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Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada.
BMC Infect Dis. 2017 12 29; 17(1):805.BI

Abstract

BACKGROUND

The Serious Outcomes Surveillance (SOS) Network was established to monitor seasonal influenza complications among hospitalized Canadian adults and to assess the effectiveness of influenza vaccination against severe outcomes. Here we report age- and strain-specific vaccine effectiveness (VE) in preventing severe outcomes during a season characterized by mixed outbreaks of four different influenza strains.

METHODS

This prospective, multicentre, test-negative case-control study evaluated the VE of trivalent influenza vaccine (TIV) in the prevention of laboratory-confirmed influenza-hospitalization in adults aged ≥16 years (all adults) and adults aged 16-64 years (younger adults). The SOS Network identified hospitalized patients with diagnoses potentially attributable to influenza during the 2011/12 influenza season. Swabs collected at admission were tested by reverse transcriptase polymerase chain reaction (RT PCR) or viral culture to discriminate influenza cases (positive) from controls (negative). VE was calculated as 1-odds ratio (OR) of vaccination in cases versus controls × 100.

RESULTS

Overall, in all adults, the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 41.8% (95% Confidence Interval [CI]: 26.0, 54.3), and 42.8% (95% CI: 23.8, 57.0), respectively. In younger adults (16-64 years), the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 35.8% (95% CI: 4.5, 56.8) and 33.2% (95% CI: -6.7, 58.2), respectively. In the all adults group, adjusted VE against influenza A/H1N1 was 72.5% (95% CI: 30.5, 89.1), against A/H3N2 was 86.1% (95% CI: 40.1, 96.8), against B/Victoria was 40.5% (95% CI: -28.9, 72.6), and against B/Yamagata was 32.3% (95% CI: -8.3, 57.7). The adjusted estimate of early season VE (from November 1 to March 11) was 54.4% (95% CI: 29.7-70.4), which was higher than late season (from March 11 to May 25) VE estimate (VE: 29.7%, 95% CI: -5.3, 53.1).

CONCLUSIONS

These results suggest that TIV was highly effective against A viruses and moderately effective against B viruses during a mild season characterised by co-circulation of four influenza strains in Canada. Findings underscore the need to provide VE assessment by subtype/lineage as well as the timing of vaccination (early season vs late season) to accurately evaluate vaccine performance and thus guide public health decision-making.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01517191. Registration was retrospective and the date of registration was January 17, 2012.

Authors+Show Affiliations

Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.GSK, King of Prussia, Current affiliation: Novavax Vaccines, Washington, DC, USA.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.Centre Hospitalier Universitaire de Québec, 2705 Boulevard Laurier, RC-709, Québec, Québec, G1V 4G2, Canada.University of British Columbia, 452D, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia, V5Z 3J5, Canada.Leslie Dan Faculty of Pharmacy, University of Toronto, Current affiliation: Sanofi Pasteur, Swiftwater, Pennsylvania, USA.Business & Decision Life Sciences, Bruxelles, Belgium, on behalf of GSK (Wavre, Belgium), Current affiliation: GSK, Wavre, Belgium.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.Mount Sinai Hospital, 600 University Ave, Room 210, Toronto, Ontario, M5G 1X5, Canada.GSK, Wavre, Belgium.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.GSK, Mississauga, Ontario, Canada, Current affiliation: Bayer Inc, Mississauga, Ontario, Canada.McMaster University, Michael G. DeGroote Centre for Learning, 1200 Main Street West, Room 3208, Hamilton, Ontario, L8S 4K1, Canada.North York General Hospital, 4001 Leslie St, Toronto, Ontario, M2K 1E1, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.McMaster University, Michael G. DeGroote Centre for Learning, 1200 Main Street West, Room 3208, Hamilton, Ontario, L8S 4K1, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.The Ottawa Hospital, Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.Health Sciences North Research Institute, 41 Ramsey Lake Rd, Sudbury, Ontario, P3E 5J1, Canada.Mount Sinai Hospital, 600 University Ave, Room 210, Toronto, Ontario, M5G 1X5, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.Michael Garron Hospital, 825 Coxwell Ave, Toronto, Ontario, M4C 3E7, Canada.William Osler Health System, Department of Infectious Diseases and Medical Microbiology, 2100 Bovaird Dr East, Brampton, Ontario, L6R 3J7, Canada.McGill University, McGill University Health Centre, Glen Site, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.University of British Columbia, 452D, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia, V5Z 3J5, Canada.Centre Hospitalier Universitaire de Québec, 2705 Boulevard Laurier, RC-709, Québec, Québec, G1V 4G2, Canada.Université de Sherbrooke, 3001 12th Ave North, Sherbrooke, Quebec, J1H 5N4, Canada.Saint John Regional Hospital, Dalhousie University, 400 University Ave, Saint John, New Brunswick, E2L 4L2, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada.Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada. Shelly.McNeil@nshealth.ca.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

29284435

Citation

Andrew, Melissa K., et al. "Influenza Vaccine Effectiveness Against Influenza-related Hospitalization During a Season With Mixed Outbreaks of Four Influenza Viruses: a Test-negative Case-control Study in Adults in Canada." BMC Infectious Diseases, vol. 17, no. 1, 2017, p. 805.
Andrew MK, Shinde V, Hatchette T, et al. Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada. BMC Infect Dis. 2017;17(1):805.
Andrew, M. K., Shinde, V., Hatchette, T., Ambrose, A., Boivin, G., Bowie, W., Chit, A., Dos Santos, G., ElSherif, M., Green, K., Haguinet, F., Halperin, S. A., Ibarguchi, B., Johnstone, J., Katz, K., Langley, J. M., LeBlanc, J., Loeb, M., MacKinnon-Cameron, D., ... McNeil, S. A. (2017). Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada. BMC Infectious Diseases, 17(1), 805. https://doi.org/10.1186/s12879-017-2905-8
Andrew MK, et al. Influenza Vaccine Effectiveness Against Influenza-related Hospitalization During a Season With Mixed Outbreaks of Four Influenza Viruses: a Test-negative Case-control Study in Adults in Canada. BMC Infect Dis. 2017 12 29;17(1):805. PubMed PMID: 29284435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada. AU - Andrew,Melissa K, AU - Shinde,Vivek, AU - Hatchette,Todd, AU - Ambrose,Ardith, AU - Boivin,Guy, AU - Bowie,William, AU - Chit,Ayman, AU - Dos Santos,Gael, AU - ElSherif,May, AU - Green,Karen, AU - Haguinet,François, AU - Halperin,Scott A, AU - Ibarguchi,Barbara, AU - Johnstone,Jennie, AU - Katz,Kevin, AU - Langley,Joanne M, AU - LeBlanc,Jason, AU - Loeb,Mark, AU - MacKinnon-Cameron,Donna, AU - McCarthy,Anne, AU - McElhaney,Janet, AU - McGeer,Allison, AU - Nichols,Michaela K, AU - Powis,Jeff, AU - Richardson,David, AU - Semret,Makeda, AU - Stiver,Grant, AU - Trottier,Sylvie, AU - Valiquette,Louis, AU - Webster,Duncan, AU - Ye,Lingyun, AU - McNeil,Shelly A, AU - ,, Y1 - 2017/12/29/ PY - 2017/06/22/received PY - 2017/12/11/accepted PY - 2017/12/30/entrez PY - 2017/12/30/pubmed PY - 2018/5/22/medline KW - Adults KW - Effectiveness KW - Hospitalization KW - Influenza KW - Vaccine SP - 805 EP - 805 JF - BMC infectious diseases JO - BMC Infect Dis VL - 17 IS - 1 N2 - BACKGROUND: The Serious Outcomes Surveillance (SOS) Network was established to monitor seasonal influenza complications among hospitalized Canadian adults and to assess the effectiveness of influenza vaccination against severe outcomes. Here we report age- and strain-specific vaccine effectiveness (VE) in preventing severe outcomes during a season characterized by mixed outbreaks of four different influenza strains. METHODS: This prospective, multicentre, test-negative case-control study evaluated the VE of trivalent influenza vaccine (TIV) in the prevention of laboratory-confirmed influenza-hospitalization in adults aged ≥16 years (all adults) and adults aged 16-64 years (younger adults). The SOS Network identified hospitalized patients with diagnoses potentially attributable to influenza during the 2011/12 influenza season. Swabs collected at admission were tested by reverse transcriptase polymerase chain reaction (RT PCR) or viral culture to discriminate influenza cases (positive) from controls (negative). VE was calculated as 1-odds ratio (OR) of vaccination in cases versus controls × 100. RESULTS: Overall, in all adults, the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 41.8% (95% Confidence Interval [CI]: 26.0, 54.3), and 42.8% (95% CI: 23.8, 57.0), respectively. In younger adults (16-64 years), the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 35.8% (95% CI: 4.5, 56.8) and 33.2% (95% CI: -6.7, 58.2), respectively. In the all adults group, adjusted VE against influenza A/H1N1 was 72.5% (95% CI: 30.5, 89.1), against A/H3N2 was 86.1% (95% CI: 40.1, 96.8), against B/Victoria was 40.5% (95% CI: -28.9, 72.6), and against B/Yamagata was 32.3% (95% CI: -8.3, 57.7). The adjusted estimate of early season VE (from November 1 to March 11) was 54.4% (95% CI: 29.7-70.4), which was higher than late season (from March 11 to May 25) VE estimate (VE: 29.7%, 95% CI: -5.3, 53.1). CONCLUSIONS: These results suggest that TIV was highly effective against A viruses and moderately effective against B viruses during a mild season characterised by co-circulation of four influenza strains in Canada. Findings underscore the need to provide VE assessment by subtype/lineage as well as the timing of vaccination (early season vs late season) to accurately evaluate vaccine performance and thus guide public health decision-making. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01517191. Registration was retrospective and the date of registration was January 17, 2012. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/29284435/Influenza_vaccine_effectiveness_against_influenza_related_hospitalization_during_a_season_with_mixed_outbreaks_of_four_influenza_viruses:_a_test_negative_case_control_study_in_adults_in_Canada_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2905-8 DB - PRIME DP - Unbound Medicine ER -