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Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences on Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada.
J Infect Dis. 2017 12 19; 216(12):1487-1500.JI

Abstract

Background

Vaccine effectiveness (VE) estimates for 2015-2016 seasonal influenza vaccine are reported from Canada's Sentinel Practitioner Surveillance Network (SPSN). This season was characterized by a delayed 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09) epidemic and concurrent influenza B(Victoria) virus activity. Potential influences on VE beyond antigenic match are explored, including viral genomic variation, birth cohort effects, prior vaccination, and epidemic period.

Methods

VE was estimated by a test-negative design comparing the adjusted odds ratio for influenza test positivity among vaccinated compared to unvaccinated participants. Vaccine-virus relatedness was assessed by gene sequencing and hemagglutination inhibition assay.

Results

Analyses included 596 influenza A(H1N1)pdm09 and 305 B(Victoria) cases and 926 test-negative controls. A(H1N1)pdm09 viruses were considered antigenically related to vaccine (unchanged since 2009), despite phylogenetic clustering within emerging clade 6B.1. The adjusted VE against A(H1N1)pdm09 was 43% (95% confidence interval [CI], 25%-57%). Compared to other age groups, VE against A(H1N1)pdm09 was lower for adults born during 1957-1976 (25%; 95% CI, -16%-51%). The VE against A(H1N1)pdm09 was also lower for participants consecutively vaccinated during both the current and prior seasons (41%; 95% CI, 18%-57%) than for those vaccinated during the current season only (75%; 95% CI, 45%-88%), and the VE among participants presenting in March-April 2016 (19%; 95% CI, -15%-44%) was lower than that among those presenting during January-February 2016 (62%; 95% CI, 44%-74%). The adjusted VE for B(Victoria) viruses was 54% (95% CI, 32%-68%), despite lineage-level mismatch to B(Yamagata) vaccine. The further variation in VE as observed for A(H1N1)pdm09 was not observed for B(Victoria).

Conclusions

Influenza VE findings may require consideration of other agent-host and immuno-epidemiologic influences on vaccine performance beyond antigenic match, including viral genomic variation, repeat vaccination, birth (immunological) cohort effects, and potential within-season waning of vaccine protection.

Links

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Authors+Show Affiliations

Skowronski DM
British Columbia Centre for Disease Control, Vancouver. University of British Columbia, Vancouver.
Chambers C
British Columbia Centre for Disease Control, Vancouver.
Sabaiduc S
British Columbia Centre for Disease Control, Vancouver.
De Serres G
Institut National de Santé Publique du Québec. Laval University, Québec. Centre Hospitalier Universitaire de Québec, Québec.
Winter AL
Public Health Ontario, Toronto.
Dickinson JA
University of Calgary, Calgary.
Gubbay JB
Public Health Ontario, Toronto. University of Toronto, Toronto.
Drews SJ
Alberta Provincial Laboratory, Edmonton. University of Alberta, Edmonton.
Martineau C
Institut National de Santé Publique du Québec.
Charest H
Institut National de Santé Publique du Québec.
Krajden M
British Columbia Centre for Disease Control, Vancouver. University of British Columbia, Vancouver.
Bastien N
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada.
Li Y
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada.

MeSH

AdultAge FactorsAgedAged, 80 and overAntigenic VariationAntigens, ViralCanadaChildChild, PreschoolCluster AnalysisFemaleHemagglutination Inhibition TestsHumansImmunizationImmunogenicity, VaccineInfantInfluenza A Virus, H1N1 SubtypeInfluenza B virusInfluenza VaccinesInfluenza, HumanMaleMiddle AgedPhylogenySequence Analysis, DNASequence HomologyTreatment OutcomeYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29029166

Citation

Skowronski, Danuta M., et al. "Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences On Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada." The Journal of Infectious Diseases, vol. 216, no. 12, 2017, pp. 1487-1500.
Skowronski DM, Chambers C, Sabaiduc S, et al. Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences on Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada. J Infect Dis. 2017;216(12):1487-1500.
Skowronski, D. M., Chambers, C., Sabaiduc, S., De Serres, G., Winter, A. L., Dickinson, J. A., Gubbay, J. B., Drews, S. J., Martineau, C., Charest, H., Krajden, M., Bastien, N., & Li, Y. (2017). Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences on Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada. The Journal of Infectious Diseases, 216(12), 1487-1500. https://doi.org/10.1093/infdis/jix526
Skowronski DM, et al. Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences On Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada. J Infect Dis. 2017 12 19;216(12):1487-1500. PubMed PMID: 29029166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences on Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada. AU - Skowronski,Danuta M, AU - Chambers,Catharine, AU - Sabaiduc,Suzana, AU - De Serres,Gaston, AU - Winter,Anne-Luise, AU - Dickinson,James A, AU - Gubbay,Jonathan B, AU - Drews,Steven J, AU - Martineau,Christine, AU - Charest,Hugues, AU - Krajden,Mel, AU - Bastien,Nathalie, AU - Li,Yan, PY - 2017/10/14/pubmed PY - 2019/3/26/medline PY - 2017/10/14/entrez KW - Influenza KW - birth cohort effects KW - hemagglutination inhibition KW - influenza A subtype KW - influenza B lineage KW - influenza vaccine KW - original antigenic sin KW - repeat vaccination KW - sequencing KW - vaccine effectiveness SP - 1487 EP - 1500 JF - The Journal of infectious diseases JO - J Infect Dis VL - 216 IS - 12 N2 - Background: Vaccine effectiveness (VE) estimates for 2015-2016 seasonal influenza vaccine are reported from Canada's Sentinel Practitioner Surveillance Network (SPSN). This season was characterized by a delayed 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09) epidemic and concurrent influenza B(Victoria) virus activity. Potential influences on VE beyond antigenic match are explored, including viral genomic variation, birth cohort effects, prior vaccination, and epidemic period. Methods: VE was estimated by a test-negative design comparing the adjusted odds ratio for influenza test positivity among vaccinated compared to unvaccinated participants. Vaccine-virus relatedness was assessed by gene sequencing and hemagglutination inhibition assay. Results: Analyses included 596 influenza A(H1N1)pdm09 and 305 B(Victoria) cases and 926 test-negative controls. A(H1N1)pdm09 viruses were considered antigenically related to vaccine (unchanged since 2009), despite phylogenetic clustering within emerging clade 6B.1. The adjusted VE against A(H1N1)pdm09 was 43% (95% confidence interval [CI], 25%-57%). Compared to other age groups, VE against A(H1N1)pdm09 was lower for adults born during 1957-1976 (25%; 95% CI, -16%-51%). The VE against A(H1N1)pdm09 was also lower for participants consecutively vaccinated during both the current and prior seasons (41%; 95% CI, 18%-57%) than for those vaccinated during the current season only (75%; 95% CI, 45%-88%), and the VE among participants presenting in March-April 2016 (19%; 95% CI, -15%-44%) was lower than that among those presenting during January-February 2016 (62%; 95% CI, 44%-74%). The adjusted VE for B(Victoria) viruses was 54% (95% CI, 32%-68%), despite lineage-level mismatch to B(Yamagata) vaccine. The further variation in VE as observed for A(H1N1)pdm09 was not observed for B(Victoria). Conclusions: Influenza VE findings may require consideration of other agent-host and immuno-epidemiologic influences on vaccine performance beyond antigenic match, including viral genomic variation, repeat vaccination, birth (immunological) cohort effects, and potential within-season waning of vaccine protection. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/29029166/Beyond_Antigenic_Match:_Possible_Agent_Host_and_Immuno_epidemiological_Influences_on_Influenza_Vaccine_Effectiveness_During_the_2015_2016_Season_in_Canada_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓52 ↑41]

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