70%) was almost invariably achieved in all age groups, and even after one dose and at low antigen content (except in children under 3 years receiving one dose of non-adjuvanted vaccine). Non-adjuvanted vaccine from international companies and adjuvanted vaccines containing oil in water emulsion (e.g. AS03, MF59), rather than aluminium, performed better. Two serious vaccination-associated adverse events were reported, both of which resolved fully. No death or case of Guillain-Barré syndrome was reported. The pandemic influenza (H1N1) 2009 vaccine, with or without adjuvant, appears generally to be seroprotective after just one dose and safe among healthy populations aged ≥36 months; very young children (6-35 months) may need to receive two doses of non-adjuvanted vaccine or one dose of AS03(A/B)-adjuvanted product to achieve seroprotection.
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Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Disease, The Children's Hospital at Westmead, New South Wales, Australia.
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