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Braeye T, van Loenhout JAF, Brondeel R, Stouten V, Hubin P, Billuart M, Chung PYJ, Vandromme M, Wyndham-Thomas C, Blot K, Catteau L. COVID-19 vaccine effectiveness against symptomatic infection and hospitalisation in Belgium, July 2021 to May 2022. Euro Surveill 2023; 28:2200768. [PMID: 37382885 PMCID: PMC10311948 DOI: 10.2807/1560-7917.es.2023.28.26.2200768] [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: 09/14/2022] [Accepted: 02/15/2023] [Indexed: 06/30/2023] Open
Abstract
BackgroundThe Belgian COVID-19 vaccination campaign aimed to reduce disease spread and severity.AimWe estimated SARS-CoV-2 variant-specific vaccine effectiveness against symptomatic infection (VEi) and hospitalisation (VEh), given time since vaccination and prior infection.MethodsNationwide healthcare records from July 2021 to May 2022 on testing and vaccination were combined with a clinical hospital survey. We used a test-negative design and proportional hazard regression to estimate VEi and VEh, controlling for prior infection, time since vaccination, age, sex, residence and calendar week of sampling.ResultsWe included 1,932,546 symptomatic individuals, of whom 734,115 tested positive. VEi against Delta waned from an initial estimate of 80% (95% confidence interval (CI): 80-81) to 55% (95% CI: 54-55) 100-150 days after the primary vaccination course. Booster vaccination increased initial VEi to 85% (95% CI: 84-85). Against Omicron, an initial VEi of 33% (95% CI: 30-36) waned to 17% (95% CI: 15-18), while booster vaccination increased VEi to 50% (95% CI: 49-50), which waned to 20% (95% CI: 19-21) 100-150 days after vaccination. Initial VEh for booster vaccination decreased from 96% (95% CI: 95-96) against Delta to 87% (95% CI: 86-89) against Omicron. VEh against Omicron waned to 73% (95% CI: 71-75) 100-150 days after booster vaccination. While recent prior infections conferred higher protection, infections occurring before 2021 remained associated with significant risk reduction against symptomatic infection. Vaccination and prior infection outperformed vaccination or prior infection only.ConclusionWe report waning and a significant decrease in VEi and VEh from Delta to Omicron-dominant periods. Booster vaccination and prior infection attenuated these effects.
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Affiliation(s)
- Toon Braeye
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Ruben Brondeel
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Veerle Stouten
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Pierre Hubin
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Mathil Vandromme
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Koen Blot
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
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2
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Price AM, Flannery B, Talbot HK, Grijalva CG, Wernli KJ, Phillips CH, Monto AS, Martin ET, Belongia EA, McLean HQ, Gaglani M, Mutnal M, Geffel KM, Nowalk MP, Tartof SY, Florea A, McLean C, Kim SS, Patel MM, Chung JR. Influenza Vaccine Effectiveness Against Influenza A(H3N2)-Related Illness in the United States During the 2021-2022 Influenza Season. Clin Infect Dis 2023; 76:1358-1363. [PMID: 36504336 PMCID: PMC10893961 DOI: 10.1093/cid/ciac941] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/05/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the United States, influenza activity during the 2021-2022 season was modest and sufficient enough to estimate influenza vaccine effectiveness (VE) for the first time since the beginning of the coronavirus disease 2019 pandemic. We estimated influenza VE against laboratory-confirmed outpatient acute illness caused by predominant A(H3N2) viruses. METHODS Between October 2021 and April 2022, research staff across 7 sites enrolled patients aged ≥6 months seeking outpatient care for acute respiratory illness with cough. Using a test-negative design, we assessed VE against influenza A(H3N2). Due to strong correlation between influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, participants who tested positive for SARS-CoV-2 were excluded from VE estimations. Estimates were adjusted for site, age, month of illness, race/ethnicity, and general health status. RESULTS Among 6260 participants, 468 (7%) tested positive for influenza only, including 440 (94%) for A(H3N2). All 206 sequenced A(H3N2) viruses were characterized as belonging to genetic group 3C.2a1b subclade 2a.2, which has antigenic differences from the 2021-2022 season A(H3N2) vaccine component that belongs to clade 3C.2a1b subclade 2a.1. After excluding 1948 SARS-CoV-2-positive patients, 4312 patients were included in analyses of influenza VE; 2463 (57%) were vaccinated against influenza. Effectiveness against A(H3N2) for all ages was 36% (95% confidence interval, 20%-49%) overall. CONCLUSIONS Influenza vaccination in 2021-2022 provided protection against influenza A(H3N2)-related outpatient visits among young persons.
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Affiliation(s)
- Ashley M Price
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - C Hallie Phillips
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | | | - Manjusha Gaglani
- Department of Pediatrics, Baylor Scott & White Health, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Manohar Mutnal
- Department of Pediatrics, Baylor Scott & White Health, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Krissy Moehling Geffel
- Department of Family Medicine, University of Pittsburgh Schools of the Health Sciences and University of Pittsburgh Medical Center, Pittsburgh, Pannsylvania, USA
| | - Mary Patricia Nowalk
- Department of Family Medicine, University of Pittsburgh Schools of the Health Sciences and University of Pittsburgh Medical Center, Pittsburgh, Pannsylvania, USA
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Ana Florea
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Callie McLean
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara S Kim
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessie R Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Rebecca Kahn, Cara B. Janusz, Marcia C. Castro, Aline da Rocha Matos, Carla Domingues, Jamie Ponmattam, Gloria Rey-Benito, Cristiana M. Toscano, Lucia Helena de Oliveira, Regional COVID-19 VE in Adults Study Working GroupRearteAnaliaUriarteIgnacio LeandroBaumesterElsaBordaMaria ElenaDiaz CordobaMiguelFacundo PetrinaJuanConsiglioEzequielVizzottiCarlaGuimarães de NoronhaTatianaGomes MourãoMaria PaulaBaima ColaresJeova KenyRaboniSonia MaraVanniTazioGuzmanLelyPontes LucenaAdriana Regina FariasSantolayaMaria ElenaUrquidiCinthyaCortesClaudia P.Usedo LopezPedro PabloBenitezRosanaLatorreVeronica MenaresMoller RothAndreaCerdaIván BrstiloSantillanaSolangeAbaakoukZohraCaicedoAngel PaterninaAlvis GuzmanNelsonFernandez MercadoJuan Carlosde la Hoz RestrepoFernandoSantiago QuevedoDavidRios OliverosSofiaMoyano RomeroDiane. The effectiveness of COVID-19 vaccines in Latin America, 2021: a multicenter regional case–control study. Lancet Reg Health Am 2023; 20. [PMID: 37008741 PMCID: PMC10049854 DOI: 10.1016/j.lana.2023.100474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/31/2023]
Abstract
Background As of September 2022, nearly 1.3 billion doses of COVID-19 vaccine products have been administered in Latin America and the Caribbean, where 27% of global COVID-19 deaths have occurred. This study aimed to estimate the effectiveness of COVID-19 vaccines against lab-confirmed COVID-19 related hospitalizations and deaths among adults in Argentina, Brazil, Chile, and Colombia. Methods Using a test-negative case control design, we evaluated the effectiveness of a primary vaccination series considering six COVID-19 vaccine products (Sputnik V, mRNA-1273, CoronaVac, ChAdOx1, BNT162b2, Ad26.COV2.S) against lab-confirmed COVID-19 hospitalizations and deaths among 83,708 hospitalized adults from February–December, 2021. Data from hospitalization records, COVID surveillance, and vaccination registries were used. Vaccine effectiveness was estimated using logistic regression ((1-OR) x 100). Findings The average age of participants was 56.7 (SD = 17.5), and 45,894 (54.8%) were male. Adjusted VE (aVE) estimates for full vaccination against hospitalization were 82% for mRNA-1273 (95% confidence interval (CI) = −30 to 98%), 76% (71%–81%) for BNT162b2, 65% (61–68%) for ChAdOx1, 57% (10–79%) for Sputnik V, 53% (50–56%) for CoronaVac, and 46% (23–62%) for Ad26.COV2.S. Estimates, particularly for CoronaVac, varied by variant. Decreasing aVE was estimated as age increased, particularly for CoronaVac and ChAdOx1. aVE estimates against death were generally higher, with 100% (CI not estimated) for mRNA-1273, 82% (69–90%) for BNT162b2, 73% (69–77%) for ChAdOx1, 65% (60–67%) for CoronaVac, 38% (−75 to 78%) for Sputnik V, 6% (−58 to 44%) for Ad26.COV2.S. Interpretation Primary series vaccination with available COVID-19 vaccine products was effective against COVID-19 hospitalization and mortality. Effectiveness varied by product and declined with increasing age. Funding This study was funded by the Pan-American Health Organization (10.13039/100011893PAHO, World Health Organization (WHO)). PAHO convened and led the study implementation.
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4
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Tartof SY, Frankland TB, Puzniak L, Slezak JM, Hong V, Takhar H, Ogun OA, Simmons S, Xie F, Zamparo J, Ackerson BK, Jodar L, McLaughlin JM. BNT162b2 against COVID-19-associated Emergency Department and Urgent Care Visits among Children 5-11 Years of Age: a Test Negative Design. J Pediatric Infect Dis Soc 2023; 12:177-179. [PMID: 36715070 PMCID: PMC10112675 DOI: 10.1093/jpids/piad005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
In a 1:1 matched test-negative design among 5-11-year-olds in the Kaiser Permanente Southern California health system (n=3984), BNT162b2 effectiveness against omicron-related emergency department or urgent care encounters was 60% [95%CI: 47-69] <3 months post-dose-two and 28% [8-43] after ≥3 months. A booster improved protection to 77% [53-88].
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Affiliation(s)
- Sara Y Tartof
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Timothy B Frankland
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI
| | | | - Jeff M Slezak
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
| | - Vennis Hong
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
| | - Harpreet Takhar
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
| | - Oluwaseye A Ogun
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
| | - Sarah Simmons
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
| | - Fagen Xie
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
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5
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Tenforde MW, Kondor RJG, Chung JR, Zimmerman RK, Nowalk MP, Jackson ML, Jackson LA, Monto AS, Martin ET, Belongia EA, McLean HQ, Gaglani M, Rao A, Kim SS, Stark TJ, Barnes JR, Wentworth DE, Patel MM, Flannery B. Effect of Antigenic Drift on Influenza Vaccine Effectiveness in the United States-2019-2020. Clin Infect Dis 2021; 73:e4244-e4250. [PMID: 33367650 PMCID: PMC8664438 DOI: 10.1093/cid/ciaa1884] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND At the start of the 2019-2020 influenza season, concern arose that circulating B/Victoria viruses of the globally emerging clade V1A.3 were antigenically drifted from the strain included in the vaccine. Intense B/Victoria activity was followed by circulation of genetically diverse A(H1N1)pdm09 viruses that were also antigenically drifted. We measured vaccine effectiveness (VE) in the United States against illness from these emerging viruses. METHODS We enrolled outpatients aged ≥6 months with acute respiratory illness at 5 sites. Respiratory specimens were tested for influenza by reverse-transcriptase polymerase chain reaction (RT-PCR). Using the test-negative design, we determined influenza VE by virus subtype/lineage and genetic subclades by comparing odds of vaccination in influenza cases versus test-negative controls. RESULTS Among 8845 enrollees, 2722 (31%) tested positive for influenza, including 1209 (44%) for B/Victoria and 1405 (51%) for A(H1N1)pdm09. Effectiveness against any influenza illness was 39% (95% confidence interval [CI]: 32-44), 45% (95% CI: 37-52) against B/Victoria and 30% (95% CI: 21-39) against A(H1N1)pdm09-associated illness. Vaccination offered no protection against A(H1N1)pdm09 viruses with antigenically drifted clade 6B.1A 183P-5A+156K HA genes (VE 7%; 95% CI: -14 to 23%) which predominated after January. CONCLUSIONS Vaccination provided protection against influenza illness, mainly due to infections from B/Victoria viruses. Vaccine protection against illness from A(H1N1)pdm09 was lower than historically observed effectiveness of 40%-60%, due to late-season vaccine mismatch following emergence of antigenically drifted viruses. The effect of drift on vaccine protection is not easy to predict and, even in drifted years, significant protection can be observed.
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Affiliation(s)
| | | | - Jessie R Chung
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
| | | | | | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield WI, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple TX, USA
| | - Arundhati Rao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple TX, USA
| | - Sara S Kim
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Thomas J Stark
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - John R Barnes
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | - Manish M Patel
- Centers for Disease Control and Prevention, Atlanta GA, USA
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6
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Ghamande S, Shaver C, Murthy K, Raiyani C, White HD, Lat T, Arroliga AC, Wyatt D, Talbot HK, Martin ET, Monto AS, Zimmerman RK, Middleton DB, Silveira FP, Ferdinands JM, Patel MM, Gaglani M. Vaccine effectiveness against acute respiratory illness hospitalizations for influenza-associated pneumonia during the 2015-2016 to 2017-2018 seasons, US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). Clin Infect Dis 2021; 74:1329-1337. [PMID: 34320171 DOI: 10.1093/cid/ciab654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence for vaccine effectiveness (VE) against influenza-associated pneumonia has varied by season, location, and strain. We estimate VE against hospitalization for radiographically identified influenza-associated pneumonia during 2015-2016 to 2017-2018 seasons in the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). METHODS Among adults aged ≥18 years admitted to 10 US hospitals for acute respiratory illness (ARI), clinician-investigators used keywords from reports of chest imaging performed during 3 days around hospital admission to assign a diagnosis of 'definite/probable pneumonia'. We used a test-negative design to estimate VE against hospitalization for radiographically identified laboratory-confirmed influenza-associated pneumonia, comparing RT-PCR confirmed influenza cases with test-negative subjects. Influenza vaccination status was documented in immunization records or self-reported, including date and location. Multivariable logistic regression models were used to adjust for age, site, season, calendar-time, and other factors. RESULTS Of 4,843 adults hospitalized with ARI included in the primary analysis, 266 (5.5%) had 'definite/probable pneumonia' and confirmed influenza. Adjusted VE against hospitalization for any radiographically confirmed influenza-associated pneumonia was 38% (95% confidence interval [CI]): 17%-53%); by type/subtype, it was 74% (95% CI: 52%-87%), influenza A (H1N1)pdm09; 25% (-15% to 50%), A (H3N2); and 23% (95% CI: -32% to 54%), influenza B. Adjusted VE against intensive care for any influenza was 57% (95% CI, 19%-77%). CONCLUSIONS Influenza vaccination was modestly effective among adults in preventing hospitalizations and the need for intensive care associated with influenza pneumonia. VE was significantly higher against A (H1N1)pdm09 and was low against A (H3N2) and B.
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Affiliation(s)
- Shekhar Ghamande
- Baylor Scott & White Health, Temple, TX, USA.,Texas A & M University College of Medicine, Temple, TX, USA
| | | | | | | | - Heath D White
- Baylor Scott & White Health, Temple, TX, USA.,Texas A & M University College of Medicine, Temple, TX, USA
| | - Tasnim Lat
- Baylor Scott & White Health, Temple, TX, USA.,Texas A & M University College of Medicine, Temple, TX, USA
| | - Alejandro C Arroliga
- Baylor Scott & White Health, Temple, TX, USA.,Texas A & M University College of Medicine, Temple, TX, USA
| | - Dayna Wyatt
- Vanderbilt University Medical Center; Nashville, TN, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center; Nashville, TN, USA
| | - Emily T Martin
- University of Michigan School of Public Health; Ann Arbor, MI, USA
| | - Arnold S Monto
- University of Michigan School of Public Health; Ann Arbor, MI, USA
| | - Richard K Zimmerman
- University of Pittsburgh Schools of Medicine and University of Pittsburgh Medical Center; Pittsburgh, PA, USA
| | - Donald B Middleton
- University of Pittsburgh Schools of Medicine and University of Pittsburgh Medical Center; Pittsburgh, PA, USA
| | - Fernanda P Silveira
- University of Pittsburgh Schools of Medicine and University of Pittsburgh Medical Center; Pittsburgh, PA, USA
| | - Jill M Ferdinands
- Influenza Division, US Centers for Disease Control and Prevention; Atlanta GA, USA
| | - Manish M Patel
- Influenza Division, US Centers for Disease Control and Prevention; Atlanta GA, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA.,Texas A & M University College of Medicine, Temple, TX, USA
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7
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Abstract
BACKGROUND The 2017-2018 influenza season was of high severity. Circulating influenza strains change periodically, making it important to determine vaccine effectiveness on an annual basis, especially for susceptible populations. The primary aim of our study was to estimate the effectiveness of the influenza vaccine among children. Secondary aims were to assess the effect of previous season vaccination and intraseasonal waning of immunity. METHODS Children 6 months to 17 years of age tested for influenza during the 2017-2018 season were included. Clinical charts were reviewed, and immunization status was confirmed via the Louisiana Immunization Registry. Influenza vaccine effectiveness (IVE) was estimated in a test-negative design by comparing vaccination status of influenza-positive vs influenza-negative cases. RESULTS A total of 3595 children were included, 26% of whom tested positive for influenza, mostly type A (79%); 15% had received an influenza vaccine prior to illness: 8% among the influenza-positive and 17% among influenza-negative cases (P <.0001). IVE for the 2017-2018 influenza season was 52% overall (95% confidence interval, 38%-62%), 49% for influenza A, and 60% for influenza B. While receiving current year (2017-2018) vaccine had the most effect, receiving the previous year (2016-2017) vaccine had a small benefit and no interference. We found no evidence of waning immunity of the vaccine for the 2017-2018 season. CONCLUSIONS IVE was moderate for children. Previous year vaccination had a small but significant benefit and there was no evidence of waning immunity in our cohort. Ongoing national and local surveillance is important to understand the benefit of influenza vaccination.
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Affiliation(s)
- Lauren N Powell
- Department of Pediatrics, Louisiana State University Health Sciences Center
| | - Rodolfo E Bégué
- Division of Pediatric Infectious Diseases, New Orleans, Louisiana
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8
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Kao CM, Lai K, McAteer JM, Elmontser M, Quincer EM, Yee MEM, Tippet A, Jerris RC, Lane PA, Anderson EJ, Bakshi N, Yildirim I. Influenza vaccine effectiveness and disease burden in children and adolescents with sickle cell disease: 2012-2017. Pediatr Blood Cancer 2020; 67:e28358. [PMID: 32469138 PMCID: PMC8221251 DOI: 10.1002/pbc.28358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/16/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Data are limited on the burden of influenza and seasonal influenza vaccine effectiveness (VE) in children with sickle cell disease (SCD). METHODS We used a prospectively collected clinical registry of SCD patients 6 months to 21 years of age to determine the influenza cases per 100 patient-years, vaccination rates, and a test-negative case-control study design to estimate influenza VE against medically attended laboratory-confirmed influenza infection. Influenza-positive cases were randomly matched to test-negative controls on age and influenza season in 1:1 ratio. We used adjusted logistic regression models to compare odds ratio (OR) of vaccination in cases to controls. We calculated VE as [100% × (1 - adjusted OR)] and computed 95% confidence intervals (CIs) around the estimate. RESULTS There were 1037 children with SCD who were tested for influenza, 307 children (29.6%) had at least one influenza infection (338 infections, incidence rate 3.7 per 100 person-years; 95% CI, 3.4-4.1) and 56.2% of those tested received annual influenza vaccine. Overall VE pooled over five seasons was 22.3% (95% CI, -7.3% to 43.7%). Adjusted VE estimates ranged from 39.7% (95% CI, -70.1% to 78.6%) in 2015/2016 to -5.9% (95% CI, -88.4% to 40.4%) in the 2016/17 seasons. Influenza VE varied by age and was highest in children 1-5 years of age (66.6%; 95% CI, 30.3-84.0). Adjusted VE against acute chest syndrome during influenza infection was 39.4% (95% CI, -113.0 to 82.8%). CONCLUSIONS Influenza VE in patients with SCD varies by season and age. Multicenter prospective studies are needed to better establish and monitor influenza VE among children with SCD.
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Affiliation(s)
- Carol M Kao
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Kristina Lai
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - John M McAteer
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Mohnd Elmontser
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Elizabeth M Quincer
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Marianne EM Yee
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Ashley Tippet
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Robert C Jerris
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Peter A Lane
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Evan J Anderson
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Nitya Bakshi
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
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9
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Scott AN, Buchan SA, Kwong JC, Drews SJ, Simmonds KA, Svenson LW. Using population-wide administrative and laboratory data to estimate type- and subtype-specific influenza vaccine effectiveness: a surveillance protocol. BMJ Open 2019; 9:e029708. [PMID: 31575570 PMCID: PMC6773297 DOI: 10.1136/bmjopen-2019-029708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods. METHODS AND ANALYSIS We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual's first positive influenza test during the season, and potential controls will be defined based on an individual's first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Alberta's Health Research Ethics Board-Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.
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Affiliation(s)
- Allison Nicole Scott
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Public Health, Concordia University of Edmonton, Edmonton, Alberta, Canada
| | - Sarah A Buchan
- Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
- Public Health Sciences, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
- Public Health Sciences, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kimberley A Simmonds
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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10
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Abstract
Introduction: Influenza vaccination is regarded as the most effective way to prevent influenza infection. Due to the rapid genetic changes that influenza viruses undergo, seasonal influenza vaccines must be reformulated and re-administered annually necessitating the evaluation of influenza vaccine effectiveness (VE) each year. The estimation of influenza VE presents numerous challenges. Areas Covered: This review aims to identify, discuss, and, where possible, offer suggestions for dealing with the following challenges in estimating influenza VE: different outcomes of interest against which VE is estimated, study designs used to assess VE, sources of bias and confounding, repeat vaccination, waning immunity, population level effects of vaccination, and VE in at-risk populations. Expert Opinion: The estimation of influenza VE has improved with surveillance networks, better understanding of sources of bias and confounding, and the implementation of advanced statistical methods. Future research should focus on better estimates of the indirect effects of vaccination, the biological effects of vaccination, and how vaccines interact with the immune system. Specifically, little is known about how influenza vaccination impacts an individual's infectiousness, how vaccines wane over time, and the impact of repeated vaccination.
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Affiliation(s)
- Kylie E. C. Ainslie
- Research Associate in Influenza Disease Dynamics, MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Michael Haber
- Professor, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Walt A. Orenstein
- Professor, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 1462 Clifton Rd NE, Atlanta, GA 30322, USA
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11
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Doll MK, Morrison KT, Buckeridge DL, Quach C. Two Birds With One Stone: Estimating Population Vaccination Coverage From a Test-negative Vaccine Effectiveness Case-control Study. Clin Infect Dis 2016; 63:1080-1086. [PMID: 27313264 DOI: 10.1093/cid/ciw397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/26/2016] [Accepted: 06/09/2016] [Indexed: 02/02/2023] Open
Abstract
Vaccination program evaluation includes assessment of vaccine uptake and direct vaccine effectiveness (VE). Often examined separately, we propose a design to estimate rotavirus vaccination coverage using controls from a rotavirus VE test-negative case-control study and to examine coverage following implementation of the Quebec, Canada, rotavirus vaccination program. We present our assumptions for using these data as a proxy for coverage in the general population, explore effects of diagnostic accuracy on coverage estimates via simulations, and validate estimates with an external source. We found 79.0% (95% confidence interval, 74.3%, 83.0%) ≥2-dose rotavirus coverage among participants eligible for publicly funded vaccination. No differences were detected between study and external coverage estimates. Simulations revealed minimal bias in estimates with high diagnostic sensitivity and specificity. We conclude that controls from a VE case-control study may be a valuable resource of coverage information when reasonable assumptions can be made for estimate generalizability; high rotavirus coverage demonstrates success of the Quebec program.
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Affiliation(s)
- Margaret K Doll
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | - Kathryn T Morrison
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | - Caroline Quach
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University.,Department of Pediatrics, Division of Infectious Diseases, The Montreal Children's Hospital.,Vaccine Study Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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